Epidemiology, Risk Factors, and Molecular Identification of Burn-Associated Fungal Pathogens in Thi-Qar General Hospital, Southern Iraq

Abstract

Background: Burn-associated fungal infections have become an increasingly important cause of morbidity and mortality worldwide. The destruction of the skin barrier, prolonged hospitalization, extensive antibiotic exposure, and burn-induced immunosuppression create favorable conditions for fungal colonization and invasion. Despite the growing clinical significance of these infections, comprehensive epidemiological and molecular studies from Iraq remain limited. This study investigated the prevalence, demographic distribution, species diversity, and molecular characteristics of fungal pathogens isolated from burn patients admitted to Thi-Qar General Hospital, Southern Iraq.

Materials and Methods: A cross-sectional study was conducted between March and September 2025 and included 95 hospitalized burn patients with a minimum stay of seven days. Burn wound swabs were collected and cultured on standard mycological media. Fungal isolates were identified using conventional phenotypic methods and confirmed by Internal Transcribed Spacer (ITS) sequencing. Phylogenetic relationships were reconstructed using the Maximum Likelihood method in MEGA software. Statistical analyses were performed to determine associations between fungal positivity and demographic or clinical variables.

Results: Overall fungal culture positivity reached 76.8% (73/95). Male patients represented 56.8% of the study population, while females accounted for 43.2%. Eight fungal species were identified. Aspergillus fumigatus was the predominant isolate (31.5%), followed by Candida albicans (21.9%) and Rhizopus arrhizus (16.4%). Significant associations were observed between fungal positivity and gender (p = 0.003), age group (p = 0.039), and total body surface area burned (TBSA%) (p = 0.030). ITS sequencing confirmed species-level identification and corrected several preliminary morphological classifications. Phylogenetic analysis demonstrated close clustering of local isolates with international clinical strains.

Conclusions: Burn patients in Southern Iraq exhibit a high burden of opportunistic fungal infections. Molecular identification significantly improves diagnostic accuracy and supports epidemiological surveillance. A. fumigatus, C. albicans, and R. arrhizus represent the most clinically relevant fungal pathogens in this setting.