Difference between revisions of "Mucormycosis"

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==Background==
 
==Background==
#Infection of fungal hyphae in immunocompromised hosts
+
*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>
##DM
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*Caused by saprophytic fungi (''Mucorales'')
##HIV
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*Fungal spores are dispersed in air → route of entry is inhalation<ref name="Selvamani" />
##Neutropenic
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**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
  
'''Locations'''
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===Clinical Types===
#Most commonly affects paranasal sinuses (rhinocerebral mucormycosis)
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*6 clinical types, based on location of infection<ref name="Selvamani" />
#Pulmonary
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*#Rhino-orbital-cerebral (most common form)
#GI
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*#Pulmonary
#CNS
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*#Gastrointestinal
 +
*#Cutaneous
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*#Disseminated
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*#Miscellaneous
  
 
==Clinical Features==
 
==Clinical Features==
Rhinocerebral: mimics acute bacterial sinusitis, however a much more rapid, extensive expansion of the fungus to the surrounding anatomy is classic
+
*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:
 
#Vision changes
 
#Nasopharyngeal and oropharyngeal ulceration or eschars
 
#Facial edema, pain
 
#Cranial nerve deficits
 
#Headache
 
  
 
==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.
 
==Prognosis==
 
Mortality 30-90%
 
  
 
==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]
    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

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.

See Also

External Links

References

  1. 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.