Mucormycosis

Background

• Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp uncontrolled diabetics)
• Caused by saprophytic fungi (Mucorales)
• Fungal spores are dispersed in air → route of entry is inhalation
  • 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)
  2. Pulmonary
  3. Gastrointestinal
  4. Cutaneous
  5. Disseminated
  6. 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

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.

See Also

• Fungal Infections