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Man Loses Leg To Flesh-Eating Disease Caused By Very Rare Fungus Infection

© iStock Stock image: Artist's illustration of a mold that causes the mucormycosis fungal disease. A man had to have his leg amputated after contracting a "flesh-eating" disease resulting from an "extremely rare" fungal infection.

A man came close to death and had to have his leg amputated after contracting a "flesh-eating" disease resulting from an "extremely rare" fungal infection.

The individual in his 60s, who was a machinery operator, went to the hospital in Queensland, Australia, with a skin tear to his left calf, a BMJ Case Report said earlier this month. The man said he had injured his leg on a caravan door.

Doctors eventually diagnosed him with necrotizing fasciitis—a rapidly progressing soft tissue infection that can potentially be fatal.

Necrotizing fasciitis is already rare, but is primarily caused by certain types of bacteria, which move rapidly through the body, attacking the skin and soft tissue, according to the Centers for Disease Control and Prevention (CDC.)

The name of the disease refers to the fact that it is characterized by the death of soft tissue—for example those that surround muscles, nerves, fat and blood vessels—which, in severe cases, can result in the shutting down of organs.

But in "extremely rare" cases—as occurred with the man in his 60s—a fungal infection can be the underlying causative agent of necrotizing fasciitis, the authors of the BMJ paper wrote.

When the man went to his local hospital his leg wound was tender and warm. Doctors treated the injured leg, but his condition deteriorated and he developed a fever, forcing him to be transferred to a larger, regional hospital for a few days.

There, the man suffered kidney failure as well as sepsis—a potentially life-threatening condition occurring when the body produces an immune response to an infection that damages its own tissues, causing organs to function poorly and abnormally. He was then transferred to another hospital where doctors began treating him for a necrotizing soft tissue infection.

According to the BMJ report, doctors "debrided" a significant part of the man's lower leg. Debridement is the medical term for the removal of dead, damaged or infected tissue—a procedure that is conducted in an attempt to help the remaining healthy tissue in a given area to heal. Further debridement was required, with the man undergoing three further operating procedures over the subsequent two weeks.

But despite the fact that doctors had removed adequate margins of healthy tissue around the area of infection—leaving a large chunk of the man's leg missing right down to the bone—they continued to find ongoing evidence of soft tissue necrosis. As a result, a decision was made with the man's next of kin to conduct an amputation of the infected leg above the knee.

After amputating the leg, doctors treated the wound with a technique known as negative pressure wound therapy. This method involves drawing out fluid and infected tissue from a wound to help it heal. A special dressing is sealed over the wound and attached to a vacuum pump.

However, during a procedure to replace the dressing, which required a trip to the operating room, the man suffered a hyperkalemic cardiac arrest after being placed under general anesthetic. Hyperkalemia is an elevated level of potassium in the blood, which can cause an abnormal heart rhythm, potentially resulting in cardiac arrest and death.

Fortunately, doctors managed to resuscitate the man, who returned to the intensive care unit (ICU). During his time there, doctors had to manage his kidney failure, as well as other complications such as acute anemia (an abrupt drop in red blood cells that can also be life-threatening in severe cases), coagulopathy (a bleeding disorder in which the blood's ability to form clots is impaired), and multiple organ failure.

Doctors also conducted several lab tests of the patient, which eventually revealed that he had mucormycosis—a serious, but rare fungal infection caused by a group of molds called mucormycetes. The infection was "angioinvasive" in nature, meaning it had infiltrated the blood vessels.

With this knowledge in hand, medics began treating the man with an anti-fungal medication called amphotericin B for seven days. His condition improved and he was eventually moved to ward-level care having spent a month in the ICU.

During his time in the hospital, doctors had sent fungal samples to the National Mycology Reference Centre at the University of Adelaide, Australia. There, scientists identified the fungus responsible for the man's infection as the species Saksenaea vasiformis.

The man was eventually discharged home after spending some time at his local hospital for further rehabilitation.

