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Mucormycosis

Mucormycoses

Mucormycosis, also known as zygomycosis, is a rare fungal infection caused by the fungus Mucoromycotina (order Murcorales). Mucoromycotina were previously classified as Zygomycota. These organisms are usually found in soil and decaying organic matter, including leaves, compost or rotting wood.

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Presentation

Mucormycosis is most often an acute surgical emergency, however, some cases display chronic symptoms that gradually develop over time (weeks or months). Symptoms depend heavily on which form of the disease patients have.

Symptoms of rhino-orbito-cerebral mucormycosis include acute sinusitis, fever, eye swelling and protrusion, dark nasal scabbing, cellulitis, facial pain, retinal artery thrombosis, redness of skin around sinuses and nasal congestion with black discharge. Diplopia and blindness may be observed in later stages of the disease, which indicates the infection has spread to the orbital nerves and vessels, and prognosis for these patients is poor.

Symptoms of pulmonary mucormycosis are nonspecific and may include fever, cough, rales, shortness of breath and possibly hemoptysis if tissue necrosis is present. Symptoms of GI mucormycosis include abdominal pain and distension, nausea, vomiting blood, tenderness upon palpation and hematochezia [5]. Presentation of cutaneous mucormycosis is marked by a single area of skin that is painful, hardened and may have a necrotic (blackened) central area [11]. If the mucormycosis infection has disseminated to the central nervous system patients will present with decreased consciousness and focal neurological symptoms, such as cranial nerve deficits.

