Difference between revisions of "Mucormycosis"

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'''Mucormycosis''' (also known as zygomycosis) is a rare but serious infection of fungi of the [[Mucorales]] order.<ref>{{cite web |url=http://www.emedicine.com/med/topic1513.htm |title=eMedicine - Mucormycosis : Article by Nancy F Crum-Cianflone, MD MPH |accessdate=2007-09-30 |format= |work=}}</ref> The most common fungi responsible for mucormycosis in humans are ''[[Mucor]]'' and ''Rhizopus''.   
 
'''Mucormycosis''' (also known as zygomycosis) is a rare but serious infection of fungi of the [[Mucorales]] order.<ref>{{cite web |url=http://www.emedicine.com/med/topic1513.htm |title=eMedicine - Mucormycosis : Article by Nancy F Crum-Cianflone, MD MPH |accessdate=2007-09-30 |format= |work=}}</ref> The most common fungi responsible for mucormycosis in humans are ''[[Mucor]]'' and ''Rhizopus''.   
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==Signs and symptoms==
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Zygomycosis frequently involves the [[Paranasal sinus|sinuses]], [[brain]], or [[lungs]] as the sites of infection. While oral or [[cerebral]] zygomycosis are the most common types of the disease, this infection can also manifest in the gastrointestinal tract, skin, and in other organ systems.<ref name=Emedicine/> In rare cases, the [[maxilla]] may be affected by zygomycosis.<ref name="maxilla"/> The rich vascularity of maxillofacial areas usually prevents fungal infections, although more prevalent fungi, such as those responsible for zygomycosis, can often overcome this difficulty.<ref name="maxilla"/>
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There are several key signs which point towards zygomycosis. One such sign is fungal invasion into the [[vascular]] network which results in [[thrombosis]] and [[necrosis|death]] of surrounding tissue by loss of [[blood supply]].<ref name=cmrasm/> If the disease involves the [[cerebrum|brain]] then symptoms may include a [[unilateral|one-sided]] [[headache]] behind the eyes, facial pain, [[fevers]], nasal stuffiness that progresses to black [[discharge]], and acute [[sinusitis]] along with swelling of the eye.<ref name=medplus/> Affected skin may appear relatively normal during the earliest stages of infection. This skin quickly progresses to an [[erythemic]] (reddening, occasionally with [[edema]]) stage, before eventually turning black due to necrosis.<ref name=cmrasm>{{cite journal |author=Spellberg B, Edwards J, Ibrahim A |title=Novel perspectives on mucormycosis: pathophysiology, presentation, and management |journal=Clin. Microbiol. Rev. |volume=18 |issue=3 |pages=556–69 |year=2005 |pmid=16020690 |doi=10.1128/CMR.18.3.556-569.2005| url=http://cmr.asm.org/cgi/content/full/18/3/556}} {{PMC|1195964}}</ref> In other forms of zygomycosis, such as [[pulmonary]], [[cutaneous]], or disseminated zygomycosis, symptoms may also include [[dyspnea]] (difficulty breathing), and persistent [[cough]]; in cases of necrosis, symptoms include [[nausea]] and [[vomiting]], [[hemoptysis|coughing blood]], and [[abdominal pain]].<ref name=Emedicine/><ref name=medplus/>
  
 
==Presentation==
 
==Presentation==
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==Associated conditions==
 
==Associated conditions==
Some 50-75% of patients diagnosed with mucormycosis are estimated to have underlying poorly controlled [[diabetes mellitus]] and [[ketoacidosis]].   
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Some 50-75% of patients diagnosed with mucormycosis are estimated to have underlying poorly controlled [[diabetes mellitus]] and [[ketoacidosis]].  
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==Diagnosis==
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[[Image:Mature_sporangium_of_a_Mucor_sp._fungus.jpg|thumb|right|200px|This photomicrograph reveals a mature sporangium of a Mucor sp. fungus, which can be responsible for zygomycosis]]
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As [[swab]]s of tissue or discharge are generally unreliable, the diagnosis of zygomycosis tends to be established by a [[biopsy]] specimen of the involved tissue.
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Diagnosis for phycomycosis is through a biopsy or [[microbiological culture|culture]], although an [[ELISA]] test has been developed for ''Pythium insidiosum'' in animals.<ref name=Hensel>{{cite journal |author=Hensel P, Greene C, Medleau L, Latimer K, Mendoza L |title=Immunotherapy for treatment of multicentric cutaneous pythiosis in a dog |journal=J Am Vet Med Assoc |volume=223 |issue=2 |pages=215–8, 197 |year=2003 |pmid=12875449 |doi=10.2460/javma.2003.223.215}}</ref> Computerised imaging techniques such as [[MRI]]s, [[CT scan]]s and [[X-ray]]s may be useful in the diagnosis of specific areas.<ref name=Emedicine/><ref name=HealthAtoZ>{{cite web|title=Mucormycosis|author=Rebecca J. Frey, PhD|url=http://www.healthatoz.com/healthatoz/Atoz/clients/haz/general/custom/default.jsp|publisher=Health A to Z|accessdate=2008-05-19}}</ref>
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Diagnosis is often difficult because basidiobolomycosis is a rare disease and therefore often not recognised.  The lesions often look like [[tumour]]s rather than infection, so often no sample is sent for microbiology, however, the histopathology is characteristic:  the "Splendore-Hoeppli phenomenon" describes the presence of fungal [[hyphae]] (which may exist only as faded streaks on the film) surrounded by eosinophilic material. Basidiobolomycosis is usually a superficial infection of skin, but may very rarely cause lesions of the bowel or liver, mimicking bowel cancer,<ref>{{cite journal | title=A fatal pseudo-tumour: Disseminated basidiobolomycosis | author=Van den berk GEL, Noorduyn LA, van Ketel RJ, ''et al.'' | journal=BMC Infect Dis | year=2006 | volume=6 | pages=140 | doi=10.1186/1471-2334-6-140 }}</ref> or [[Crohn's disease]].<ref name="clininfect">{{cite journal | journal=Clin Infect Dis | year=1999 | volume=28 | issue=6 | pages=1244&ndash;8 | title=Gastrointestinal zygomycotic infection caused by ''Basidiobolus ranarum:'' case report and review | author=Zavasky DM, Samowitz W, Loftus T, Segal H, Carroll K | doi=10.1086/514781 }}</ref> In patients with deep involvement, the [[eosinophil]] count may be raised, falsely suggesting a parasitic infection.<ref name="clininfect"/> Zygomycosis also has similar symptoms to other diseases including [[anthrax]], [[aspergillosis]] and [[cellulitis]].<ref name=Emedicine/>
  
