Table 1.
Clinical Features of 22 Patients With Insect-Associated Myocutaneous Invasive Fungal Infections
| Articlea Author, Year/Country | Patient Age and Sex, Underlying Disease(s) | Location of Insect Bite | Insect | Fungus | Clinical Manifestation | Initial Diagnosis/ Delayed Diagnosis | Medical Treatment | Surgical Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| 1. Lober, 1980 USA |
44 M, immunocompetent | Central abdomen | NS | Sporothrix schenckii | Multiple nodular ulcerative lesions, cutaneous fistulas | Leishmaniasis | Oral potassium iodide | None | Resolved |
| 2. Barrios, 1990 USA |
5 F, ALL, neutropenia | Thenar eminence | Brown recluse spider | Aspergillus flavus, Fusarium proliferatum | Gangrenous changes, progressive nodules | Bacterial cellulitis | AMB, 5-FC, rifampin, WBC transfusions | Thumb and arm amputation | Survived, WBC recovery |
| 3. Clark, 1990 USA |
31 M, HTLV, DKA | Arm | Spider | Rhizopus arrhizus | Necrotic pustules, culture also grew Klebsiella and Bacillus spp. | Bacterial cellulitis | AMB, cefuroxime | Repeated debridements | Survived, WBC recovery |
| 4.Prevoo, 1991 Netherlands |
10 F, immunocompetent | Lateral eyebrow | NS | Mucor spp. | Slowly expanding plaque | Dermatophytosis | AMB, potassium iodide | None | Resolved |
| 5.Weinberg, 1993 USA |
59 M, immunocompetent | Prescapular area | Brown recluse spider | Apophysomyces elegans | Tender eschar | Brown recluse spider bite, bacterial cellulitis | AMB | Resection, skin graft | Flail shoulder, resolved |
| 6.Adam, 1994 USA |
43 M, cardiac transplant recipient on azathiprine + prednisone | Calf | Spider | Rhizopus spp. | Slowly progressing chronic ulcer | N/R | AMB,ketoconazole | None | Died within 7 d |
| 7.Hicks, 1995 USA |
31 M, Hodgkin’s disease, s/p transplant, pancytopenia | Lateral neck | NS | Rhizopus spp. | Necrotizing neck cellulitis | Bacterial cellulitis | AMB, rifampin | Wide debridement | Resolved |
| 8.Sauterteig, 1998 Venezuela |
59 F, breast cancer | Upper arm | NS | Chromoblasto-mycosis | Nodular dark pink lesion, fistula | Cutaneous leishmaniasis | Not stated | Extirpation of lesion | Resolved |
| 9.Moaven, 1999 Australia |
31 F, immunocompetent | Wrist | Large hairy spider | Sporothrix schenckii | Rapidly evolving nodular ulcer, lymphangitis | Necrotizing arachnidism | Itraconazole | None | Resolved |
| 10.Bauza, 2005 Spain |
73 M, liver transplant recipient, DM | Arm | NS | Cryptococcus neoformans serotype D | Edema/suppuration | Bacterial cellulitis | AMB, fluconazole | Debridement, reconstruction, skin graft | Resolved |
| 11.Takahara, 2005 Japan |
85 F, ITP on azathioprine + prednisone | Middle finger, hand, arm | NS | Exophiala spinifera | Multiple nodules/abscesses, lymphocutaneous nocardiosis | N/R | Itraconazole | None | Resolved |
| 12.Lechevalier, 2008 France |
14 M, immunocompetent | Calf | Scorpion | Saksenaea vasiformis | Cellulitis with necrotic eschar, fever | Bacterial cellulitis | AMB | Wide debridement, skin graft | Resolved |
| 13.Rath, 2009 India |
55 M, immunocompetent | N/R | NS | Candida spp., Aspergillus flavus | Periorbital necrotizing fasciitis | Bacterial orbital cellulitis | Fluconazole | Debridement, skin graft | Resolved |
| 14.Saravia-Flores, 2009 Guatemala |
30 F, immunocompetent | Medial thigh | Loxosceles spider | Apophysomyces elegans | Cellulitis with blisters, necrosis, disseminated sepsis | Bacterial cellulitis | AMB | Repeated debridements, limb amputation | Died after surgery |
| 15.Pourahmad, 2012 Iran |
55 F, immunocompetent | Flank | Scorpion | Mucorales (NS) | Progressive extensive cellulitis, necrotic eschar | Bacterial cellulitis | AMB | Wide excision, reconstruction | Resolved |
| 16.Ho, 2015 Singapore |
73 M, DM | Hand | NS | Cryptococcus gattii | Necrotizing fasciitis | Bacterial cellulitis | AMB, 5-FC | Wide debridement, skin graft | Resolved |
| 17.Thompson, 2015 Australia | 72 W, immunocompetent | Hand | Spider | Purpureocillium lilacinum | Tender erythematous plaque | Allergic dermatitis | No | Repeated debridements | Resolved |
| 18.Lee, 2016 Taiwan |
61 M, immunocompetent | Eye | NS | Aspergillus flavus | Progressive keratitis, blepharitis | Bacterial keratitis | Topical natamycin | None | Resolved |
| 19.Chen, 2016 China |
42 M, immunocompetent | Ear | Dog flea | Fonsecaea nubica | Slowly progessing plaque | Bacterial cellulitis, dermatophytic infection | Itraconazole, terbinafine | None | Resolved |
| 20.Fernandez, 2017 Mexico |
47 M, HIV | Cheek | NS | Cocciodioides posadasii | Pruritic nodule, fever, malaise | N/R | AMB, itraconazole | None | Resolved |
| 21.Dogra, 2018 India |
25 M, immunocompetent | Eye | Honey bee | Aspergillus fumigatus | Necrotizing scleritis | Bee-sting induced toxic keratosclerouveitis | Itraconazole, topical AMB, intravitreal AMB + dexamethasone | Pars plana lensectomy and vitrectomy | Poor visual outcome |
| 22.Tormos, 2018 Spain |
71 M, colon adenocarcinoma, DM | Forearm | Loxosceles laeta spider | Saksenaea vasiformis | Rapidly evolving necrotic eschar, compartment syndrome | Cutaneous loxoscelism | AMB, anidulafungin | Fasciotomy, amputation of right arm | Resolved |
Abbreviations: 5-FC, 5-flucytosine; ALL, acute lymphocytic leukemia; AMB, amphotericin B; DKA, diabetic ketoacidosis; DM, diabetes mellitus; F, female; HTLV, human lymphotropic virus; ITP, idiopathic thrombocytopenic purpura; M, male; N/R, not reported; NS, nonspecified; WBC, white blood cell.
aArranged chronologically.