Mucormycosis: Difference between revisions
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==Background== | ==Background== | ||
*Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp uncontrolled diabetics)<ref name="Selvamani">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.</ref> | |||
*Caused by saprophytic fungi (''Mucorales'') | |||
*Fungal spores are dispersed in air → route of entry is inhalation<ref name="Selvamani" /> | |||
**Infection typically begins in nose and paranasal sinuses | |||
**Can also affect pulmonary, GI and CNS systems | |||
*Fungi have vascular proclivity, and can cause thrombosis → tissue and bone necrosis | |||
*Prognosis is poor, with 30-90% mortality | |||
===Clinical Types=== | |||
# | *6 clinical types, based on location of infection<ref name="Selvamani" /> | ||
#Pulmonary | *#Rhino-orbital-cerebral (most common form) | ||
# | *#Pulmonary | ||
# | *#Gastrointestinal | ||
*#Cutaneous | |||
*#Disseminated | |||
*#Miscellaneous | |||
==Clinical Features== | ==Clinical Features== | ||
Rhinocerebral | *Rhinocerebral form mimics acute bacterial sinusitis, however 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 | |||
Can spread to orbits, oropharynx, nasopharynx, brain, nearby vasculature leading to: | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Start Amphotericin B 1mg/kg IV | *Start Amphotericin B 1mg/kg IV | ||
*Aggressive resuscitation, airway management, and supportive care while in ED. | *Aggressive resuscitation, airway management, and supportive care while in ED. | ||
==See Also== | ==See Also== | ||
Revision as of 04:48, 8 September 2015
Background
- Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp uncontrolled diabetics)[1]
- Caused by saprophytic fungi (Mucorales)
- 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
- Fungi have vascular proclivity, and can cause thrombosis → tissue and bone necrosis
- Prognosis is poor, with 30-90% mortality
Clinical Types
- 6 clinical types, based on location of infection[1]
- Rhino-orbital-cerebral (most common form)
- Pulmonary
- Gastrointestinal
- Cutaneous
- Disseminated
- Miscellaneous
Clinical Features
- Rhinocerebral form mimics acute bacterial sinusitis, however 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
Differential Diagnosis
Diagnostic Evaluation
- Can be clinical diagnosis
- CT scan of sinuses with IV contrast can assist with diagnosis
Management
- Emergent ENT consult for OR debridement (definitive treatment)
- Start Amphotericin B 1mg/kg IV
- Aggressive resuscitation, airway management, and supportive care while in ED.