{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:42:10Z","timestamp":1792114930863,"version":"4.4.0"},"reference-count":51,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T00:00:00Z","timestamp":1562198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Necrotizing mucormycosis is a devastating complication of wounds incurred in the setting of military (combat) injuries, natural disasters, burns, or other civilian trauma. Apophysomyces species, Saksenaea species and Lichtheimia (formerly Absidia) species, although uncommon as causes of sinopulmonary mucormycosis, are relatively frequent agents of trauma-related mucormycosis. The pathogenesis of these infections likely involves a complex interaction among organism, impaired innate host defenses, and biofilms related to traumatically implanted foreign materials. Effective management depends upon timely diagnosis, thorough surgical debridement, and early initiation of antifungal therapy.<\/jats:p>","DOI":"10.3390\/jof5030057","type":"journal-article","created":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T11:13:18Z","timestamp":1562238798000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Necrotizing Mucormycosis of Wounds Following Combat Injuries, Natural Disasters, Burns, and Other Trauma"],"prefix":"10.3390","volume":"5","author":[{"given":"Thomas J.","family":"Walsh","sequence":"first","affiliation":[{"name":"Departments of Medicine, Pediatrics, and Microbiology &amp; Immunology; Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duane R.","family":"Hospenthal","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-4467","authenticated-orcid":false,"given":"Vidmantas","family":"Petraitis","sequence":"additional","affiliation":[{"name":"Departments of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios P.","family":"Kontoyiannis","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and Clinical Manifestations of Mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s12281-014-0205-y","article-title":"Combat-Related Invasive Fungal Wound Infections","volume":"8","author":"Tribble","year":"2014","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijid.2017.07.002","article-title":"Invasive Fungal Infections Secondary to Traumatic Injury","volume":"62","author":"Kronen","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Devauchelle, P., Jeanne, M., and Frealle, E. (2019). Mucormycosis in Burns Patients. J. Fungi, 5.","DOI":"10.3390\/jof5010025"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3201\/eid2003.131230","article-title":"Invasive fungal infections after natural disasters","volume":"20","author":"Benedict","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1097\/MD.0000000000000221","article-title":"Posttraumatic mucormycosis: A nationwide study in France and review of the literature","volume":"93","author":"Lelievre","year":"2014","journal-title":"Medicine (Baltimore)"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1128\/JCM.00835-15","article-title":"Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections","volume":"53","author":"Warkentien","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1093\/cid\/cis749","article-title":"Invasive mold infections following combat-related injuries","volume":"55","author":"Warkentien","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1056\/NEJMoa1204781","article-title":"Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011","volume":"367","author":"Benedict","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"R50","DOI":"10.1186\/cc4868","article-title":"One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia","volume":"10","author":"Maegele","year":"2006","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/01.prs.0000233624.34950.f8","article-title":"Necrotizing fasciitis caused by Apophysomyces elegans complicating soft-tissue and pelvic injuries in a tsunami survivor from Thailand","volume":"119","author":"Snell","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"681","DOI":"10.7205\/MILMED-D-11-00364","article-title":"Invasive fungal infections following combat-related injury","volume":"177","author":"Paolino","year":"2012","journal-title":"Mil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Etienne, K.A., Gillece, J., Hilsabeck, R., Schupp, J.M., Colman, R., Lockhart, S.R., Gade, L., Thompson, E.H., Sutton, D.A., and Neblett-Fanfair, R. (2012). Whole genome sequence typing to investigate the Apophysomyces outbreak following a tornado in Joplin, Missouri, 2011. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0049989"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/BF01659058","article-title":"Necrotizing lesions of soft tissues: A review","volume":"15","author":"Castro","year":"1991","journal-title":"World J. Surg."},{"key":"ref_16","first-page":"280","article-title":"Burn injuries and soft tissue traumas complicated by mucormycosis infection: A report of six cases and review of the literature","volume":"28","author":"Kyriopoulos","year":"2015","journal-title":"Ann. Burns Fire Disasters"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.burns.2012.02.028","article-title":"Epidemiology of fungal infection in burns: Therapeutic implications","volume":"38","author":"Schaal","year":"2012","journal-title":"Burns"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1097\/01.inf.0000136870.17071.fd","article-title":"Successful treatment of a child with post-traumatic narcotizing fasciitis caused by Apophysomyces elegans: Case report and review of literature","volume":"23","author":"Kordy","year":"2004","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s13054-016-1250-4","article-title":"The role of neutrophils in immune dysfunction during severe inflammation","volume":"20","author":"Leliefeld","year":"2016","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.cyto.2016.09.010","article-title":"Th1Coexistence of Th1\/Th2 and Th17\/Treg imbalances in patients with post traumatic sepsis","volume":"88","author":"Gupta","year":"2016","journal-title":"Cytokine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1017\/S095026881400051X","article-title":"Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification","volume":"143","author":"Weintrob","year":"2015","journal-title":"Epidemiol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.3201\/eid2110.141759","article-title":"Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009\u20132011","volume":"21","author":"Tribble","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1089\/sur.2013.123","article-title":"Risk factors associated with invasive fungal infections in combat trauma","volume":"15","author":"Rodriguez","year":"2014","journal-title":"Surg. Infect. (Larchmt)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1097\/BOT.0000000000000447","article-title":"Early Complications and Outcomes in Combat Injury-Related Invasive Fungal Wound Infections: A Case-Control Analysis","volume":"30","author":"Lewandowski","year":"2016","journal-title":"J. Orthop. Trauma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/TA.0000000000000438","article-title":"Clinical