Mixed Fungal Infection (Aspergillus, Mucor, and Candida) of Severe Hand Injury

Severe hand injuries are almost always heavily contaminated and hence wound infections in those patients are frequent. Fungal wound infections are rare in immunocompetent patients. A case of mixed fungal infection (Aspergillus, Mucor, and Candida) was documented in a young male patient, with a severe hand injury caused by a corn picker. The diagnosis of fungal infection was confirmed microbiologically and histopathologically. The treatment was conducted with repeated surgical necrectomy and administration of antifungal drugs according to the antimycogram. After ten weeks the patient was successfully cured. The aggressive nature of Mucor and Aspergillus skin infection was described. A high degree of suspicion and a multidisciplinary approach are necessary for an early diagnosis and the initiation of the adequate treatment. Early detection, surgical intervention, and appropriate antifungal therapy are essential in the treatment of this rare infection that could potentially lead to loss of limbs or even death. 1. Introduction Molds such as Aspergillus and Mucor are the most common opportunistic filamentous fungi, which can cause very serious infections that develop rapidly and that can sometimes be fatal. Generally these infections occur in immunocompromised patients, patients with unregulated diabetes, and patients treated with immunosuppressive drugs. Rare cases of these types of fungal infections in previously healthy immunocompetent patients are documented. The infection is caused by spores from the environment, which get into the body through the lungs, gastrointestinal system, or the skin. Primary infection of the skin may occur only when the skin is damaged [1, 2]. Here we present the case of a young farmer with a hand injury sustained on a farm, where a mixed infection caused by bacteria and fungi developed and was successfully cured. 2. Case Report A 28-year-old male patient was admitted to the hospital with a severe left hand injury caused by a corn picker (Figure 1). The patient was a young and healthy person. He underwent an operation within the first 6 hours after the injury occurred. Amputation of the I–V fingers was done in general anesthesia and defects of the skin were covered with split-thickness skin grafts. Wound toilet was conducted with povidone iodine. Upon admission, the patient received antitetanus and antibiotic prophylaxis (ceftriaxone ？gr, amikacin ？mg, and metronidazole ？mg). The operative and early postoperative course were normal. In the further postoperative period the patient was in good general condition, with normal body