Infection by Saksenaea vasiformis in Spain: Case report and literature review.

Abstract

Introduction: Saksenaea vasiformis is a filamentous fungus from the Mucorales family, responsible for isolated infections with high morbidity and mortality, especially in tropical or subtropical areas. The objective is to describe the clinical characteristics of the cases reported in Spain.

Methods: In addition to presenting a case of S. vasiformis infection treated at Hospital Universitario Cruces in 2023, a systematic literature review was conducted on 17/04/2024, analyzing a total of 11 cases. Epidemiological and clinical data were obtained, and a descriptive analysis was performed.

Results: The average age was 64.9 years, with most being male (72.7%) and immunocompetent. Acquisition was related to severe trauma (45.5%) or insect bites (36.4%). 90.1% suffered from skin and soft tissue infections. The diagnostic process was complex, with the following being useful: direct staining (36.4%), culture in specific media (27.3%), molecular techniques (54.5%), and histopathological findings (90.9%). MICs of antifungals was determined in 3 cases, with low MICs for liposomal amphotericin B (L-AMB) and posaconazole, and variable MICs for voriconazole. L-AMB was the most commonly used antifungal, combined in all cases with extensive surgical debridement. Mortality was 45.5%.

Conclusion: Infection by S. vasiformis is rare in our environment but clinically significant due to its severity and difficult diagnosis. Rapid recognition, along with early and aggressive debridement and appropriate antifungal treatment, are essential.