Contents

Search

mucormycosis (Zygomycosis, Phycomycosis)

Etiology: - Mucorales (Phycomycetes) species - Rhizopus arrhizus [2] - risk factors - diabetes mellitus - immunosuppression Epidemiology: - 90 reported deaths from mucormycosis after recovery from Covid-19, mostly diabetics, in India May 2021 [9] Pathology: 1) following inhalation of spores, infection initially localizes to the nasal turbinates & paranasal sinuses 2) infection can progress to the orbit &/or brain 3) spread from the sphenoid sinus to the adjacent carvenous sinus resulting in cranial nerve palsy, cavernous sinus thrombosis & carotid artery invasion [2] 4) invasion of blood vessels by the Mucorales - ischemic, infarction & necrosis of adjacent tissue [2] 5) bronchial stenosis may occur Clinical manifestations: - epistaxis - black necrotic tissue on nasal musoca or palate is pathognomonic - sinusitis - hemoptysis - headache - ocular manifestations - proptosis, periorbital edema, visual impairment - 5 major clinical forms - rhinocerebral - pulmonary - abdominal, pelvic, gastrointestinal - primary cutaneous - disseminated Laboratory: 1) laboratory tests non-specific - diagnosis relies on high index of suspicion 2) sputum culture may suggest mucormycosis 3) blood cultures of no benefit 4) no useful serologic test available 5) biopsy - broad, sparsely septated hyphae that branch at right angles [5] 6) culture of bronchoalveolar lavage with lactophenol cotton-blue staining [8] * images [5,8] Radiology: 1) patchy infiltrates 2) consolidation 3) cavitation 4) effusion * image (chest CT) [8] Complications: - serious infections of the paranasal sinuses, lungs, central nervous system* & skin in patients with severe diabetes mellitus, hematologic malignancies - skin or mucosal injuries & in immunocompromised individuals - acute & rapidly fatal, even with early diagnosis & treatment - mortality 25-62% [2] * case report of cerebral mucormycosis (images) [5] Management: - reversal of predisposing conditions - surgical debridement [2] - liposomal amphotericin B [2] - step-down antifungals: posaconazole, isavuconazonium sulfate [2]

Related

Mucorales

General

mycosis; fungal infection

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 809
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
  3. Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. Lancet Infect Dis. 2011 Apr;11(4):301-11 PMID: 21453871
  4. Spellberg B, Ibrahim AS. Recent advances in the treatment of mucormycosis. Curr Infect Dis Rep. 2010 Nov;12(6):423-9 PMID: 21308550
  5. Terry AR, Kahle KT, Larvie M, Vyas JM, Stemmer-Rachamimov A. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 5-2016. A 43-Year-Old Man with Altered Mental Status and a History of Alcohol Use. (images) N Engl J Med. 2016 Feb 18;374(7):671-80 PMID: 26886525 http://www.nejm.org/doi/full/10.1056/NEJMcpc1509361
  6. Ibrahim AS, Kontoyiannis DP. Update on mucormycosis pathogenesis. Curr Opin Infect Dis. 2013 Dec;26(6):508-15. Review. PMID: 24126718 Free PMC Article
  7. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016 Mar;30(1):143-63. Review. PMID: 26897065
  8. Mejia Buritica L, Karduss Urueta AJ Images in Clinical Medicine: Pulmonary Mucormycosis N Engl J Med 2021. May 1. PMID: 33951358 https://www.nejm.org/doi/full/10.1056/NEJMicm2030205
  9. Yeung J They recovered from Covid, only to die of 'black fungus.' What we know about the disease sweeping India. CNN. May 21, 2021 https://www.cnn.com/2021/05/21/india/black-fungus-mucormycosis-covid-explainer-intl-hnk/index.html