mucormycosis (Zygomycosis, Phycomycosis)
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Etiology
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 (rhino-orbital-cerebral)
- 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
- tissue biopsy & culture
- 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
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Cornely OA, Alastruey-Izquierdo A, Arenz D et al Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec;19(12):e405-e421. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31699664 PMCID: PMC8559573 Free PMC article. Review.