Friday, 15 June 2012

Wounded Soldiers Attacked by Aspergillus Infections

Soldiers sustaining blast injuries in Iraq and Afghanistan have been found to be suffering from invasive fungal infections at a higher rate than that expected. 75 out of 2755 injury cases have been positively identified as invasive fungal infection.

 The victims are mainly those suffering from explosions at very close quarters where large quantities if dust and soil are hurled into wounds, carrying large quantities of fungal spores and other material into those wounds. Until fairly recently no specific antifungal treatment was given until signs of infection were clear, but in many cases this takes days or weeks and in one case this was too late and the patient died of invasive aspergillosis and mucormycosis.

A recent article describes the steps taken to improve speed of diagnosis for these patients (via direct microscopic examination of tissue sections:
Frozen-section histopathology was initially used for diagnosis because of its quick turnaround, but resulted in a 33% negative predictive value in their lab and is no longer used, Dr. Malone said. This led to the 24-hour IFI protocol utilizing permanent sections. Periodic acid-Schiff and Gomori methenamine silver staining have proved efficacious for Aspergillus species, but not as efficacious for identifying Mucorales species. Calcofluor white staining is also used and may allow morphology-based speciation.
These steps decrease the time from injury to diagnosis of an invasive fungal infection from 10 days to 3, thus allowing earlier treatment and hopefully improving outcomes. Antifungal medication is also now given much earlier during treatment when fungal infection is only suspected rather than proven.

This type of injury is of course much rarer in civilian life, but the techniques learned in the intense arena of warfare may well contribute to improving the speed and efficacy of treatment for people suffering from invasive fungal infection after surgery or car accident for example.

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