Mucormycosis

Background
  • Opportunistic invasive fungal infection, typically affecting immunocompromised patients (especially 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]
    1. Rhino-orbital-cerebral (most common form)
    2. Pulmonary
    3. Gastrointestinal
    4. Cutaneous
    5. Disseminated
    6. 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

Rhinorrhea

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

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
  • 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


References
  1. 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. 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. 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. 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.
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