Evaluation of Fungal Infections in Burn Patients at Ali-ebn AbiTalib Hospital in Zahedan

Document Type : Original Article

Authors

1 Department of Surgery, Clinical Immunology Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.

2 Department of Surgery, Student Research Committee, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.

3 Department of Medical Laboratory Sciences, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, School of ParaMedicine, Zahedan University of Medical Sciences, Zahedan, Iran.

Abstract

Background: Burns are the leading cause of disability and mortality in the world, which has led to serious economic and social consequences. 

Objectives: The present study aimed to investigate fungal infections in burn patients admitted to Ali-ebn Abitalib Hospital in Zahedan.

Methods: This study was conducted from April 2023 to October 2023. The research population was 113 burn patients admitted to Ali-ebn Abitalib Hospital. Data was collected by recording demographic data, sampling lesions suspected of fungal infection, and laboratory tests. All samples were recognized using phenotypic methods such as microscopy and culture on Sabouraud dextrose agar with chloramphenicol. The data was analyzed using SPSS software version 26.

Results: About 13.3% of the studied burn patients had a positive fungal culture. The most common fungus grown in burn patients was Candida albicans/C. dubliniensis (46.6%), Aspergillus niger species complex (40%), Fusarium spp. (13.3%) Furthermore, Aspergillus fumigatus species complex (13.3%) and the prevalence of other species was less than 10%. It was also found that positive fungal culture in burn patients is directly related to age, high percentage of burns, and length of hospitalization. 

Conclusion: Considering the high prevalence of fungal infection in burn patients and the identification of influential risk factors, all patients should be examined for fungal infection.

Keywords


Acknowledgments: The authors would like to express their gratitude to all the patients who participated in this study. We also thank the staff of Ali-ebn AbiTalib Hospital who helped us in conducting the study.

 

Availability of data and materials: The data supporting the findings of this research is available upon request from the corresponding author.

 

Conflicts of interest: The authors declare no conflict of interest.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: The current research is taken from the thesis approved in Zahedan University of Medical Sciences. All the experimental procedures in this study were approved by the Vice-Chancellor of Zahedan University of Medical Sciences of Iran, Zahedan (ethical code: IR.ZAUMS.REC.1401.385).The study was conducted in accordance with the principles of the Helsinki Declaration and written Informed Consent was obtained from all subjects.

 

Authors’ contribution: Study concept and design: H. A. D. and N.K. Analysis and interpretation of data: H. A.D, E. Sh. V. Drafting of the manuscript: H. A. D. Critical revision of the manuscript for important intellectual content: N.K. Statistical analysis: H. A.D. and E. Sh. V.

 

Financial disclosure: The authors have no relevant financial or non-financial interests to disclose.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Omranifard M, Ansari M, Jazebi N, Rouzbahani R, Akbari M. The Comparison between Long-term Results of Treatment with Amnion Graft and Skin Graft in Children Second Degree Burn Wounds. Journal of Isfahan Medical School. 2011 Apr 11; 29(126).
 
2. Fernández JM, Pablo CL. Body temperature and heating temperature in major burns patients care. Enfermería Global. 2021; 20(1):478-88.
 
3. Lotfi N, Shokohi T. A review on fungal infection in burn patients, diagnosis and treatment. Journal of Mazandaran University of Medical Sciences. 2014 Jan 10; 23(108):151-65.
 
4. Norbury W, Herndon DN, Tanksley J, Jeschke MG, Finnerty CC: Infection in Burns. Surg Infect (Larchmt). 2016; 17: 250-5.
https://doi.org/10.1089/sur.2013.134
PMid:26978531 PMCid:PMC4790211
 
5. Struck MF, Gille J. Fungal infections in burns: a comprehensive review. Ann Burns Fire Disasters 2013; 26(3): 147 -53
 
6. Luo G, Tan J, Peng Y, Wu J, Huang Y, Peng D, et al. Guidelines for diagnosis, prophylaxis, and treatment of invasive fungal infection post-burn injury in China 2013. Burns Trauma 2014; 2(2): 45 -52.
https://doi.org/10.4103/2321-3868.130182
PMid:27602362 PMCid:PMC5012031
 
7. Diba K, Afshar Yavari S. Opportunistic fungi in air, surface and burn wound in burn ICU patients. Proceedings of the National Burn Congress; Tehran, Iran; 2002: 1-3.
 