Fever
  • […] include: Cough Coughing blood (occasionally) Fever Shortness of breath Symptoms of gastrointestinal mucormycosis include: Abdominal pain Blood in the stools Diarrhea Vomiting blood Symptoms of kidney (renal) mucormycosis include: Fever Pain in the upper[nlm.nih.gov]
  • However, the patient then developed fever, dyspnea, and subsequent right hemiparesis.[ncbi.nlm.nih.gov]
  • Physicians must have a high level of suspicion in immunocompromised patients with fever and respiratory symptoms refractory to antibiotics.[ncbi.nlm.nih.gov]
  • Abstract A 2-year-old Brazilian female child from the countryside in Bahia State presented with pain in the right flank of the abdomen, accompanied by a daily fever for about 2 weeks before admission.[ncbi.nlm.nih.gov]
  • Abstract A 60-year-old man with chronic lymphocytic leukemiadeveloped a deeply violaceous annular patchwith a halo of erythema on the right thigh duringhospitalization for neutropenic fever.[ncbi.nlm.nih.gov]
Pain
  • […] include: Cough Coughing blood (occasionally) Fever Shortness of breath Symptoms of gastrointestinal mucormycosis include: Abdominal pain Blood in the stools Diarrhea Vomiting blood Symptoms of kidney (renal) mucormycosis include: Fever Pain in the upper[nlm.nih.gov]
  • Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis.[ncbi.nlm.nih.gov]
  • Symptoms of mucormycosis infection include fever, facial pain, swollen eyes, redness of skin over sinuses, bloody cough, shortness of breath, abdominal pain, vomiting blood, pain on side of the body between upper abdomen and back and a skin infection[symptoma.com]
  • Abstract A 2-year-old Brazilian female child from the countryside in Bahia State presented with pain in the right flank of the abdomen, accompanied by a daily fever for about 2 weeks before admission.[ncbi.nlm.nih.gov]
  • Abstract We report the case of a 23-year-old immunocompetent patient who presented at the emergency department of a Brazilian hospital with epigastric pain and fever.[ncbi.nlm.nih.gov]
Malaise
  • Presentation The onset of sinus mucormycosis may be associated with nonspecific symptoms such as nasal congestion, postnasal drip, dark blood-tinged or purulent rhinorrhea, sinus tenderness, headache, fever, and malaise.[aao.org]
  • The timeliness of definitive surgical and medical treatment is directly related to the prevention of morbidity and mortality in affected patients. 1 Case Reports Case 1 A 66-year-old man with diabetes presented to the emergency department with malaise[ajnr.org]
  • […] incidence of rhinocerebral mucormycosis, is expected.[ 1 5 7 ] It is essential for the clinician to maintain a high index of suspicion in populations at risk, as early diagnosis can be life-saving.[ 4 ] Clinical symptoms usually begin as nonspecific malaise[surgicalneurologyint.com]
  • He was seen in the outpatient clinic September 15, 1995, with a 2-week history of sore throat, nonproductive cough, dyspnea on exertion, fever, chills, generalized malaise, and myalgias.[doi.org]
Hypoxemia
  • In addition, although the liver and kidney functions were normal, the patients had hypoxemia and decreased diffusion capacity, lung capacity and carbon dioxide binding force.[ncbi.nlm.nih.gov]
Cough
  • Associatedsymptoms included chronic cough and fatigue.Bilateral lung opacities with hilar lymphadenopathywere noted on chest computed tomographyscan.[ncbi.nlm.nih.gov]
  • Coughing blood (occasionally) Fever Shortness of breath Symptoms of gastrointestinal mucormycosis include: Abdominal pain Blood in the stools Diarrhea Vomiting blood Symptoms of kidney (renal) mucormycosis include: Fever Pain in the upper abdomen or[nlm.nih.gov]
  • The clinical symptoms of diabetic combined pulmonary mucormycosis included different degrees of fever, cough, sputum and dyspnea.[ncbi.nlm.nih.gov]
  • After prolonged severe neutropenia, he complained of coughing with aspiration. Imaging showed a bronchoesophageal fistula with extensive necrotizing pneumonia in the middle and lower lobes of his right lung.[ncbi.nlm.nih.gov]
  • Common presenting clinical findings were fever, neutropenia, dyspnea, and cough. Radiologic findings included pleural effusion and nodules. All patients received medical therapy and 43% underwent additional surgical intervention.[ncbi.nlm.nih.gov]
Dyspnea
  • Fungal airway infections should be considered in the differential diagnosis of an immunosuppressed patient who presents with dyspnea, dysphonia, and vocal fold immobility.[ncbi.nlm.nih.gov]
  • However, the patient then developed fever, dyspnea, and subsequent right hemiparesis.[ncbi.nlm.nih.gov]
  • Overall in-hospital mortality was 52.5%, with hemoptysis (P   .017), dyspnea at presentation (P   .022) and angioinvasion (P   .03) as independent risk prognostic factors.[ncbi.nlm.nih.gov]
  • The clinical symptoms of diabetic combined pulmonary mucormycosis included different degrees of fever, cough, sputum and dyspnea.[ncbi.nlm.nih.gov]
  • Common presenting clinical findings were fever, neutropenia, dyspnea, and cough. Radiologic findings included pleural effusion and nodules. All patients received medical therapy and 43% underwent additional surgical intervention.[ncbi.nlm.nih.gov]
Hemoptysis
  • Typically, pulmonary mucormycosis causes tissue necrosis resulting from angioinvasion and subsequent thrombosis, so most cases can occur with necrotizing pneumonia and/or hemoptysis.[ncbi.nlm.nih.gov]
