A review on fungal infection in burn patients, diagnosis and treatment

Burn wound is a suitable environment for growth and reproduction of microorganisms. The tissue in the burn wounds is not live and do not have blood vessels; so, polymorphonuclear antibodies and systemic antibiotics cannot diffuse into it. Thus, the condition of the wound is provided for the growth of bacteria and opportunistic fungi such as Candida, Mucor, Rhizopus, Penicillium, and Aspergillus. While the widespread use of topical and systemic antibiotics and early surgical, surveillance or isolation procedures of burn patients led to a significant reduction in wound bacterial infections, the incidence of invasive fungal infections in burn patients with extensive burns has increased. The ubiquitous presence of fungi in the environment and patients’ fungal flora, in combination with the immune system dysfunction, make burn patients susceptible to serious fungal infections. Conventional methods for the identification of fungi include direct microscopic examination and culture; however, recently, for faster and more reliable diagnosis, polymerase chain reaction (PCR)-based molecular methods are recommended. As diagnosis of fungal infection remains challenging, surveillance, prophylactic and empirical treatment is necessary. To improve the safety and efficacy of antifungal therapy, the causing species, infection site, patient’s age, and kidney and liver function should be considered in selecting the appropriate agents.