- Opportunistic invasive fungal infection, typically affecting immunocompromised patients (esp uncontrolled diabetics)
- Caused by saprophytic fungi (Mucorales)
- Found in soil, bread mold, decaying fruits
- 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
- Mucorales fungi have vascular proclivity, and can cause thrombosis → tissue and bone necrosis
- Prognosis is poor, with 17-51% mortality, higher in cerebral involvement
- 6 clinical types, based on location of infection
- Rhino-orbital-cerebral (most common form)
- Rhinocerebral form initially mimics acute bacterial sinusitis (pain/swelling of cheeks and periorbital region)
- 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
- 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
- Emergent ENT consult for OR debridement (definitive treatment)
- Start Amphotericin B 1mg/kg IV OR
- 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.
- Do not use deferoxamine (can worsen disease caused by certain fungal genera) - deferiprone is preferred
- 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.
- 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.
- 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.
- 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.