He can walk now with a prosthetic leg and the authors of the BMJ study said he is "thankful" for the quality of life that he has been left with. The amputation wound has completely healed and he has suffered no other long-term consequences from his severe fungal infection.

Different Types of Necrotizing Fasciitis

Necrotizing fasciitis is broadly classified into four types (I-IV) with I and II being the most common. Types I-III are caused by various types of bacteria, whereas type IV involves fungal pathogens. In the fungal cases, a group known as the zygomycetes or the genus (group of species) Candida are usually responsible.

The zygomycetes are subdivided into two subgroups—Mucorales and Entomophthorale. Mucorales fungi are the primary cause of mucormycosis, with S. Vasiformis being the sixth most prevalent species of this subgroup.

In this case, the patient in the study survived the disease, which is rare for angioinvasive mucormycosis. This infection has a "very high" mortality rate, according to the authors.

One review of the scientific literature showed that infection with S. Vasiformis and very similar related species led to death in 17 out of 46 patients.

Infections with these species are usually reported in individuals living in warm climates—as was the case with the patient in the BMJ study who lived in rural Queensland. In most cases identified in the review, the fungus, which is extremely fast growing, infected the lower limbs first.

The molds that cause mucormycosis are found throughout the environment, primarily in the soil and decaying organic matter, but also in the air.

People can become infected by inhaling fungal spores, or via a cut, burn, or other type of skin injury. Mucormycosis is not contagious and cannot be spread from one person to another. These fungi are not harmful to most people, primarily affecting individuals who have weakened immune systems or other health problems.

The man in the BMJ study had a history of heart disease, type 2 diabetes and other health conditions, and was taking several medications. His survival in this case can be attributed to prompt treatment once the causative pathogen was discovered accompanied by the appropriate anti-fungal therapy, debridement and amputation, according to the study.

The authors in the report said his case highlights the importance for doctors of considering rare type IV causes of necrotizing fasciitis—specifically mucormycosis—in patients who do not respond to early debridement and appropriate administration of antibiotics.

"Although mucormycosis is a rare occurrence, it carries a high mortality if left to become angioinvasive and so awareness of this condition is important," the authors wrote.

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13 Causes Of Blisters

Warning: Graphic images ahead.

1. Herpes simplex

The herpes virus causes painful blisters that occur alone or in clusters, weep clear yellow fluid, and then crust over. On the mouth, it is known as a cold sore. On the genitals, it is known as genital herpes and is a sexually transmitted infection (STI).

Most often, the viruses HSV-1 and HSV-2 cause oral and genital lesions, respectively. Less commonly, HSV-1 can also cause genital herpes.

The blisters may be triggered by stress, menstruation, illness, or sun exposure. The infected site often starts to itch or tingle before the actual appearance of blisters.

Learn more about cold sores and genital herpes.

2. Impetigo

Impetigo is a common bacterial infection in babies and children. It causes an irritating rash and fluid-filled blisters that pop easily and form a honey-colored crust.

The rash is often located in the area around the mouth, chin, and nose.

All About Common Skin Disorders

Skin disorders, such as acne and eczema, vary greatly in symptoms and severity. They can be temporary or permanent and may be painless or painful. Some can be life threatening.

Some skin disorders have situational causes, while others may be genetic. While most skin disorders are minor, others can indicate a more serious issue.

Contact a doctor if you believe you may have one of these common skin problems.

There are many different types of skin disorders. Here are pictures of 25 different conditions, followed by a list of details for each.

Acne

Acne is commonly located on the face, neck, shoulders, chest, and upper back.

Breakouts on the skin are composed of redness, blackheads, whiteheads, pimples, or deep, painful cysts and nodules.

This condition may leave scars or darken the skin if untreated.

People of Color can experience dark spots known as post-inflammatory hyperpigmentation (PIH).

Learn more about acne.

