Table 4.
Features and Treatment of Fungal Infections Commonly Encountered in Burn Patients
| Fungus | Features | Suggested therapy | Notes |
|---|---|---|---|
| Candida albicans | Commensal; exists as yeast or mycelial form. Yeast forms blastosphere that buds to form pseudohyphae with branching | Caspofungin Amphotericin Ba |
Most commonly isolated Treatment generally not indicated for isolated urinary tract infection |
| Non-albicans Candida (including C. tropicalis, glabrata, parapsilosis, krusei, and guilliermondii) | Surgery, renal failure, vascular catheter, and fluconazole prophylaxis C. tropicalis associated with characteristic embolic lesions C. glabrata produces only yeast cells (no hyphae) |
Amphotericin B for C. krusei and C. glabrata (fluconazole resistant) Voriconazole for C. parapsilosis and C. guilliermondii (echinocandin and polyene resistance reported) |
Antifungal susceptibility differs significantly, in contrast to C. albicans, and treatment should be guided by species and in vitro susceptibility findings |
| Aspergillus spp. | High mortality rate for invasive aspergillosis Septate hyphae, suppurative inflammation with ischemic necrosis Blood vessel invasion |
Voriconazole Amphotericin B (lipid formulation or deoxycholate) Caspofungin |
Combination treatment could be considered in severe or refractory cases Polyene resistance reported for Aspergillus terreus |
| Fusarium spp. | Hyphae Virulent organism creates wave-front of necrosis Reported in hospital water systems |
Amphotericin B (lipid formulation or deoxycholate) Voriconazole Consider amphotericin B plus caspofungin (intrinsically resistant to caspofungin but synergy reported) |
One of the most drug-resistant fungi, with resistance to polyene, azole, and echinocandin drug classes |
| Zygomycetes (including Rhizopus and Mucor spp.) | Sparsely septate hyphae, suppurative inflammation Arterial invasion with embolization, thrombosis, and infarction (angio-invasive) Sterile bread can be used for isolation Rhinocerebral infection associated with diabetes |
Amphotericin B (lipid formulation or deoxycholate) Itraconazole Ketoconazole Voriconazole |
Azole and echinocandin resistance |