Novel use of hyperbaric oxygen treatment for treatment-resistant disseminated Saksenaea and Fusarium in a patient on extracorporeal membrane oxygenation (ECMO): a case report
Year: 2025
Type: article
Study design: Case Report
Abstract: Filamentous soil moulds such as Saksenaea and Fusarium are angioinvasive fungi responsible for severe disseminated infections. Saksenaea causes zygomycosis, with disseminated cases having over ninety percent mortality. Fusarium, a hyphomycetes mould, can also cause disseminated infections in immunocompromised individuals, with high mortality. We describe the case of a normally healthy 20-year-old male who survived major traumatic injuries resulting from an aviation incident. He subsequently developed disseminated cutaneous zygomycetes (Saksenaea) and Fusarium infection with associated immunosuppression, multiorgan dysfunction and sepsis. Treatment strategies included repeated and extensive surgical debridement (inferior orbital region to carotid sheath in the neck, to a depth of buccal mucosa and zygomatic bone in the cheek), antifungal agents including intravenous (IV) liposomal amphotericin B and voriconazole, and IV immunoglobulin and granulocyte colony stimulating factor. Despite maximal medical and surgical treatment, disease control was not achieved. After multi-specialty consensus that current management had failed to control the disease process, hyperbaric oxygen treatment (HBOT) was added to standard therapy on an experimental basis based on several case reports, pathophysiological rationale, and institutional experience with angioinvasive Mucor. The patient was on venovenous extracorporeal membrane oxygenation for all HBOT sessions; details are reported separately. Thirteen treatment sessions (243 kPa [2.4 atmospheres absolute], 95 min) were successfully delivered. Local and systemic disease control was achieved within several days of commencing HBOT, and after a prolonged period of rehabilitation and reconstruction, the patient was discharged home. We conclude that HBOT may have an important role in the management of angioinvasive fungal disease.
Authors: Bridget Devaney, Joseph Mathew, Trauma Service, Alfred Health, Melbourne, Australia, Scott Ferris, Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Australia, Lloyd Roberts, Christopher Covelli, Judit Orosz, Vinodh Bhagyalakshmi Nanjayya, Andrew Fuller, Ian Miller
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4417174151