relevance of mold culture positivity with and without recurrent wound necrosis following combat-related injuries","volume":"77","author":"Rodriguez","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1086\/597615","article-title":"Increased Virulence of Zygomycetes Organisms Following Exposure to Voriconazole: A Study Involving Fly and Murine Models of Zygomycosis","volume":"199","author":"Chamilos","year":"2009","journal-title":"J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1093\/milmed\/usy079","article-title":"Treatment of Suspected Invasive Fungal Infection in War Wounds","volume":"183","author":"Rodriguez","year":"2018","journal-title":"Mil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/S0140-6736(05)71046-1","article-title":"Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka","volume":"365","author":"Andresen","year":"2005","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/BF01659059","article-title":"Necrotizing soft tissue lesions after a volcanic cataclysm","volume":"15","author":"Castro","year":"1991","journal-title":"World J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.burns.2014.10.024","article-title":"Epidemiology of filamentous fungal infections in burned patients: A French retrospective study","volume":"41","author":"Schaal","year":"2015","journal-title":"Burns"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jhin.2004.12.011","article-title":"An outbreak of Absidia corymbifera infection associated with bandage contamination in a burns unit","volume":"61","author":"Christiaens","year":"2005","journal-title":"J. Hosp. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1093\/cid\/cir880","article-title":"A Global Analysis of Mucormycosis in France: The RetroZygo Study (2005\u20132007)","volume":"54","author":"Dannaoui","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","first-page":"691","article-title":"Bone and joint infections caused by Mucormycetes: A challenging osteoarticular mycosis of the 21st century","volume":"55","author":"Gamaletsou","year":"2017","journal-title":"Med. Mycol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1089\/sur.2012.245","article-title":"Effect of Early Screening for Invasive Fungal Infections in U.S. Service Members with Explosive Blast Injuries","volume":"15","author":"Lloyd","year":"2014","journal-title":"Surg. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1093\/cid\/cir868","article-title":"Early Clinical and Laboratory Diagnosis of Invasive Pulmonary, Extrapulmonary, and Disseminated Mucormycosis (Zygomycosis)","volume":"54","author":"Gamaletsou","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3690","DOI":"10.1128\/JCM.00917-08","article-title":"Detection of molecular biomarkers for Rhizopus spp., Mucor spp., and Cunninghamella spp. by quantitative PCR and melt curve analysis in plasma, bronchoalveolar lavage, and lung tissue in experimental pulmonary zygomycosis","volume":"46","author":"Kasai","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"810.e1","DOI":"10.1016\/j.cmi.2015.12.006","article-title":"Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF)","volume":"22","author":"Millon","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1093\/cid\/ciw563","article-title":"Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment","volume":"63","author":"Legrand","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jhin.2018.02.004","article-title":"Real-time polymerase chain reaction detection of Lichtheimia species in bandages associated with cutaneous mucormycosis in burn patients","volume":"99","author":"Rocchi","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1016\/j.tripleo.2009.11.012","article-title":"Successful treatment of periodontal mucormycosis: Case report and literature review","volume":"109","author":"McDermott","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e13172","DOI":"10.1111\/petr.13172","article-title":"Isolated cutaneous mucormycosis in a pediatric renal transplant recipient","volume":"22","author":"Downie","year":"2018","journal-title":"Pediatr. Transplant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1093\/cid\/cir886","article-title":"Future Directions in Mucormycosis Research","volume":"54","author":"Kontoyiannis","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/myc.12249","article-title":"Development of new strategies for early diagnosis of mucormycosis from bench to bedside","volume":"57","author":"Walsh","year":"2014","journal-title":"Mycoses"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"594.e1","DOI":"10.1016\/j.cmi.2015.01.017","article-title":"Molecular identification of Mucorales in human tissues: Contribution of PCR electrospray-ionization mass spectrometry","volume":"21","author":"Alanio","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Millon, L., Scherer, E., Rocchi, S., and Bellanger, A.-P. (2019). Molecular Strategies to Diagnose Mucormycosis. J. Fungi, 5.","DOI":"10.3390\/jof5010024"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e00746-18","DOI":"10.1128\/JCM.00746-18","article-title":"PCR-Based Approach Targeting Mucorales-Specific Gene Family for Diagnosis of Mucormycosis","volume":"56","author":"Baldin","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1080\/14737159.2018.1522250","article-title":"Recent advances in the molecular diagnosis of mucormycosis","volume":"18","author":"Dadwal","year":"2018","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/14737159.2019.1574572","article-title":"The expanding use of matrix-assisted laser desorption\/ionization-time of flight mass spectroscopy in the diagnosis of patients with mycotic diseases","volume":"19","author":"Walsh","year":"2019","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e468","DOI":"10.1097\/MPH.0000000000000166","article-title":"Topical amphotericin B in combination with standard therapy for severe necrotizing skin and soft-tissue mucormycosis in an infant with bilineal leukemia: case report and review","volume":"36","author":"Chan","year":"2014","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S474","DOI":"10.1093\/infdis\/jix130","article-title":"Novel Agents and Drug Targets to Meet the Challenges of Resistant Fungi","volume":"216","author":"McCarthy","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s11046-018-0281-6","article-title":"Widespread Lichtheimia Infection in a Patient with Extensive Burns: Opportunities for Novel Antifungal Agents","volume":"184","author":"Thielen","year":"2019","journal-title":"Mycopathologia"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/5\/3\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:02:24Z","timestamp":1760187744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/5\/3\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,4]]},"references-count":51,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["jof5030057"],"URL":"https:\/\/doi.org\/10.3390\/jof5030057","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,4]]}}}