Mucormycosis pathophysiology

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Mucormycosis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mucormycosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Mucormycosis is a fatal fungal infection occuring most commonly in immunocompromised and diabetic patients. Impairment of host defense mechanisms leads to development of the fungus within the human body. Iron is important for growth of the mucorales fungus. Thrombosis with eventual necrosis is the end point in mucormycosis infection. Glucose regulated protein 78 receptor plays a vital part in helping the organism attach to endothelial cells and for subsequent vascular invasion and dissemination. On microscopic examination, the hyphae of mucorales are found to have few septations, are non-pigmented and branch at right angle.

Pathophysiology

Pathogenesis

Agents

Transmission

Mechanism

Gross Pathology

  • The lesions in cutaneous or rhinocerebral mucormycosis appear varied in size, and ranging from raised red nodules or plaques, which sometimes produce purulent material, to ulcerated lesions with central cavitation, red exuding centres and raised epidermal margins.
  • Older lesions may be covered either partly or fully by thickened and irregular epidermis. There may be a black eschar indicating necrosis and ischemia.[14]

Microscopic Pathology

Gross appearance of mucormycosis in the right orbit, periorbital skin, and maxillary sinuses

Hemotoxylin and Eosin stain histopathology showing necrotic and edematous tissue with neutrophilic inflitrate and hyphae

References

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  2. Boelaert JR, Fenves AZ, Coburn JW (1989). "Registry on mucormycosis in dialysis patients". J. Infect. Dis. 160 (5): 914. PMID 2809271.
  3. Ribes JA, Vanover-Sams CL, Baker DJ (2000). "Zygomycetes in human disease". Clin. Microbiol. Rev. 13 (2): 236–301. PMC 100153. PMID 10756000.
  4. 4.0 4.1 Spellberg B, Edwards J, Ibrahim A (2005). "Novel perspectives on mucormycosis: pathophysiology, presentation, and management". Clin. Microbiol. Rev. 18 (3): 556–69. doi:10.1128/CMR.18.3.556-569.2005. PMC 1195964. PMID 16020690.
  5. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ (2005). "Epidemiology and outcome of zygomycosis: a review of 929 reported cases". Clin. Infect. Dis. 41 (5): 634–53. doi:10.1086/432579. PMID 16080086.
  6. Waldorf AR (1989). "Pulmonary defense mechanisms against opportunistic fungal pathogens". Immunol. Ser. 47: 243–71. PMID 2490078.
  7. Artis WM, Fountain JA, Delcher HK, Jones HE (1982). "A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: transferrin and iron availability". Diabetes. 31 (12): 1109–14. PMID 6816646.
  8. Ibrahim AS, Spellberg B, Edwards J (2008). "Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment". Curr. Opin. Infect. Dis. 21 (6): 620–5. doi:10.1097/QCO.0b013e3283165fd1. PMC 2773686. PMID 18978530.
  9. Howard DH (1999). "Acquisition, transport, and storage of iron by pathogenic fungi". Clin. Microbiol. Rev. 12 (3): 394–404. PMC 100245. PMID 10398672.
  10. Boelaert JR, de Locht M, Van Cutsem J, Kerrels V, Cantinieaux B, Verdonck A, Van Landuyt HW, Schneider YJ (1993). "Mucormycosis during deferoxamine therapy is a siderophore-mediated infection. In vitro and in vivo animal studies". J. Clin. Invest. 91 (5): 1979–86. doi:10.1172/JCI116419. PMC 288195. PMID 8486769.
  11. Bouchara JP, Oumeziane NA, Lissitzky JC, Larcher G, Tronchin G, Chabasse D (1996). "Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components". Eur. J. Cell Biol. 70 (1): 76–83. PMID 8738422.
  12. Ibrahim AS, Spellberg B, Avanessian V, Fu Y, Edwards JE (2005). "Rhizopus oryzae adheres to, is phagocytosed by, and damages endothelial cells in vitro". Infect. Immun. 73 (2): 778–83. doi:10.1128/IAI.73.2.778-783.2005. PMC 547117. PMID 15664916.
  13. Liu M, Spellberg B, Phan QT, Fu Y, Fu Y, Lee AS, Edwards JE, Filler SG, Ibrahim AS (2010). "The endothelial cell receptor GRP78 is required for mucormycosis pathogenesis in diabetic mice". J. Clin. Invest. 120 (6): 1914–24. doi:10.1172/JCI42164. PMC 2877958. PMID 20484814.
  14. 14.0 14.1 Connolly JH, Canfield PJ, Obendorf DL (2000). "Gross, histological and immunohistochemical features of mucormycosis in the platypus". J. Comp. Pathol. 123 (1): 36–46. doi:10.1053/jcpa.2000.0384. PMID 10906254.
  15. Guarner J, Brandt ME (2011). "Histopathologic diagnosis of fungal infections in the 21st century". Clin. Microbiol. Rev. 24 (2): 247–80. doi:10.1128/CMR.00053-10. PMC 3122495. PMID 21482725.

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