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Mucormycosis
From WikEM
Contents
Background
- Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp uncontrolled diabetics)[1]
- Caused by saprophytic fungi (Mucorales)
- Found in soil, bread mold, decaying fruits[2]
- Fungal spores are dispersed in air → route of entry is inhalation[1]
- Infection typically begins in nose and paranasal sinuses
- Can also affect pulmonary, GI and CNS systems
- Mucorales fungi have vascular proclivity, and can cause thrombosis → tissue and bone necrosis
- Prognosis is poor, with 17-51% mortality[3], higher in cerebral involvement[4]
Clinical Types
- 6 clinical types, based on location of infection[1][2]
- Rhino-orbital-cerebral (most common form)
- Pulmonary
- Gastrointestinal
- Cutaneous
- Disseminated
- Miscellaneous
Clinical Features
- Rhinocerebral form initially mimics acute bacterial sinusitis (pain/swelling of cheeks and periorbital region)[2]
- A much more rapid, extensive expansion of the fungus to the surrounding anatomy is classic
- Can spread to orbits, oropharynx, nasopharynx, brain, nearby vasculature leading to → Vision changes, nasopharyngeal and oropharyngeal ulceration or eschars, facial edema/pain, cranial nerve deficits, headache
- Black palatal discoloration indicates palatal necrosis
Differential Diagnosis
Evaluation
- Can be clinical diagnosis - early diagnosis is critical to limiting spread of disease
- CT scan of sinuses with IV contrast can assist with diagnosis and surgical planning
- Histopathology is confirmatory
Management
- Emergent ENT consult for OR debridement (definitive treatment)
- Start Amphotericin B 1mg/kg IV[2] OR
- Liposomal Amphotericin B 5-10mg/kg[3]
- Aggressive resuscitation, airway management, and supportive care while in ED.
- Hyperbaric oxygen therapy[4] and iron chelation (iron is required for fungal growth) may also help.[2]
- Do not use deferoxamine (can worsen disease caused by certain fungal genera) - deferiprone is preferred
See Also
External Links
References
- ↑ 1.0 1.1 1.2 Selvamani M, Donoghue M, Bharani S, Madhushankari GS. Mucormycosis causing maxillary osteomyelitis. Journal of Natural Science, Biology, and Medicine. 2015;6(2):456-459. doi:10.4103/0976-9668.160039.
- ↑ 2.0 2.1 2.2 2.3 2.4 Motaleb HYA, Mohamed MS, Mobarak FA. A Fatal Outcome of Rhino-orbito-cerebral Mucormycosis Following Tooth Extraction: A Case Report. Journal of International Oral Health : JIOH. 2015;7(Suppl 1):68-71.
- ↑ 3.0 3.1 Bellazreg F, Hattab Z, Meksi S, et al. Outcome of mucormycosis after treatment: report of five cases. New Microbes and New Infections. 2015;6:49-52. doi:10.1016/j.nmni.2014.12.002.
- ↑ 4.0 4.1 Mohamed MS, Abdel-Motaleb HY, Mobarak FA. Management of rhino-orbital mucormycosis. Saudi Medical Journal. 2015;36(7):865-868. doi:10.15537/smj.2015.7.11859.
