Saksenaea vasiformis: a multifaceted approach to a complex case
DOI:
https://doi.org/10.18203/2349-2902.isj20254343Keywords:
Saksenaea vasiformis infection, Mucormycosis, Surgical debridement, Wound infectionAbstract
Saksenaea vasiformis is a rare, opportunistic Mucorales fungus capable of causing rapidly progressive cutaneous and subcutaneous infections, including necrotising fasciitis. Early diagnosis is challenging due to its poor sporulation on routine media and often subtle initial clinical features. We describe a case of a soft-tissue infection in a co-morbid 75-year-old man from rural Australia with limited healthcare engagement. Despite broad-spectrum antibacterial therapy, operative intervention and negative-pressure wound-therapy, the wound continued to deteriorate. Eventually, sequencing of the internal transcribed spacer region confirmed S. vasiformis. The patient was commenced on liposomal amphotericin B followed by prolonged oral itraconazole due to underlying renal impairment and geographic barriers to ongoing inpatient care. This case underscores the need for early suspicion of atypical fungal pathogens in necrotic soft-tissue infections unresponsive to antibacterial therapy and highlights the importance of prompt surgical management, infectious diseases input, specialised fungal diagnostics and tailored antifungal treatment.
Metrics
References
Saksena S. A new genus of the Mucorales. Mycologia. 1953;45(3):426-36. DOI: https://doi.org/10.1080/00275514.1953.12024280
Ajello L, Dean DF, Irwin RS. The zygomycete Saksenaea vasiformis as a pathogen of humans with a critical review of the etiology of zygomycosis. Mycologia. 1976;68(1):52-62. DOI: https://doi.org/10.1080/00275514.1976.12019884
Al-Hedaithy M. Cutaneous zygomycosis due to Saksenaea vasiformis: Case report and literature review. Ann Saudi Med. 1998;18(5):428-31. DOI: https://doi.org/10.5144/0256-4947.1998.428
Singh I, Kushwaha RKS. Biology and Significance of Saksenaea vasiformis. In: Satyanarayana T, Deshmukh SK, Johri BN, editors. Develop Fungal Biol Applied Mycol. 2017;19-28. DOI: https://doi.org/10.1007/978-981-10-4768-8_2
Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus-Mucor, and-Lichtheimia species. Clin Microbiol Rev. 2011;24(2):411-45. DOI: https://doi.org/10.1128/CMR.00056-10
Andresen D, Donaldson A, Choo L, Knox A, Klaassen M, Ursic C, et al. Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet. 2005;365(9462):876-8. DOI: https://doi.org/10.1016/S0140-6736(05)71046-1
Pourahmad M, Sepidkar A, Farokhnia MH, Tadayon SMK, Salehi H, Zabetian H. Mucormycosis after scorpion sting: case report. Mycoses. 2013;56(5):589-91. DOI: https://doi.org/10.1111/myc.12066
Wilson PA. Zygomycosis due to Saksenaea vasiformis caused by a magpie peck. Med J Australia. 2008;189(9):521-2. DOI: https://doi.org/10.5694/j.1326-5377.2008.tb02150.x
Bouza E, Muñoz P, Guinea J. Mucormycosis: an emerging disease? Clin Microbiol Infect. 2006;12:7-23. DOI: https://doi.org/10.1111/j.1469-0691.2006.01604.x
Singh S, Kanaujia R, Kumar MB, Naga Santhosh Irrinki RN, Satish SN, Choudhary H, et al. Saksenaea vasiformis infection: Extensive abdominal wall necrotizing fasciitis with systematic review and analysis of 65 cases. Mycoses. 2023;66(8):697-704. DOI: https://doi.org/10.1111/myc.13592
Pilch WT, Kinnear N, Hennessey DB. Saksenaea vasiformis infection in an immunocompetent patient in rural Australia. BMJ Case Rep. 2017;2017. DOI: https://doi.org/10.1136/bcr-2017-220341
Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, et al. A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series. Int Wound J. 2009;6:1-25. DOI: https://doi.org/10.1111/j.1742-481X.2009.00628.x
Lohana P, Hogg FJ. Vacuum-assisted closure and primary cutaneous aspergillosis in a burn - a management dilemma! Ann Burns Fire Disasters. 2010;23(1):48-50.