8. Katz T, Wasiak J, Cleland H, Padiglione A. Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective. Burns. 2014 Aug 1; 40(5):881-6.
https://doi.org/10.1016/j.burns.2013.11.025
PMid:24380706
 
9. Capoor MR, Gupta S, Sarabahi S, Mishra A, Tiwari VK, Aggarwal P. Epidemiological and clinico‐mycological profile of fungal wound infection from largest burn center in Asia. Mycoses. 2012 Mar; 55(2):181-8.
https://doi.org/10.1111/j.1439-0507.2011.02065.x
PMid:21740469
 
10. Que AT, Nguyen NM, Do NA, Nguyen NL, Tran ND, Le TA. Infection of burn wound by Aspergillus fumigatus with gross appearance of fungal colonies. Medical mycology case reports. 2019 Jun 1; 24:30-2.
https://doi.org/10.1016/j.mmcr.2019.03.002
PMid:30949425 PMCid:PMC6429549
 
11. Palackic A, Popp D, Tapking C, Houschyar KS, Branski LK. Fungal infections in burn patients. Surgical Infections. 2021 Feb 1; 22(1):83-7.
https://doi.org/10.1089/sur.2020.299
PMid:33035112
 
12. Ballard J, Edelman L, Saffle J, Sheridan R, Kagan R, Bracco D, et al. Positive fungal cultures in burn patients: a multicentre review. J Burn Care Res. 2008; 29:213-21.
https://doi.org/10.1097/BCR.0b013e31815f6ecb
PMid:18182925
 
13. Moore EC, Padiglione AA, Wasiak J, Paul E, Cleland H. Candida in burns: risk factors and outcomes. J Burn Care Res. 2010; 31:257-63.
https://doi.org/10.1097/BCR.0b013e3181d0f536
PMid:20182372
 
14. Struck MF, Gille J. Fungal infections in burns: a comprehensive review. Annals of Burns and Fire Disasters. 2013; 26(3):147-53.
 
15. Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M. Association of hyperglycemia with increased mortality after severe burn injury. J Trauma. 2001; 51:540-44.
https://doi.org/10.1097/00005373-200109000-00021
PMid:11535907
 
16. Cochran A, Morris SE, Edelman LS, Saffle JR. Systemic candida infections in burn patients: a case-control study of management patterns and outcomes. Surg Infect. 2002; 3:367-74.
https://doi.org/10.1089/109629602762539580
PMid:12697083
 
17. Horvath EE, Murray CK, Vaghan GM, Chung KK, Hospenthal DR, Wade CE, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg. 2007; 245:978-85.
https://doi.org/10.1097/01.sla.0000256914.16754.80
PMid:17522525 PMCid:PMC1876957
 
18. Murray C, Loo F, Hospenthal D, Cancio L, Jones J, Kim S, et al. Incidence of fungal infections and related mortality following severe burns. Burns. 2008; 34:1108-12.
https://doi.org/10.1016/j.burns.2008.04.007
PMid:18691821
 
19. Mousa HA. Fungal infection of burn wound in patients with open and occlusive treatment methods. East Mediterr Health J. 1999; 5:333-36.
https://doi.org/10.26719/1999.5.2.333
PMid:10793810
 
20. Capoor MR, Sarabahi S, Tiwari VK, Narayanan RP. Fungal infections in burns: Diagnosis and management. Indian J Plast Surg. 2010; 43(Suppl S1):37-42.
https://doi.org/10.1055/s-0039-1699460
 
21. Rosanova MT, Brizuela M, Villasboas M, Guarracino F, Alvarez VL, Santos P, et al. Fusarium spp infections in a paediatric burn unit: nine years of experience. Braz J Infect Dis. 2016; 20(4):389-92.
https://doi.org/10.1016/j.bjid.2016.04.004
PMid:27235982 PMCid:PMC9427570
 
22. Bruck HM, Nash G, Foley FD, Pruitt BA. Opportunistic Fungal infection of burn wound with Phycomycetes and Aspergillus. A Clinical-pathological review. Arch Surg. 1971; 102:476.
https://doi.org/10.1001/archsurg.1971.01350050042014
PMid:5580338
 
23. Ibrahim NH, Amer TA. Frequency of bacterial and fungal infections of burn wounds at Cairo University burn center. Egyptian Journal of Medical Microbiology. 2008; 17:573-82.
 
24. Branski LK1, Al-Mousawi A, Rivero H, Jeschke MG, Sanford AP, Herndon DN. Emerging infections in burns. Surg Infect (Larchmt) 2009; 10:389-97.
https://doi.org/10.1089/sur.2009.024
PMid:19810827 PMCid:PMC2956561
 
25. Mundhada SG, Waghmare PH, Rathod PG, Ingole KV. Bacterial and fungal profile of burn wound infections in Tertiary Care Center. Indian J Burns. 2015; 23:71-55.
https://doi.org/10.4103/0971-653X.171661