Saksenaea erythrospora, an emerging mucoralean fungus causing severe necrotizing skin and soft tissue infections – a study from a tertiary care hospital in north India^*

Abstract

Background: Saksenaea erythrospora is an emerging and recently described pathogenic fungus mainly causing invasive cutaneous infections. Globally, very few human cases, caused by S. erythrospora, have been reported. In India, among the genus Saksenaea, S. vasiformis was the only reported pathogenic species, until recently when a case of fungal rhinosinusitis was reported to be caused by S. erythrospora. We observed five human cases of necrotizing skin and soft tissue infections caused by S. erythrospora following traumatic implantation over 1-year study period.

Methods: The study was conducted for a year observing the causative role of Saksenaea species in primary cutaneous necrotizing infections. The clinical entities were diagnosed by both microbiological and histopathological examination of the skin biopsies. The final identification of fungal strains was done by comparing internal transcribed spacer (ITS) and D1–D2 domains of the LSU (larger subunit) of the nuclear ribosomal RNA (rRNA) sequences with those of type strains of the different species of Saksenaea.

Results: Out of total 23 cases of necrotizing skin and soft tissue infections, 5 were caused by S. erythrospora. Intramuscular injection into the gluteal region was the predisposing factor in four patients, while upper limb involvement, following medicated adhesive tape application, was seen in one patient. All patients were treated with liposomal amphotericin B (LAMB) along with extensive debridement of necrotic tissues. Four patients responded well however one died.

Conclusion: Saksenaea erythrospora is an emerging mucoralean fungus isolated in India among patients undergoing inadvertent I/M injections entailing necrotizing fasciitis at the local site.

Keywords:

• Emerging fungi
• Mucoromycotina
• mucormycosis
• necrotizing fasciitis
• Saksenaea erythrospora

Acknowledgements

Ethical Considerations: This study was conducted after due approval of the Ethics Committee of our institute keeping in view the ethical guidelines for biomedical research on human subjects as given by the Central Ethics Committee on Human Research (CECHR) of Indian Council of Medical Research (ICMR), New Delhi in 2006 and given in the ‘Declaration of Helsinki’ of 2008.

Culture Collection Accession Numbers: The fungal isolates of Saksenaea erythrospora described herein have been deposited in the Faculty of Medicine, Reus (FMR) culture collection (Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Reus, Spain) as well as in the Mycology Reference Laboratory (Spanish National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain).

Disclosure statement

This is submitted that none of the authors has any conflict of interests.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.