This is an outdated version published on 2021-12-27. Read the most recent version.

FUNGI IN SKIN AND SOFT TISSUE INFECTIONS - A THREE-YEAR STUDY

Authors

  • Gordana Mirchevska 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Ana Kaftandzieva 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Marko Kostovski 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Blerta Mehmeti 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Marija Stojanova 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Zorica Zafirovik University Clinic for Dermatology, “Mother Theresa” Campus, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Vesna Kotevska 1Institute of Microbiology and Parasitology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia

Keywords:

wound, fungi, yeast, mold, infection

Abstract

Introduction: Exposure of subcutaneous tissue following a loss of skin integrity provides a suitable environment for microbial colonization and proliferation, which contributes to delayed healing and infection of the wound. The aim of this study was to retrospectively investigate the spectrum of fungi responsible for skin and soft tissue infections over a 3-year period, and to compare the results with those from other parts of the world.

Material and methods: The study was performed during a 3-year period (2017-2019) and included analysis of 11,863 wound samples, which were obtained from patients hospital­lized at the University Clinics of the “Mother Theresa” campus, City hospital ”8th September” and University Clinic for Surgical Diseases “St. Naum Ohridski” in Skopje. All specimens were analyzed by standard mycological methods at the Institute of Microbiology and Parasitology.

Results: Growth of fungi was confirmed in 5.5%, 5% and 6.2% of the positive speci­mens, during a 3-year period, respectively. C. albicans was a predominant yeast (67.6%, 63%, 63.2% in 2017, 2018 and 2019, respectively). Molds were represented by Aspergillus confirmed in 3, 4 and 5 specimens, and Fusarium was confirmed in 2, 3 and 3 specimens during the 3-year period, respectively. Mucor was detected in 3 patients, in 2019 only.

Conclusion: Species identification of fungal microbes in wound specimens revealed that Candida species was the most predominant species, followed by Aspergillus and non-Aspergillus molds. It is crucial for every institution that treats patients with wounds to be aware of fungi as possible etiological agents of wound infections.

References

Segre JA. Epidermal barrier formation and recovery in skin disorders. J Clin Invest 2006;116:1150-8.

Grice EA, Kong HH, Renaud G, Young AC, NISC Comparative Sequencing Program, Bouffard GG, et al. A diversity profile of the human skin microbiota. Genome Res 2008; 18(7): 1043-50. doi: 10.1101/gr.075549.107.

Fredricks DN. Microbial ecology of human skin in health and disease. J Investig Dermatol Symp Proc 2001; 6(3): 167-9.

Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol 2008; 19(2): 173-84. doi: 10.1155/2008/846453. PMID: 19352449; PMCID: PMC2605859.

Kalan L, Loesche M, Hodkinson BP, Heilmann K, Ruthel G, Gardner SE, et al. Redefining the Chronic-Wound Microbiome: Fungal Communities Are Prevalent, Dynamic, and Associated with Delayed Healing. mBio 2016; 7(5): e01058-16. doi: 10.1128/mBio.01058-16. PMID: 27601572; PMCID: PMC5013295.

Ganesan A, Shaikh F, Bradley W, Blyth DM, Bennett D, Petfield JL, et al. Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions. Emerg Infect Dis 2019; 25(9): 1639-47. doi: 10.3201/eid2509.190168. PMID: 31441428; PMCID: PMC6711217.

Negut I, Grumezescu V, Grumezescu AM. Treatment Strategies for Infected Wounds. Molecules 2018; 23(9): 2392. doi: 10.3390/molecules23092392. PMID: 30231567; PMCID: PMC6225154.

Obradovic-Tomasev M, Popovic A, Vuckovic N, Jovanovic M. Mixed fungal infection (Aspergillus, Mucor, and Candida) of severe hand injury. Case Rep Infect Dis 2014; 2014: 954186. doi: 10.1155/2014/954186. PMID: 24782933; PMCID: PMC3978409.

Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev 2011; 24(2): 411-445. doi: 10.1128/CMR.00056-10. PMID: 21482731; PMCID: PMC3122490.

Kaftandzieva A, Kostovski M, Mehmeti B, Mirchevska G. The most common bacterial isolates from wound samples - a three-year study. Arch Pub Health 2021; 13(1): 77-90.

