Mucormycosis: Difference between revisions
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*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> | *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'') | *Caused by saprophytic fungi (''Mucorales'') | ||
**Found in soil, bread mold, decaying fruits<ref name="Motaleb">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.</ref> | |||
*Fungal spores are dispersed in air → route of entry is inhalation<ref name="Selvamani" /> | *Fungal spores are dispersed in air → route of entry is inhalation<ref name="Selvamani" /> | ||
**Infection typically begins in nose and paranasal sinuses | **Infection typically begins in nose and paranasal sinuses | ||
**Can also affect pulmonary, GI and CNS systems | **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 30-90% mortality | *Prognosis is poor, with 30-90% mortality | ||
===Clinical Types=== | ===Clinical Types=== | ||
*6 clinical types, based on location of infection<ref name="Selvamani" /> | *6 clinical types, based on location of infection<ref name="Selvamani" /><ref name="Motaleb" /> | ||
*#Rhino-orbital-cerebral (most common form) | *#Rhino-orbital-cerebral (most common form) | ||
*#Pulmonary | *#Pulmonary | ||
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==Clinical Features== | ==Clinical Features== | ||
*Rhinocerebral form mimics acute bacterial sinusitis | *Rhinocerebral form initially mimics acute bacterial sinusitis (pain/swelling of cheeks and periorbital region)<ref name="Motaleb" /> | ||
**Can spread to orbits, oropharynx, nasopharynx, brain, nearby vasculature leading to | **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== | ==Differential Diagnosis== | ||
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==Diagnostic Evaluation== | ==Diagnostic Evaluation== | ||
*Can be clinical diagnosis | *Can be clinical diagnosis - early diagnosis is critical to limiting spread of disease | ||
*CT scan of sinuses with IV contrast can assist with diagnosis | *CT scan of sinuses with IV contrast can assist with diagnosis and surgical planning | ||
==Management== | ==Management== | ||
*Emergent ENT consult for OR debridement (definitive treatment) | *Emergent ENT consult for OR debridement (definitive treatment) | ||
*Start Amphotericin B | *Start Amphotericin B 1 mg/kg IV<ref name="Motaleb" /> '''OR''' | ||
**Liposomal Amphotericin B 5-7.6 mg/kg | |||
*Aggressive resuscitation, airway management, and supportive care while in ED. | *Aggressive resuscitation, airway management, and supportive care while in ED. | ||
*Hyperbaric oxygen therapy and iron chelation (iron is required for fungal growth) may also help.<ref name="Motaleb" /> | |||
**Do not use deferoxamine (can worsen disease) - deferiprone is preferred | |||
==See Also== | ==See Also== | ||
Revision as of 05:01, 8 September 2015
Background
- Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp 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 30-90% mortality
Clinical Types
- 6 clinical types, based on location of infection[1][2]
- Rhino-orbital-cerebral (most common form)
- Pulmonary
- Gastrointestinal
- Cutaneous
- Disseminated
- 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
Diagnostic 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
Management
- Emergent ENT consult for OR debridement (definitive treatment)
- Start Amphotericin B 1 mg/kg IV[2] OR
- Liposomal Amphotericin B 5-7.6 mg/kg
- Aggressive resuscitation, airway management, and supportive care while in ED.
- Hyperbaric oxygen therapy and iron chelation (iron is required for fungal growth) may also help.[2]
- Do not use deferoxamine (can worsen disease) - deferiprone is preferred
See Also
External Links
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 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.