  • Overall in-hospital mortality was 52.5%, with hemoptysis (P   .017), dyspnea at presentation (P   .022) and angioinvasion (P   .03) as independent risk prognostic factors.[ncbi.nlm.nih.gov]
  • Air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. Fiberoptic bronchoscopy was a useful diagnostic method, and histopathologic examination was more sensitive than fungal cultures.[ncbi.nlm.nih.gov]
  • The presence of hemoptysis should bring mucormycosis to mind because it is one of the angioinvasive fungi.[doi.org]
  • Pleuritic chest pain, hemoptysis, and pleural effusion are seen less frequently. Invasion of the major pulmonary blood vessels by hyphae may lead to massive, potentially fatal hemoptysis.[radiopaedia.org]
Nasal Discharge
  • Facts : Fungal infection of the sinuses, brains, lungs MCC is Rhizopus History / PE : Low grade fever Bloody nasal discharge Necrotic turbinates Diagnosis : CT / MRI imaging Treatment : Surgical debridement plus IV amphotercin B Complications : Death[medlibes.com]
  • Symptoms most frequently result from invasive necrotic lesions in the nose and palate, causing pain, fever, orbital cellulitis, proptosis, and purulent nasal discharge. CNS symptoms may follow.[msdmanuals.com]
  • Diagnosis is difficult as the symptoms can be subtle at first, but when they proceed to serious conditions such as nasal discharge and necrosis, these are usually blamed on other conditions.[house.wikia.com]
  • Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations[lifeinthefastlane.com]
  • Your doctor may collect a sample of phlegm or nasal discharge if you have a suspected sinus infection. In the case of a skin infection, your doctor may also clean the wounded area in question.[healthline.com]
Nasal Congestion
  • Mucormycosis Pathology Type Fungus Cause(s) Exposure to fungal spores Symptoms Clots, necrosis, headache on one side, facial pain, fever, black discharge after nasal congestion, acute sinusitis, swelling of eyes, reddening of skin, edema, difficulty breathing[house.wikia.com]
  • Signs of a related sinus or respiratory infection may include: cough fever headache nasal congestion sinus pain With a skin infection, mucormycosis can develop within any part of your body.[healthline.com]
  • Symptoms of rhino-orbito-cerebral mucormycosis include acute sinusitis, fever, eye swelling and protrusion, dark nasal scabbing, cellulitis, facial pain, retinal artery thrombosis, redness of skin around sinuses and nasal congestion with black discharge[symptoma.com]
  • congestion that progresses to black discharge, and acute sinusitis along with eye swelling. [9] Affected skin may appear relatively normal during the earliest stages of infection.[en.wikipedia.org]
  • Presentation The onset of sinus mucormycosis may be associated with nonspecific symptoms such as nasal congestion, postnasal drip, dark blood-tinged or purulent rhinorrhea, sinus tenderness, headache, fever, and malaise.[aao.org]
Vomiting
  • We report a case of 19 year old female, with no pre-existing co-morbidities, presented with fever, dysentery, vomiting, and melena for 4 days.[ncbi.nlm.nih.gov]
  • The most commonly reported TEAEs among isavuconazole recipients were gastrointestinal disorders such as nausea, vomiting and diarrhoea.[ncbi.nlm.nih.gov]
  • Symptoms of GI mucormycosis include abdominal pain and distension, nausea, vomiting blood, tenderness upon palpation and hematochezia.[symptoma.com]
  • […] skin above sinuses Sinus pain or congestion Symptoms of lung (pulmonary) mucormycosis include: Cough Coughing blood (occasionally) Fever Shortness of breath Symptoms of gastrointestinal mucormycosis include: Abdominal pain Blood in the stools Diarrhea Vomiting[nlm.nih.gov]
  • Exposure to fungal spores Symptoms Clots, necrosis, headache on one side, facial pain, fever, black discharge after nasal congestion, acute sinusitis, swelling of eyes, reddening of skin, edema, difficulty breathing, coughing, coughing up blood, nausea, vomiting[house.wikia.com]
Abdominal Pain
  • A 14-year-old boy presented to our clinic with fever and left upper quadrant abdominal pain, and on evaluation was found to have pancytopaenia, and imaging revealed ill-defined splenic collection with thrombus in the splenic vein.[ncbi.nlm.nih.gov]
  • CASE REPORT We present a case of isolated hepatic mucormycosis in the setting of neutropenic fever and abdominal pain following induction chemotherapy for the treatment of acute myeloid leukemia.[ncbi.nlm.nih.gov]
  • Symptoms of GI mucormycosis include abdominal pain and distension, nausea, vomiting blood, tenderness upon palpation and hematochezia.[symptoma.com]
  • pain Blood in the stools Diarrhea Vomiting blood Symptoms of kidney (renal) mucormycosis include: Fever Pain in the upper abdomen or back Symptoms of skin (cutaneous) mucormycosis include a single, painful, hardened area of skin that may have a blackened[nlm.nih.gov]
  • Presentation is nonspecific, with abdominal pain, abdominal distension, nausea, and vomiting.[patient.info]
Nausea
  • The most commonly reported TEAEs among isavuconazole recipients were gastrointestinal disorders such as nausea, vomiting and diarrhoea.[ncbi.nlm.nih.gov]
