Mucormycosis

Answer 1

Definition

Mucormycosis is a fungal infection of the sinuses, brain, or lungs that occurs primarily in people with immune disorders.

Alternative Names

Zygomycosis

Causes, incidence, and risk factors

Mucormycosis is caused by common fungi frequently found in the soil and in decaying vegetation. Most individuals are exposed to these fungi on a daily basis -- but people with immune disorders may be more susceptible to infection.

Conditions most commonly associated with mucormycosis include Diabetes (usually poorly controlled diabetes), chronic steroid use, metabolic acidosis, organ transplantation, leukemia/lymphoma, treatment with deferoxamine, and AIDS.

Syndromes associated with mucormycosis include:

• Rhinocerebral infection (infection of sinuses and brain)
  • May start as a sinus infection
  • May progress to involve inflammation of cranial nerves
  • May cause blood clots that block vessels to the brain (thrombosis)
• Pulmonary mucormycosis (lung involvement) -- pneumonia that gets worse quickly and may spread to the chest cavity, heart, and brain
• Mucormycosis of the gastrointestinal tract, skin, and kidneys

Symptoms

Symptoms of rhinocerebral mucormycosis include:

• Acute sinusitis (sinus pain or congestion)
• Eye swelling and protrusion (proptosis)
• Dark nasal eschar (scabbing)
• Fever
• Redness of skin overlying sinuses

Symptoms of lung (pulmonary) mucormycosis include:

• Cough
• Coughing blood (occasionally)
• Fever
• Shortness of breath

Symptoms of gastrointestinal mucormycosis include:

• Abdominal pain
• Vomiting blood

Symptoms of kidney (renal) mucormycosis include:

• Fever
• Flank (side) pain

Symptoms of skin (cutaneous) mucormycosis include a single, painful, hardened area of skin that may have a blackened center.

Signs and tests

Mucormycosis should be suspected if symptoms appear in individuals with immune disorders such as diabetes or those with weakened immune systems such as transplant recipients. Symptoms of rhinocerebral mucormycosis are most likely to occur among immunosuppressed people.

Depending on where the symptoms are, CT scans or MRIs may be done. Evaluation by an ear-nose-throat specialist is recommended if sinus involvement is suspected.

A tissue specimen must be taken and analyzed in order to make a definitive diagnosis of mucormycosis.

Treatment

Mucormycosis is treated right away with surgery to remove all dead and infected tissue, along with intravenous (directly into a vein) antifungal therapy. Surgical removal of infected tissue may be disfiguring because it may involve removal of the palate, parts of the nose, or parts of the eye. Withoutt his aggressive surgery, however, chances of survival are greatly decreased.

Expectations (prognosis)

Mucormycosis has an extremely high mortality rate even with aggressive surgical intervention. Death rates range from 25 - 80% depending on the body area involved and the individual's underlying immune problems.

Complications

• Blindness (if the optic nerve is involved)
• Clotting/blockage of brain or lung vessels (thrombosis)
• Death
• Loss of neurological function (nerve involvement)

Calling your health care provider

People with immune disorders (including diabetes) should seek medical attention if they develop fever, headache, sinus pain, eye swelling, or any of the other symptoms listed above.

Prevention

Because the fungi that cause mucormycosis are widespread, the most appropriate preventive measures involve improved control of the underlying illnesses associated with mucormycosis.

ReferencesStevens DA. Aspergillosis. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 360.

Answer 2

Definition

Mucormycosis is a fungal infection of the sinuses, brain, or lungs that occurs mostly in people with weakened immune systems.

Alternative Names

Zygomycosis

Causes, incidence, and risk factors

Mucormycosis is caused by common fungi frequently found in the soil and in decaying vegetation. Most individuals are exposed to these fungi on a daily basis, but people with weakened immune systems are more susceptible to infection.

Conditions most commonly associated with mucormycosis include diabetes (usually poorly controlled diabetes), chronic steroid use, metabolic acidosis, organ transplantation, leukemia, lymphoma, treatment with deferoxamine, and AIDS.

Syndromes associated with mucormycosis include:

• Rhinocerebral infection (infection of sinuses and brain)
  • May start as a sinus infection
  • May progress to involve inflammation of cranial nerves
  • May cause blood clots that block vessels to the brain (thrombosis)
• Pulmonary mucormycosis (lung involvement) -- pneumonia that gets worse quickly and may spread to the chest cavity, heart, and brain
• Mucormycosis of the gastrointestinal tract, skin, and kidneys

Symptoms

Symptoms of rhinocerebral mucormycosis include:

• Eye swelling and protrusion (proptosis)
• Dark nasal eschar (scabbing)
• Fever
• Headache
• Redness of skin overlying 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
• Vomiting blood

Symptoms of kidney (renal) mucormycosis include:

• Fever
• Flank (side) pain

Symptoms of skin (cutaneous) mucormycosis include a single, painful, hardened area of skin that may have a blackened center.

Signs and tests

Mucormycosis should be suspected if symptoms appear in individuals with weakened immune systems, such as organ transplant recipients. Symptoms of rhinocerebral mucormycosis are most likely to occur among immunosuppressed people.

Depending on where the symptoms are, CT scans or MRIs may be done. Evaluation by an ear-nose-throat specialist is recommended if sinus involvement is suspected.

A tissue specimen must be taken and analyzed in order to make a definitive diagnosis of mucormycosis.

Treatment

Surgery should be done immediately to remove all dead and infected tissue. Surgery can lead to disfiguration because it may involve removal of the palate, parts of the nose, or parts of the eye. Without such aggressive surgery, however, chances of survival are greatly decreased.

You will also receive antifungal medicines through a vein.

Expectations (prognosis)

Mucormycosis has an extremely high Death Rate even when agressive surgery is done. Death rates range from 25 - 85% depending on the body area involved and your overall health.

Complications

• Blindness (if the optic nerve is involved)
• Clotting or blockage of brain or lung blood vessels (thrombosis)
• Death
• Nerve damage

Calling your health care provider

People with weakened immune systems and immune disorders (including diabetes) should seek medical attention if they develop fever, headache, sinus pain, eye swelling, or any of the other symptoms listed above.

Prevention

Because the fungi that cause mucormycosis are widespread, the most appropriate preventive measures involve improved control of the underlying illnesses associated with mucormycosis.

ReferencesStevens DA. Aspergillosis. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 360. Reviewed By

Review Date: 09/15/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.