Cold sore

This condition causes a red, painful, fluid-filled blister that appears near the mouth and lips. People with lighter skin may notice more redness than those with darker skin.

The affected area will often tingle or burn before the sore is visible.

Outbreaks may also be accompanied by mild, flu-like symptoms such as low fever, body aches, and swollen lymph nodes.

Cold sores usually look similar on any skin color but can also cause PIH in people with darker skin.

Learn more about cold sores and cold sores on dark skin.

Blister

Blisters are characterized by a watery, clear, fluid-filled area on the skin.

They may be smaller than 1 centimeter (cm) (vesicle) or larger than 1 cm (bulla) and can occur alone or in groups.

Blisters can be found anywhere on the body.

Learn more about blisters.

Hives

This causes itchy, raised welts that occur after exposure to an allergen.

Welts may be warm and mildly painful to the touch.

Hives on darker skin can appear raised or inflamed and might be slightly darker or lighter than your natural skin color. On lighter skin, hives usually appear red.

They can be small, round, ring-shaped, or randomly shaped.

Learn more about hives.

Actinic keratosis

This condition causes a thick, scaly, or crusty skin patch.

It's typically less than 2 cm or about the size of a pencil eraser.

It often appears on parts of the body that receive a lot of sun exposure, such as the hands, arms, face, scalp, and neck.

The skin patch is usually pink in color but can have a brown, tan, or gray base. This patch may appear the same color as the surrounding skin in people with darker skin.

Learn more about actinic keratosis.

Rosacea

This chronic skin disease goes through cycles of fading and relapse.

Relapses may be triggered by spicy foods, alcoholic beverages, sunlight, stress, and the intestinal bacteria Helicobacter pylori.

There are four subtypes of rosacea encompassing a wide variety of symptoms.

Common symptoms include facial flushing, raised red bumps, skin dryness, and skin sensitivity.

People with darker skin tones may notice brown discoloration or dry and swollen patches of dark skin.

Learn more about rosacea.

Carbuncle

This causes a red, painful, and irritated lump under your skin.

It may be accompanied by fever, body aches, and fatigue.

It can also cause skin crustiness or oozing.

It may appear more violet on darker skin.

Learn more about carbuncles.

Latex allergy

This condition is considered a medical emergency. Urgent care may be required. Contact 911 or local emergency services.

This causes a rash, which may occur within minutes to hours after exposure to a latex product. It may be less visible on darker skin or appear lighter or darker than surrounding tissue.

It also causes warm, itchy wheals at the site of contact, which may take on a dry, crusted appearance with repeated exposure to latex.

Airborne latex particles may cause cough, runny nose, sneezing, and itchy, watery eyes.

A severe allergy to latex can cause swelling and difficulty breathing.

Learn more about latex allergies.

Eczema

Eczema is characterized by yellow or white scaly patches that flake off.

Affected areas may be itchy, greasy, or oily.

On light skin, eczema can cause a red rash. This rash may appear brown, purple, or gray on darker skin.

Hair loss may also occur in the area with the rash.

Learn more about eczema.

Psoriasis

This causes scaly, silvery, sharply defined skin patches. Darker skinned people might also experience dark brown or purplish patches on the skin.

Patches are commonly located on the scalp, elbows, knees, and lower back.

This condition may be itchy or asymptomatic.

Learn more about psoriasis.

Cellulitis

Cellulitis is a medical emergency. A person should contact 911 or local emergency services if they have any symptoms of cellulitis.

Cellulitis is caused by bacteria or fungi entering through a crack or cut in the skin.

It causes painful swollen skin with or without oozing that spreads quickly.

The skin might appear red on lighter skin. However, this may be less noticeable on darker skin tones.

The skin may feel hot and tender to the touch.

Fever, chills, and red streaking from the rash might be symptoms of a serious infection requiring medical attention.

Learn more about cellulitis.

Measles

Symptoms of measles include fever, sore throat, red or watery eyes, loss of appetite, cough, and runny nose.

