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Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009-2011.

Tribble DR, Rodriguez CJ, Weintrob AC, Shaikh F, Aggarwal D, Carson ML, Murray CK, Masuoka P, Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Gro - Emerging Infect. Dis. (2015)

Bottom Line: During the recent war in Afghanistan (2001-2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury.We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury.In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds.

View Article: PubMed Central - PubMed

ABSTRACT
During the recent war in Afghanistan (2001-2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions.

No MeSH data available.


Related in: MedlinePlus

Geographic distribution of 71 case-patients with invasive fungal wound infections and 101 matched control-patients. Afghanistan, 2009–2011. Inset shows a detailed view of southern Afghanistan region where most cases originated. The IFI case-patients are classified according to established definitions (13). A proven IFI is confirmed by angioinvasive fungal elements on histopathologic examination. A probable IFI had fungal elements identified on histopathologic examination without angioinvasion. A possible IFI had wound tissue grow mold; however, histopathologic features were either negative for fungal elements or a specimen was not sent for evaluation. In addition, to be identified as an IFI, the wound must demonstrate recurrent necrosis after at least 2 surgical débridements. Because injuries frequently occurred in close proximity, some points overlay other points.
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Figure 1: Geographic distribution of 71 case-patients with invasive fungal wound infections and 101 matched control-patients. Afghanistan, 2009–2011. Inset shows a detailed view of southern Afghanistan region where most cases originated. The IFI case-patients are classified according to established definitions (13). A proven IFI is confirmed by angioinvasive fungal elements on histopathologic examination. A probable IFI had fungal elements identified on histopathologic examination without angioinvasion. A possible IFI had wound tissue grow mold; however, histopathologic features were either negative for fungal elements or a specimen was not sent for evaluation. In addition, to be identified as an IFI, the wound must demonstrate recurrent necrosis after at least 2 surgical débridements. Because injuries frequently occurred in close proximity, some points overlay other points.

Mentions: As previously stated, the observed IFI cases have been identified to cluster in the southern region of Afghanistan (Figure 1) (6,17). The subset of 172 patients with available grid coordinates were classified on the basis of the presence of mold wound contamination, whether or not the patient’s condition progressed to an IFI. This classification is based on the wound microbiology results obtained at either Landstuhl Regional Medical Center or at hospitals in the United States. Specifically, the mold contamination group included patients with wound cultures that grew mold. If wound cultures did not grow mold, but the patient’s wound had histopathologic features or angioinvasion that met the case definition of an IFI (13), the patient was included in the mold contamination group. By these criteria, all 71 IFI case-patients were identified as having fungal infections. Patients who had no mold growth and did not meet IFI case definitions were included in the noncontaminated group.


Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009-2011.

Tribble DR, Rodriguez CJ, Weintrob AC, Shaikh F, Aggarwal D, Carson ML, Murray CK, Masuoka P, Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Gro - Emerging Infect. Dis. (2015)

Geographic distribution of 71 case-patients with invasive fungal wound infections and 101 matched control-patients. Afghanistan, 2009–2011. Inset shows a detailed view of southern Afghanistan region where most cases originated. The IFI case-patients are classified according to established definitions (13). A proven IFI is confirmed by angioinvasive fungal elements on histopathologic examination. A probable IFI had fungal elements identified on histopathologic examination without angioinvasion. A possible IFI had wound tissue grow mold; however, histopathologic features were either negative for fungal elements or a specimen was not sent for evaluation. In addition, to be identified as an IFI, the wound must demonstrate recurrent necrosis after at least 2 surgical débridements. Because injuries frequently occurred in close proximity, some points overlay other points.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4593427&req=5

Figure 1: Geographic distribution of 71 case-patients with invasive fungal wound infections and 101 matched control-patients. Afghanistan, 2009–2011. Inset shows a detailed view of southern Afghanistan region where most cases originated. The IFI case-patients are classified according to established definitions (13). A proven IFI is confirmed by angioinvasive fungal elements on histopathologic examination. A probable IFI had fungal elements identified on histopathologic examination without angioinvasion. A possible IFI had wound tissue grow mold; however, histopathologic features were either negative for fungal elements or a specimen was not sent for evaluation. In addition, to be identified as an IFI, the wound must demonstrate recurrent necrosis after at least 2 surgical débridements. Because injuries frequently occurred in close proximity, some points overlay other points.
Mentions: As previously stated, the observed IFI cases have been identified to cluster in the southern region of Afghanistan (Figure 1) (6,17). The subset of 172 patients with available grid coordinates were classified on the basis of the presence of mold wound contamination, whether or not the patient’s condition progressed to an IFI. This classification is based on the wound microbiology results obtained at either Landstuhl Regional Medical Center or at hospitals in the United States. Specifically, the mold contamination group included patients with wound cultures that grew mold. If wound cultures did not grow mold, but the patient’s wound had histopathologic features or angioinvasion that met the case definition of an IFI (13), the patient was included in the mold contamination group. By these criteria, all 71 IFI case-patients were identified as having fungal infections. Patients who had no mold growth and did not meet IFI case definitions were included in the noncontaminated group.

Bottom Line: During the recent war in Afghanistan (2001-2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury.We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury.In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds.

View Article: PubMed Central - PubMed

ABSTRACT
During the recent war in Afghanistan (2001-2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions.

No MeSH data available.


Related in: MedlinePlus