  • (s) Exposure to fungal spores Symptoms Clots, necrosis, headache on one side, facial pain, fever, black discharge after nasal congestion, acute sinusitis, swelling of eyes, reddening of skin, edema, difficulty breathing, coughing, coughing up blood, nausea[house.wikia.com]
  • Presentation is nonspecific, with abdominal pain, abdominal distension, nausea, and vomiting.[patient.info]
  • . ABDOMINAL PAIN,NAUSEA VOMITING, ,,,MAY PRESNT AS INTRAABDOMINAL ABSCESS,OR PERFORATION OF THE VISCUS.NEEDS BIOPSY. PROGNOSIS VERY POOR 19.[slideshare.net]
Hematochezia
  • Una enfermedad que también existe Juan Carlos Pozo Laderas,Antonio Pontes Moreno,Carmen Pozo Salido,Juan Carlos Robles Arista,María José Linares Sicilia Revista Iberoamericana de Micología. 2014; 3 Gastrointestinal Mucormycosis Initially Manifest as Hematochezia[jpgmonline.com]
  • Symptoms of GI mucormycosis include abdominal pain and distension, nausea, vomiting blood, tenderness upon palpation and hematochezia.[symptoma.com]
  • Hematochezia [24] or obstruction [25] may occur. Some patients have tenderness to palpation or a mass. Rupture may lead to signs of peritonitis.[emedicine.medscape.com]
  • A Rare Cause of Hematochezia: Colon Mucormycosis. Clin Gastroenterol Hepatol . 2012 Aug 28. [Medline] . Chawla N, Reddy SJ, Agrawal M. Ileocolic mucormycosis causing intestinal obstruction. Indian J Med Microbiol . 2012 Jul-Sep. 30(3):373-4.[emedicine.com]
  • Fever and hematochezia may also occur. The patient is often thought to have an intra-abdominal abscess. The diagnosis may be made by biopsy of the suspected area during surgery or endoscopy.[cmr.asm.org]
Abdominal Distension
  • PATIENT CONCERNS: This patient was presented as abdominal distension and gastrointestinal bleeding. DIAGNOSES: A variety of hemostatic methods was ineffective to stop the bleeding.[ncbi.nlm.nih.gov]
  • Presentation is nonspecific, with abdominal pain, abdominal distension, nausea, and vomiting.[patient.info]
  • distension, flank pain , an ulcer with a dark center and sharply defined edges, and mental-status changes may occur.[medicinenet.com]
Skin Lesion
  • PATIENT CONCERNS: We reported the case of a 37-year-old man presenting with a skin lesion on the left side of the chest wall with no history of trauma or primary diseases.[ncbi.nlm.nih.gov]
  • The identification of pathogen based on the fungus morphology and DNA sequencing revealed M. irregularis as the responsible fungus for skin lesion.[ncbi.nlm.nih.gov]
  • The spores may also enter percutaneously through traumas, skin lesions, insect bites, or injections (e.g. through intravenous drug use); as well as via the alimentary tract with contaminated foodstuff.[ncbi.nlm.nih.gov]
  • Figure 4 (left panel) shows an immunocompromised host with rhinocerebral mucormycosis and secondary ecchymotic skin lesions. Figure 5.[clinicaladvisor.com]
  • Organisms enter through the respiratory tract, digestive tract, or a skin lesion, and then invade blood vessel walls and are disseminated in the blood; spread along nerve trunks also occurs.[medical-dictionary.thefreedictionary.com]
Diplopia
  • Late symptoms from invasion of the orbital nerves and vessels include diplopia and visual field loss. These are late symptoms with a poor prognosis and usually are followed by reduced consciousness.[patient.info]
  • However, 60% to 89% of mucoceles arise from the frontal sinuses, an unusual site for mucor involvement, according to investigators. 25 Thyroid eye disease can also present with pain, diplopia, chemosis, and pressure sensation behind the eyes.[reviewofoptometry.com]
  • Involvement of the superior orbital fissure and its contents, such as cranial nerves III, IV, and VI, and branches of V1 and V2, may cause diplopia, ophthalmoplegia, and sensory loss to the corresponding areas of the cornea and face.[aao.org]
Eye Swelling
  • swelling Any of the other symptoms listed above Because the fungi that cause mucormycosis are widespread, the best way to prevent this infection is to improve control of the illnesses associated with mucormycosis.[nlm.nih.gov]
  • Symptoms of rhino-orbito-cerebral mucormycosis include acute sinusitis, fever, eye swelling and protrusion, dark nasal scabbing, cellulitis, facial pain, retinal artery thrombosis, redness of skin around sinuses and nasal congestion with black discharge[symptoma.com]
  • swelling. [9] Affected skin may appear relatively normal during the earliest stages of infection.[en.wikipedia.org]
Facial Pain
  • Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis.[ncbi.nlm.nih.gov]
  • Critical Essential Core Tested Community Questions (1) (M2.ID.4766) A 54-year-old male presents to the emergency department with facial pain. He reports feeling well until yesterday, when he developed a headache that has gotten progressively worse.[medbullets.com]
  • Symptoms of rhino-orbito-cerebral mucormycosis include acute sinusitis, fever, eye swelling and protrusion, dark nasal scabbing, cellulitis, facial pain, retinal artery thrombosis, redness of skin around sinuses and nasal congestion with black discharge[symptoma.com]
  • Mucormycosis Pathology Type Fungus Cause(s) Exposure to fungal spores Symptoms Clots, necrosis, headache on one side, facial pain, fever, black discharge after nasal congestion, acute sinusitis, swelling of eyes, reddening of skin, edema, difficulty breathing[house.wikia.com]
  • Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations[lifeinthefastlane.com]