It also causes a red rash, which spreads from the face down the body 3 to 5 days after the first symptoms appear. This rash might be more difficult to see on darker skin.

Tiny red spots with blue-white centers may appear inside the mouth.

Measles may cause more obvious PIH in People of Color

Learn more about measles.

Basal cell carcinoma

This condition is often characterized by raised, firm, and pale areas that may resemble a scar.

It can cause dome-like, pink or red, shiny, and pearly areas that may have a sunk-in center, like a crater. For people with dark skin, it might appear darker and less pearly.

Blood vessels on the growth may be visible.

It might cause easy bleeding or an oozing wound that doesn't seem to heal or heals and then reappears.

Learn more about basal cell carcinoma.

Squamous cell carcinoma

This condition often occurs in areas exposed to ultraviolet (UV) radiation, such as the face, ears, and back of the hands.

It may be characterized by a scaly, reddish patch of skin, which progresses to a raised bump that continues to grow. The bump may be lighter on darker skin.

It can also cause a growth that bleeds easily, doesn't heal, or heals and then reappears.

Learn more about squamous cell carcinoma.

Melanoma

This is the most serious form of skin cancer, which is more common in people with light skin.

It can appear anywhere on the body as a mole that has irregularly shaped edges, asymmetrical shapes, and multiple colors. In People of Color, melanoma often appears in areas that are less exposed to the sun.

It might also appear as a mole that has changed color or gotten bigger over time, which is usually larger than a pencil eraser.

Learn more about melanoma.

Lupus

Lupus symptoms include fatigue, headaches, fever, and swollen or painful joints.

It can cause a scaly, disc-shaped rash that doesn't itch or hurt.

Scaly red patches or ring shapes are most commonly located on the shoulders, forearms, neck, and upper torso and worsen with exposure to sunlight. People of Color have a greater risk of developing PIH and abnormal scarring.

It also causes a warm, brown, or red rash that spreads across the cheeks and bridge of the nose like butterfly wings and worsens in the sun.

Learn more about lupus.

Contact dermatitis

This condition appears hours to days after contact with an allergen.

It causes a rash with visible borders and appears where your skin touched the irritating substance.

The skin may be itchy, scaly, or raw. Lighter skin can appear red, while darker skin may appear purple, gray, or dark brown.

It might also cause blisters that weep, ooze, or become crusty.

Learn more about contact dermatitis.

Vitiligo

Vitiligo is characterized by loss of pigment in the skin due to autoimmune destruction of the cells that give skin its color.

Focal vitiligo causes loss of skin color in only a few small areas, which may merge together.

Segmental pattern vitiligo causes depigmentation on one side of the body.

Vitiligo can also cause premature graying of the scalp or facial hair.

People of different skin tones will usually develop skin patches much lighter than their natural skin tone. In people with darker skin, it tends to be more noticeable, which may cause increased stigma related to the condition.

Learn more about vitiligo.

Wart

Warts are caused by many different types of a virus called the human papillomavirus (HPV).

They may be found on the skin or mucous membranes and can occur singly or in groups.

Warts are contagious and may be passed to others. They may appear darker on skin of color.

Learn more about warts.

Chickenpox

This can cause clusters of itchy, red or brown, fluid-filled blisters in various stages of healing all over the body.

The rash is accompanied by fever, body aches, sore throat, and loss of appetite.

Chickenpox remains contagious until all blisters have crusted over.

Chickenpox can be harder to see on darker skin.

Learn more about chickenpox.

Seborrheic eczema

This condition is characterized by yellow or white scaly patches that flake off.

Affected areas may be red, itchy, greasy, or oily.

People with darker skin may also notice hypopigmentation, or loss of skin color, in affected areas.

Hair loss may occur in the area with the rash.

Learn more about seborrheic eczema.

Keratosis pilaris

This common skin condition is most often seen on the arms and legs but might also occur on the face, buttocks, and trunk.

