Diagnostic Challenges of Non-Sporulating Fungal Isolates Recovered from Traumatic Wounds Following Motor Vehicle Collisions: Subramaniula asteroides and Aspergillus quadrilineatus in the United Arab Emirates

Environmental fungi may be recovered from traumatic wounds following motor vehicle collisions (MVCs), but distinguishing transient environmental inoculation, colonization, or contamination from true fungal infection can be challenging. Diagnostic challenges arise when fungal isolates recovered from clinical specimens remain non-sporulating (i.e., sterile), limiting conventional morphological identification and potentially remaining unidentified by routine laboratory platforms such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We describe two cases involving the recovery and diagnostic characterization of Subramaniula asteroides and Aspergillus quadrilineatus from traumatic wounds following MVC-related polytrauma in the United Arab Emirates. In Case 1, a 55-year-old man with a severe crush–degloving hand injury underwent infectious disease evaluation for a suspected complicated skin and soft tissue infection (SSTI), prompting wound culture and antibacterial therapy. The recovered non-sporulating mold was identified as S. asteroides by ITS and D1/D2 sequencing and phylogenetic analysis; histopathologic assessment for fungal tissue invasion was not performed, no antifungal therapy was documented, and the wound improved following surgical and antibacterial management. In Case 2, a 40-year-old man with extensive upper-limb trauma underwent debridement and skin grafting, with wound culture yielding an initially non-sporulating mold subsequently identified as A. quadrilineatus by multilocus analysis of ITS, β-tubulin, and calmodulin. Voriconazole was initiated following communication of the species-level identification and discontinued after 15 days when the isolate was considered more likely to represent colonization or contamination than true wound infection. Although invasive fungal disease was not established in either case, these reports highlight the diagnostic challenges posed by non-sporulating molds, particularly in distinguishing fungal recovery from true infection in traumatic wounds. They also demonstrate the value of reference mycology laboratories integrating phenotypic and molecular approaches in accurately identifying uncommon environmental fungi and informing the interpretation of their clinical significance.