Workup

Diagnosis is achieved through a variety of factors including patient’s history, risk factors and physical exam, however, a definitive diagnosis is hard to reach. The extent of infection or necrosis may be assessed through magnetic resonance imaging (MRI) or computerized tomography (CT) scan but these findings are nonspecific [12]. Biopsies can be stained with Grocott methenamine-silver stain or periodic acid-Schiff (PAS) stain and others to identify the fungus, but the specific fungal species is hard to determine [13]. More complicated cultivation and imaging techniques must be performed to identify structures unique to mucormycosis and distinguish this from other fungal infections like candidiasis and histoplasmosis. Therefore, the diagnosis of mucormycosis may be used without definitive evidence since the supportive care and treatment for many fungal infections are similar.

Cavitary Lesion
  • Imaging features in pulmonary mucormycosis are nonspecific, it can present as a solitary nodule , lobular consolidation as in pneumonia, cavitary lesion or in disseminated form 2 . CT On CT ground-glass opacities may be encountered 3 .[radiopaedia.org]
  • Imaging features in pulmonary mucormycosis are nonspecific, it can present as a solitary nodule, lobular consolidation as in pneumonia, cavitary lesion or in disseminated form 2. CT On CT, ground-glass opacities may be encountered 3.[radiopaedia.org]
  • Gross specimen from the left upper lobectomy shows a 7 cm cavitary lesion surrounded by congestive and necrotic lung tissue. Fig. 5.[rc.rcjournal.com]
  • Consequently, serious complications such as blindness, meningitis , brain abscesses, osteomyelitis , pulmonary hemorrhages, gastrointestinal hemorrhages, cavitary lesions in organs and eventually secondary bacterial infections, sepsis , and death may[medicinenet.com]

Treatment

Mucormycosis is treated with antifungal medications (conventional or lipid formulations of amphotericin B) administered orally or IV [14] [15]. Infected areas of skin may require surgical resection to remove infected and dead tissues [15]. Patient survival relies on proper debridement of necrotic tissue when applicable. Surgical care of rhino-orbito-cerebral infection may include repeated surgeries to excise orbital contents and infected brain tissue along with drainage of sinuses.

There are a number of potential adjunct therapies to treat mucormycosis. Hyperbaric oxygen after surgery is thought to improve neutrophil function and wound healing and inhibit fungal growth. However, the effectiveness of hyperbaric oxygen for mucormycosis has not been studies extensively and this is not a currently approved use of hyperbaric oxygen. Administration of colony stimulating factor (CSF) or interferon-gamma (IFNγ) may be done to enhance immune response in neutropenic patients and white blood cell transfusions, respectively. However, the effectiveness of these treatments is unclear. Case reports on the use of iron chelators without xenosiderophore activity, such as deferasirox, indicated that adjunct use of deferasirox leads to increased mortality rates although only a small patient sample was investigated [16].