It often clears up on its own by age 30.

It often causes patches of skin that appear bumpy, appear slightly red, and feel rough.

Symptoms may get worse in dry weather.

The hair follicles may look darker than the surrounding skin on darker skin. They'll usually look red or purple on lighter skin.

Learn more about keratosis pilaris.

Ringworm

This condition causes circular, scaly rashes with a raised border.

Skin in the middle of the ring might appear clear and healthy, and the ring's edges may spread outward.

The skin often feels itchy.

The ring is usually red or pink on light skin and brown or gray on darker skin.

Learn more about ringworm.

Melasma

This common skin condition causes dark patches to appear on the face and — rarely — the neck, chest, or arms.

Melasma is more common in pregnant people (chloasma) and individuals with a darker skin color or heavy sun exposure.

It might not cause other symptoms beyond skin discoloration.

It may go away on its own within a year or may become permanent.

Learn more about melasma.

Impetigo

This condition is common in babies and children.

It usually causes an irritating rash, which is often located in the area around the mouth, chin, and nose.

It might also cause fluid-filled blisters that pop easily and form a honey-colored crust.

It may be harder to see on darker skin.

Learn more about impetigo.

Contact dermatitis

Contact dermatitis is one of the most common occupational illnesses, often resulting from contact with chemicals or other irritating materials.

These substances can trigger a reaction that causes the skin to become itchy and inflamed. Affected areas might also appear red, purple, gray, or dark brown. Most cases of contact dermatitis aren't severe, but they can be rather itchy.

Topical creams and avoiding the irritant are typical treatments.

Keratosis pilaris

Keratosis pilaris is a minor condition that causes small, rough bumps on the skin. These bumps usually form on the upper arms, thighs, or cheeks. They're typically red or white and don't hurt or itch.

Treatment isn't necessary, but medicated creams can improve skin appearance.

Some chronic skin conditions present from birth, while others appear suddenly later.

The cause of these disorders isn't always known. Many permanent skin disorders have effective treatments that enable extended periods of remission. However, they're incurable, and symptoms can reappear at any time.

Examples of chronic skin conditions include:

rosacea, which is characterized by small, pus-filled bumps on the face

psoriasis, which causes scaly, itchy, and dry patches

vitiligo, which results in large, irregular patches of lighter skin

Skin disorders are common in children. Children can experience many of the same skin conditions as adults. Infants and toddlers are also at risk of diaper-related skin problems.

Since children have more frequent exposure to other children and germs, they may also develop skin disorders that rarely occur in adults.

Many childhood skin problems disappear with age, but children can also inherit permanent skin disorders. In most cases, doctors can treat childhood skin disorders with topical creams, medicated lotions, or condition-specific drugs.

Common childhood skin disorders include:

Skin conditions have a wide range of symptoms. Symptoms on your skin that appear due to common problems aren't always the result of a skin disorder. Such symptoms can include blisters from new shoes or chafing from tight pants.

However, skin problems with no obvious cause may indicate the presence of a skin disorder that requires treatment.

Skin irregularities that are typically symptoms of a skin disorder include:

Common known causes of skin disorders include:

bacteria trapped in skin pores and hair follicles

fungus, parasites, or microorganisms living on the skin

viruses

a weakened immune system

contact with allergens, irritants, or another person's infected skin

genetic factors

illnesses affecting the thyroid, immune system, kidneys, and other body systems

Numerous health conditions and lifestyle factors can also lead to the development of certain skin disorders. Some skin conditions have no known cause.

Inflammatory bowel disease

Inflammatory bowel disease is a term for a group of intestinal disorders that cause prolonged inflammation of the digestive tract. These bowel-related disorders often cause skin problems.

The drugs used to treat these diseases can cause certain skin conditions, such as:

Diabetes

Many people with diabetes experience a skin problem due to their condition at some point.

Some of these skin disorders only affect people with diabetes. Others occur more frequently in people with diabetes because the disease increases the risk of infection and blood circulation problems.

