Mucormycosis is a complex and rare fungal infection with a high mortality rate. It presents with scattered black/necrotic ulcers, white fungal elements, and progression of wounds despite seemingly adequate debridement. Diagnosis is confirmed on wound histology with culture, however diagnosis is often delayed and it is difficult to treat.
There is currently no comprehensive review of burns related mucormycosis infections within the literature, making this the first paper to provide evidence-based recommendations to treat this complex problem. We performed a systematic review of publications from 1946, and identified 151 cases of mucormycosis complicating burns. The mortality rate was 54.5%, and there was no significant change in survival over time. There was a significant increase in mortality with axial body site involvement compared with isolated peripheral involvement.
The standard treatment within the reported cases was prompt and radical surgical debridement. Utilisation of frozen section to guide debridement seemed to aid in clinical decision making around extent. No systemic treatment reached statistical significance, however IV amphotericin B trended towards significance. Although there is no strong evidence for topical amphotericin B or hyperbaric oxygen treatment, there may be benefit in some cases. In the absence of burns specific evidence, we recommend early and aggressive debridement in conjunction with the European Confederation of Medical Mycology guidelines of IV liposomal or lipid complex amphotericin B at >5mg/kg/day, with posaconazole at 800mg daily in divided doses as a salvage therapy or oral step-down option1. Treatment should be directed by susceptibility data where possible.