Prognosis

The mortality rate for mucormycosis is extremely high (at least 50%). Due to the late diagnosis associated with pulmonary and GI mucormycosis infections, the mortality rate in these forms is relatively higher. Transplant patients that contract mucormycosis may experience mortality rates of 80%. An Italian study indicated that 65% of diagnoses were made postmortem [10]. The lifesaving surgery associated with rhino-orbito-cerebral mucormycosis often leaves survivors with severe facial disfigurements.

Etiology

The primary risk factor for murcormycosis is a compromised immune system. Patients with particularly high risk include those with uncontrolled diabetes mellitus, especially with ketoacidosis. Cancer patients receiving broad-spectrum antibiotics that display neutropenia, hematologic cancer patients with herpetic infection (eg. Cytomegalovirus) and graft versus host disease and individuals on immunosuppressive drugs, such as steroids and tumor necrosis factor (TNF) blockers are also at high risk for contracting murcormycosis infection.

The GI form of murcormycosis infection is linked to extreme malnutrition. The cutaneous form of murcormycosis is associated with trauma, the use of contaminated medical supplies, burns and intravenous (IV) drug use. Not all patients that develop murcormycosis will exhibit risk factors [2] [4].

Chemicals that increase chances of developing murcormycosis include iron, which is a growth stimulant for Mucorales, and deforoxamine, which is a siderophore that delivers iron to Mucorales [2] [3].

Epidemiology

Compared to other fungal infections, Mucorales infections occur much less frequently (10 to 15 fold less) [5]. Annually in the United States (US) there are an estimated 1.7 cases per million people which equates to about 500 cases per year [5].

Mucormycosis is commonly observed in immunosuppressed individuals but certain strains, such as those in the order Entomophthorales, have occurred in immunocompetent hosts. Individuals with the highest risk include those with diabetic ketoacidosis, hematologic malignancies, organ transplant recipients, chronic corticosteroid use and graft-versus-host-disease [5].

The most common form of mucormycosis is rhino-orbito-cerebral (44-49%) [7]. Cutaneous mucormycosis accounts for 10-16% of cases followed by pulmonary (10-11%), disseminated (6-11.6%) and GI (2-11%). Diabetic patients are more likely to present rhino-orbito-cerebral mucormycosis, while patients with hematological malignancies or transplants commonly present with pulmonary mucormycosis.

Outbreaks of mucormycosis have been reported including a nosocomial outbreak of GI mucormycosis that occurred in a hospital in Spain. This outbreak was linked to the use of wooden tongue depressors that were contaminated with Rhizopus and the mortality rate in this case was 40% [6].

Sex distribution
Age distribution

Pathophysiology

The most common mode of entry of Mucorales is inhalation of fungal spores. Once spores enter a host they may germinate to produce hyphae that can enter blood vessels and cause thrombosis which may results in tissue necrosis. Experimentally, germinated fungal spores can adhere to the sub-endothelial matrix and cause damage to endothelial cells after phagocytosis [9]. This outcome occurs regardless of viability indicating that cidal antifungals will not be effective for the treatment of established disease [9]. Mucorales may be disseminated to other organs through the blood stream. An efficient host immune response to Mucorales infection requires normal mononuclear and polymorphonuclear phagocytes that can produce oxidative metabolites and definsins to kill fungi along with macrophages and neutrophils to inhibit spore germination and damage hyphae, respectively [8].

Factors that decrease the abundance or functioning of neutrophils, such as chemotherapy (induces neutropenia), corticosteroids, acidosis and hyperglycemia, increase the risk of developing mucormycosis [5]. Other conditions and factors that hamper the immune response to fungi include acidosis and hyperglycemia which hinder the ability of phagocytes to kill fungi and corticosteroids which prevent the ability of macrophages to stop germination [9]. Actions that result in better outcomes include early recognition and appropriate treatment along with reversal of acidosis (if it applies).

Prevention

To prevent risk of mucormycosis infection, immunosuppressants, such as corticosteroids, should be used sparingly and patients should control their diabetes. Physicians and hospitals should use appropriate rooms equipped with high-efficiency particulate air (HEPA) filters and patients with immunosuppressive conditions should use masks [5].