Diabetes-related skin conditions include:

Lupus

Lupus is a chronic inflammatory disease that can damage the skin, joints, or organs inside the body. Common skin problems that occur from lupus include:

a red, butterfly-shaped rash on the cheeks and nose

round lesions on the face and head

thick, red, scaly lesions

red, ring-shaped lesions on body parts exposed to sunlight

flat rash on the face and body that looks like a sunburn

red, purple, or black spots on fingers and toes

sores inside the mouth and nose

tiny red spots on the legs

Pregnancy

Pregnancy causes significant changes in hormone levels that may lead to skin problems. Preexisting skin problems may change or get worse during pregnancy. Most skin conditions that arise during pregnancy go away after the baby is born. Others require medical attention during pregnancy.

Common skin conditions caused by pregnancy include:

Stress

Stress can cause hormonal imbalances, which may trigger or aggravate skin disorders. Stress-related skin problems include:

Sun

The sun can cause many different skin disorders. Some are common and harmless, while others are rare or life threatening. Knowing if the sun causes or worsens your skin disorder is important for treating it properly.

Sunlight exposure may cause or aggravate the following conditions:

Many skin disorders are treatable. Common treatment methods for skin conditions include:

antihistamines

medicated creams and ointments

antibiotics

vitamin or steroid injections

laser therapy

targeted prescription medications

biologics

Skin flare-ups

Not all skin disorders respond to treatment, and some conditions go away without treatment.

People with permanent skin conditions often go through periods of severe symptoms. Sometimes people are able to force incurable conditions into remission. However, most skin conditions reappear due to certain triggers, such as stress or illness.

You can often treat skin disorders that are temporary and cosmetic with:

medicated makeup

over-the-counter (OTC) skin care products

good hygiene practices

small lifestyle adjustments, such as making certain dietary changes

Certain skin disorders aren't preventable, including genetic conditions and some skin problems due to other illnesses. However, it's possible to prevent some skin disorders.

Follow these tips to prevent infectious skin disorders:

Wash your hands with soap and warm water frequently.

Avoid sharing eating utensils and drinking glasses with other people.

Avoid direct contact with the skin of other people who have an infection.

Clean things in public spaces, such as gym equipment, before using them.

Don't share personal items like blankets, hairbrushes, or swimsuits.

Sleep for at least 7 hours each night.

Drink plenty of water.

Avoid excessive physical or emotional stress.

Eat a nutritious diet.

Get vaccinated for infectious skin conditions, such as chickenpox.

Noncontagious skin disorders

Noninfectious skin disorders, such as acne and atopic dermatitis, are sometimes preventable. Prevention techniques vary depending on the condition. Here are some tips for preventing some noninfectious skin disorders:

Wash your face with a gentle cleanser and water every day.

Use moisturizer.

Avoid environmental and dietary allergens.

Avoid contact with harsh chemicals or other irritants.

Sleep for at least 7 hours each night, as many skin conditions can worsen due to lack of sleep.

Drink plenty of water.

Eat a balanced diet.

Protect your skin from excessive cold, heat, and wind.

Learning about proper skin care and treatment for skin disorders can be very important for skin health. Some conditions require a doctor's attention, while you can address others safely at home.

You should learn about your symptoms or condition and talk with a doctor to determine the best treatment methods.

What are the most common skin disorders?

According to the American Academy of Dermatology Association, acne is the most common skin condition in the United States. Other common skin disorders include atopic dermatitis, hair loss, and rosacea.

What is the most serious skin disease?

There are several serious skin conditions. In particular, melanoma is a type of skin cancer that can be especially dangerous, as it could spread to other parts of the body if not caught early. Cellulitis and latex allergy can also be very serious if left untreated.

Which skin disease is not curable?

A few examples of chronic skin conditions include rosacea, psoriasis, and vitiligo. While these conditions can't be cured, some may have treatments available to help manage symptoms.

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