Biermann N, Taeger CD, Schatz V, Eigenberger A, Prantl L, Felthaus O. The influence of negative pressure wound therapy on bacterial and fungal growth. J Tissue Viability. 2023;32(4):613-7. DOI: https://doi.org/10.1016/j.jtv.2023.06.010
Romo MA, Leach G, Reid CM, Dean RA, Suliman A. Infiltrating Wound Vacuum-Assisted Closure With Topical Amphotericin for Mucormycosis Infection of the Achilles Tendon. Fed Pract. 2023;40(2):47-9. DOI: https://doi.org/10.12788/fp.0359
Salas V, Pastor FJ, Calvo E, Sutton D, García-Hermoso D, Mayayo E, et al. Experimental murine model of disseminated infection by Saksenaea vasiformis: successful treatment with posaconazole. Med Mycol. 2012;50(7):710-5. DOI: https://doi.org/10.3109/13693786.2012.673137
Trotter DJ, Gonis G, Cottrill E, Coombs C. Disseminated Saksenaea vasiformis in an immunocompetent host. Med J Australia. 2008;189(9):519-20. DOI: https://doi.org/10.5694/j.1326-5377.2008.tb02149.x
Sun QN, Fothergill AW, McCarthy DI, Rinaldi MG, Graybill JR. In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother. 2002;46(5):1581-2. DOI: https://doi.org/10.1128/AAC.46.5.1581-1582.2002
Lewis R, Niazi-Ali S, McIvor A, Kanj SS, Maertens J, Bassetti M, et al. Triazole antifungal drug interactions—practical considerations for excellent prescribing. J Antimicrob Chemother. 2024;79(6):1203-17. DOI: https://doi.org/10.1093/jac/dkae103
Coronel-Pérez IM, Rodríguez-Rey EM, Castilla-Guerra L, Domínguez MC. Primary Cutaneous Mucormycosis Due to Saksenaea vasiformis in an Immunocompetent Patient. Actas Dermo-Sifiliográficas. 2015;106(6):516-8. DOI: https://doi.org/10.1016/j.adengl.2015.05.018
Sigera LSM, Gamage KKK, Jayawardena MN, Abeydeera WPH, Malkanthi MA, Jayasekera PI, et al. Cutaneous mucormycosis caused by Saksenaea vasiformis in a patient with systemic lupus erythematosus. Clin Case Rep. 2018;6(9):1730-4. DOI: https://doi.org/10.1002/ccr3.1698
Planegger A, Uyulmaz S, Poskevicius A, Zbinden A, Müller NJ, Calcagni M. Cutaneous Invasive Fungal Infections with Saksenaea Species in Immunocompetent Patients in Europe: A Systematic Review and Case Report. Plast Reconstr Surg Glob Open. 2022;10(4):e4230. DOI: https://doi.org/10.1097/GOX.0000000000004230
Hammond SP, Bialek R, Milner DA, Petschnigg EM, Baden LR, Marty FM. Molecular methods to improve diagnosis and identification of mucormycosis. J Clin Microbiol. 2011;49(6):2151-3. DOI: https://doi.org/10.1128/JCM.00256-11
Tanphaichitr VS, Chaiprasert A, Suvatte V, Thasnakorn P. Subcutaneous mucormycosis caused by Saksenaea vasiformis in a thalassaemic child: first case report in Thailand. Mycoses. 1990;33(6):303-9. DOI: https://doi.org/10.1111/myc.1990.33.6.303
Kaufman L, Padhye AA, Parker S. Rhinocerebral zygomycosis caused by Saksenaea vasiformis. J Med Vet Mycol. 1988;26(4):237-41. DOI: https://doi.org/10.1080/02681218880000331
Padhye AA, Ajello L. Simple method of inducing sporulation by Apophysomyces elegans and Saksenaea vasiformis. J Clin Microbiol. 1988;26(9):1861-3. DOI: https://doi.org/10.1128/jcm.26.9.1861-1863.1988
Lumyongsatien M, Jaru-Ampornpan P, Uiprasertkul M, Selva D. Orbital Infection by Saksenaea vasiformis in an Immunocompetent Host. Case Rep Ophthalmol Med. 2020;2020:8827074. DOI: https://doi.org/10.1155/2020/8827074
Bialek R, Zelck UE. PCR-based diagnosis of mucormycosis in tissue samples. Pathologe. 2013;34(6):511-8. DOI: https://doi.org/10.1007/s00292-013-1831-9
Lau A, Chen S, Sorrell T, Carter D, Malik R, Martin P, et al. Development and clinical application of a panfungal PCR assay to detect and identify fungal DNA in tissue specimens. J Clin Microbiol. 2007;45(2):380-5. DOI: https://doi.org/10.1128/JCM.01862-06
Meason-Smith C, Edwards EE, Older CE, Branco M, Bryan LK, Lawhon SD, et al. Panfungal Polymerase Chain Reaction for Identification of Fungal Pathogens in Formalin-Fixed Animal Tissues. Vet Pathol. 2017;54(4):640-8. DOI: https://doi.org/10.1177/0300985817698207
Downloads
Published
How to Cite
Issue
Section