Summary

Several different fungal species in the order Mucorales may cause murcormycosis infections. The organisms most commonly associated with murcormycosis infection are Rhizopus. Other disease causing genera include Mucor, Cunninghamella, Apophysomyces, Absidia, Saksenaea and Rhizomucor [1] [2]. Mucormycosis infections are serious and in most cases life-threatening with disorders such as diabetic ketoacidosis and neutropenia present in most cases. Patients commonly present with severe infection of the facial sinuses which may extend to the brain (rhino-orbito-cerebral). Other infections, including pulmonary, cutaneous, gastrointestinal (GI) and disseminated, are also observed. Effective treatment of murcormycosis requires rapid correction of underlying risk factors, administration of antifungals (liposomal amphotericin B) and aggressive surgery.

Patient Information

Mucormycosis is a serious and sometimes life-threatening fungal infection that may affect the sinuses, brain, lungs and skin. The fungi that cause mucormycosis are often found in soil, decaying plants and compost and can enter the body through cuts or inhalation. Once the fungus enters the body it can spread quickly. Individuals with healthy immune systems often destroy and eliminate the fungus, however, if the immune system is weak the fungus may go on to cause a severe infection. Symptoms of mucormycosis infection include fever, facial pain, swollen eyes, redness of skin over sinuses, bloody cough, shortness of breath, abdominal pain, vomiting blood, pain on side of the body between upper abdomen and back and a skin infection that starts with blisters and later becomes tender, red, swollen and black in the center.

Patients with a compromised immune system that display the symptoms above are often diagnosed with mucormycosis. Analysis of tissue biopsies (tissue removed using small needle) is required to obtain a definitive diagnosis. Doctors may also perform CT scan or MRI to determine the extent of infection within the body and whether surgery is needed. If the central nervous system is thought to be infected patients may receive a lumbar puncture (spinal tap), if it is safe, to assess protein levels in the cerebrospinal fluid (CSF). Aggressive treatment is required if mucormycosis is suspected and early treatment is associated with better outcomes. Oral or IV antifungal medication will be administered as soon as possible and surgery may be required to remove infected and dead tissue.

References

Article

  1. Kontoyiannis DP, Lewis RE. Agents of mucormycosis and Entomophthoramycosis. Mandell GL, Bennett GE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone; 2010; 3257-69.
  2. Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis. 2012; 54 Suppl 1:S8-S15.
  3. Mohindra S, Mohindra S, Gupta R, Bakshi J, Gupta SK. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses. 2007; 50(4):290-6.
  4. Rahman A, Akter K, Hossain S, Rashid HU. Rhino-orbital mucourmycosis in a non-immunocompromised patient. BMJ Case Rep. 2. 2013; 013
  5. Antachopoulos C, Gea-Banacloche JC, Walsh TJ. Zygomycosis (mucormycosis). In: Hospenthal DR, Rinaldi MG, eds. Diagnosis and treatment of human mycoses. New York, NY: Springer. 2008; 227-243.
  6. Maravi-Poma E, Rodriguez-Tudela JL, de Jalon JG, et al. Outbreak of gastric mucormycosis associated with the use of wooden tongue depressors in critically ill patients. Intensive Care Med. 2004; 30:724-728.
  7. Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004; 10(suppl s1):S31-S47.
  8. Almyroudis NG, Sutton DA, Linden P, et al. Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature. Am J Transplant. 2006; 6:2365-2374.
  9. Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18:556-569.
  10. Pagano L, Ricci P, Tonso A, et al; Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). Br J Haematol. 1997; 99(2):331-6.
  11. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634-653.
  12. Garces P, Mueller D, Trevenen C. Rhinocerebral mucormycosis in a child with leukemia: CT and MRI findings. Pediatr Radiol. 1994;24:50-1.
  13. Lass-Florl C; Zygomycosis: conventional laboratory diagnosis. Clin Microbiol Infect. 2009; 15 Suppl 5:60-5.
  14. Malani AN, Kauffman CA; Changing epidemiology of rare mould infections: implications for therapy. Drugs. 2007; 67(13):1803-12.
  15. Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011; 118(5):1216-24.
  16. Donnelly JP, Lahav M. Deferasirox as adjunctive therapy for mucormycosis. J Antimicrob Chemother. 2012; 67(3):519-20.

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Last updated: 2017-08-09 17:29