Beardsley J, Halliday CL, Chen SC, Sorrell TC. Responding to the emergence of antifungal drug resistance: perspectives from the bench and the bedside. Future Microbiol 2018; 13(10): 1175-1191. doi: 10.2217/fmb-2018-0059. PMID: 30113223; PMCID: PMC6190174.

Schroeder M, Weber T, Denker T, Winterland S, Wichmann D, Rohde H, et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care 2020; 10: 142.

Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin Microbiol Infect 2019; 25(7): 792-8.

Kołaczkowska A, Kołaczkowski M. Drug resistance mechanisms and their regulation in non-albicans Candida species. J Antimicrob Chemother 2016; 71(6): 1438-50.

Li H, Guo M, Wang C, Li Y, Fernandez AM, Ferraro TN, et al. Epidemiological study of Trichosporon asahii infections over the past 23 years. Epidemiol Infect 2020; 148: e169. doi: 10.1017/S0950268820001624. PMID: 32703332; PMCID: PMC7439294.

Mirchevska G, Panovski N, Petrovska M, Trajkovska-Dokic E, Cekovska Z, Jankoska G, et al. Diagnostic aspects of identification of Trichosporon asahii in clinical specimens in our critically ill patients. Physioacta 2011; 5(1): 39-54.

de Almeida Júnior JN, Hennequin C. Invasive Trichosporon Infection: a Systematic Review on a Re-emerging Fungal Pathogen. Front Microbiol 2016; 7: 1629. doi: 10.3389/fmicb.2016.01629. PMID: 27799926; PMCID: PMC5065970.

Colombo AL, Padovan AC, Chaves GM. Current knowledge of Trichosporon spp. and Trichosporonosis. Clin Microbiol Rev 2011;24(4):682-700. doi: 10.1128/CMR.00003-11. PMID: 21976604; PMCID: PMC3194827.

Liao Y, Lu X, Yang S, Luo Y, Chen Q, Yang R. Epidemiology and Outcome of Trichosporon Fungemia: A Review of 185 Reported Cases From 1975 to 2014. Open Forum Infect Dis 2015; 2(4): ofv141. doi: 10.1093/ofid/ofv141. PMID: 26566536; PMCID: PMC4630454.

Baraboutis I, Belesiotou E, Platsouka E, Papastamopoulos V, Mentzelopoulos S, Nanas S, et al. Poststernotomy sternal osteomyelitis and mediastinitis by Trichosporon asahii: a rare occurrence with a grave prognosis. Mycoses. 2010; 53(3): 272-4.

Mada PK, Ayoade F, Li A, Todd J. Trichosporon asahii septic thrombophlebitis following lower extremity amputation in an immunocompetent host. BMJ Case Rep 2018: bcr2017221441. doi: 10.1136/bcr-2017-221441. PMID: 29306852; PMCID: PMC5775776

Pasqualotto AC, Denning DW. Post-operative aspergillosis. Clin Microbiol Infect 2006; 12(11): 1060-1076.

van Burik JA, Colven R, Spach DH. Cutaneous aspergillosis. J Clin Microbiol 1998; 36(11): 3115-21. doi: 10.1128/JCM.36.11.3115-3121.1998. PMID: 9774549; PMCID: PMC105285.

Walsh TJ, Groll AH. Emerging fungal pathogens: evolving challenges to immunocompromised patients for the twenty-first century. Transpl Infect Dis 1999; 1(4): 247-61. doi: 10.1034/j.1399-3062.1999.010404.x. PMID: 11428996.

Nucci M, Anaissie E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev 2007; 20: 695-704.

Nucci M, Anaissie E. Cutaneous Infection by Fusarium Species in Healthy and Immunocompromised Hosts: Implications for Diagnosis and Management. Clin Infect Dis 2002; 35(8): 909-20.

Wilson W, Ali-Osman F, Sucher J, Shirah G, Mangram A. Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma). Trauma Case Rep 2019; 24: 100251. doi: 10.1016/j.tcr.2019.100251. PMID: 31788530; PMCID: PMC6880135.

Pruskowski KA, Mitchell TA, Kiley JL, Wellington T, Britton GW, Cancio LC. Diagnosis and Management of Invasive Fungal Wound Infections in Burn Patients. Eur Burn J 2021; 2(4): 168-83.

Prakash H, Chakrabarti A. Global Epidemiology of Mucormycosis. J Fungi (Basel) 2019; 5(1): 26.

Downloads

Published

2021-12-27

Versions

Issue

Vol. 1 No. 2 (2021): Acad Med J

Section

Original Articles