mucormycosis (Zygomycosis, Phycomycosis)
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Etiology
- Mucorales (Phycomycetes) species
- Rhizopus arrhizus[2]
- risk factors
Epidemiology
- 90 reported deaths from mucormycosis after recovery from Covid-19, mostly diabetics, in India May 2021[9]
Pathology
- following inhalation of spores, infection initially localizes to the nasal turbinates & paranasal sinuses
- infection can progress to the orbit &/or brain
- spread from the sphenoid sinus to the adjacent carvenous sinus resulting in cranial nerve palsy, cavernous sinus thrombosis & carotid artery invasion[2]
- invasion of blood vessels by the Mucorales
- ischemic, infarction & necrosis of adjacent tissue[2]
- bronchial stenosis may occur
Clinical manifestations
- epistaxis
- black necrotic tissue on nasal musoca or palate is pathognomonic
- sinusitis
- hemoptysis
- headache
- ocular manifestations
- 5 major clinical forms
- rhinocerebral
- pulmonary
- abdominal, pelvic, gastrointestinal
- primary cutaneous
- disseminated
Laboratory
- laboratory tests non-specific
- diagnosis relies on high index of suspicion
- sputum culture may suggest mucormycosis
- blood cultures of no benefit
- no useful serologic test available
- biopsy
- culture of bronchoalveolar lavage with lactophenol cotton-blue staining[8]
Radiology
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]
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 809
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. Lancet Infect Dis. 2011 Apr;11(4):301-11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21453871
- ↑ Spellberg B, Ibrahim AS. Recent advances in the treatment of mucormycosis. Curr Infect Dis Rep. 2010 Nov;12(6):423-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21308550
- ↑ 5.0 5.1 5.2 5.3 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26886525 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1509361
- ↑ Ibrahim AS, Kontoyiannis DP. Update on mucormycosis pathogenesis. Curr Opin Infect Dis. 2013 Dec;26(6):508-15. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24126718 Free PMC Article
- ↑ Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016 Mar;30(1):143-63. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26897065
- ↑ 8.0 8.1 8.2 8.3 Mejia Buritica L, Karduss Urueta AJ Images in Clinical Medicine: Pulmonary Mucormycosis N Engl J Med 2021. May 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33951358 https://www.nejm.org/doi/full/10.1056/NEJMicm2030205
- ↑ 9.0 9.1 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