Phycomycosis in the Extensively Burned:Report of Three Cases with Review of Literature

Three patients were seriously burned and died of invasive phycomycotic infection of burn wound. They have the following common features. 1. Extremely severe injury: burn areas exceeding 70% （70-94%）, with fullthickness injury exceeding 50% （52-71%） 2. Age: over 45 years （45-59）. 3. Treatment with multiple broad-spectrum antibiotics in large doses. 4. Administration of corticosteroid （dexamethasone 110-120 mg） prior to advent of deep mycotic infection. 5. Uncontrolled hyperglycemia; blood sugar over 300 mg/dl. 6. Presence of multiple systemic organ failure. The pathological features of invasive phycomycotic infection in major burn patients are as follows: 1. Invasion of blood vessels results in thrombosis, infarction, and hemorrhage. 2. Tendency of invading muscles resulting in necrosis. 3. Tendency of invading bones causing acute osteomyelitis. 4. Tendency of spreading along fascial planes, nerves or subcutaneous tissue, producing necrosis of unburned skin. 5. Blood dissemination produces metastatic lesons in the brain, lungs, heart, liver, kidneys and skin. The most important diagnostic method for detecting and confirming invasive phycomycosis is the biopsy from the burn wound. At present the only effective treatment is early surgical intervention.