 
==Treatment==
 
==Treatment==

Revision as of 01:30, 11 November 2008

Mucormycosis
Mucormycosis.jpg
Periorbital fungal infection known as mucormycosis or phycomycosis
ICD-10 B46.0-B46.5
ICD-9 117.7
DiseasesDB 31759
eMedicine med/1513 
MeSH D009091
Phycomycosis
ICD-10 B46
ICD-9 117.7
DiseasesDB 31329
MeSH D020096
Basidiobolomycosis
ICD-10 B46
ICD-9 117.7
MedlinePlus 000649
eMedicine med/2735  med/1513
MeSH D009091

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Mucormycosis (also known as zygomycosis) is a rare but serious infection of fungi of the Mucorales order.[1] The most common fungi responsible for mucormycosis in humans are Mucor and Rhizopus.

Signs and symptoms

Zygomycosis frequently involves the sinuses, brain, or lungs as the sites of infection. While oral or cerebral zygomycosis are the most common types of the disease, this infection can also manifest in the gastrointestinal tract, skin, and in other organ systems.[2] In rare cases, the maxilla may be affected by zygomycosis.[3] The rich vascularity of maxillofacial areas usually prevents fungal infections, although more prevalent fungi, such as those responsible for zygomycosis, can often overcome this difficulty.[3]

There are several key signs which point towards zygomycosis. One such sign is fungal invasion into the vascular network which results in thrombosis and death of surrounding tissue by loss of blood supply.[4] If the disease involves the brain then symptoms may include a one-sided headache behind the eyes, facial pain, fevers, nasal stuffiness that progresses to black discharge, and acute sinusitis along with swelling of the eye.[5] Affected skin may appear relatively normal during the earliest stages of infection. This skin quickly progresses to an erythemic (reddening, occasionally with edema) stage, before eventually turning black due to necrosis.[4] In other forms of zygomycosis, such as pulmonary, cutaneous, or disseminated zygomycosis, symptoms may also include dyspnea (difficulty breathing), and persistent cough; in cases of necrosis, symptoms include nausea and vomiting, coughing blood, and abdominal pain.[2][5]

Presentation

It that frequently involves the sinuses, brain, or lungs and most commonly presents in immunocompromised patients.

While orbitorhinocerebral mucormycosis is the most common type of the disease, this infection can also manifest in the gastrointestinal tract, skin, and in other organ systems.

Associated conditions

Some 50-75% of patients diagnosed with mucormycosis are estimated to have underlying poorly controlled diabetes mellitus and ketoacidosis.

Diagnosis

This photomicrograph reveals a mature sporangium of a Mucor sp. fungus, which can be responsible for zygomycosis

As swabs of tissue or discharge are generally unreliable, the diagnosis of zygomycosis tends to be established by a biopsy specimen of the involved tissue.

Diagnosis for phycomycosis is through a biopsy or culture, although an ELISA test has been developed for Pythium insidiosum in animals.[6] Computerised imaging techniques such as MRIs, CT scans and X-rays may be useful in the diagnosis of specific areas.[2][7]

Diagnosis is often difficult because basidiobolomycosis is a rare disease and therefore often not recognised. The lesions often look like tumours rather than infection, so often no sample is sent for microbiology, however, the histopathology is characteristic: the "Splendore-Hoeppli phenomenon" describes the presence of fungal hyphae (which may exist only as faded streaks on the film) surrounded by eosinophilic material. Basidiobolomycosis is usually a superficial infection of skin, but may very rarely cause lesions of the bowel or liver, mimicking bowel cancer,[8] or Crohn's disease.[9] In patients with deep involvement, the eosinophil count may be raised, falsely suggesting a parasitic infection.[9] Zygomycosis also has similar symptoms to other diseases including anthrax, aspergillosis and cellulitis.[2]

Treatment

Surgical resection of the "fungus ball" and intravenous amphotericin B is the recommended therapy.

Case Example: Carotid Artery Mucormycosis

Clinical Summary

A 63-year-old white male was in his usual state of good health until eight weeks before his death when he developed sudden onset of shortness of breath. A thoracotomy was performed for plication of ruptured emphysematous blebs.

Following improvement and discharge from the hospital he developed weakness, lethargy, and a left lower lobe lung infiltrate. The patient's condition soon deteriorated further, with almost every organ system having failed. The patient developed DIC and peripheral embolic phenomena, including gangrene of his extremities and face.

A single antemortem blood culture grew Staphylococcus aureus.

Postmortem Findings

Autopsy revealed severe emphysema, severe widespread abscessiform and necrotizing pneumonia, and bacterial endocarditis (Staphylococcus aureus) of the pulmonic valve. The right internal carotid artery was occluded by a thrombus and there were areas of necrosis (due to CVAs) in the brain.

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology




References

  1. "eMedicine - Mucormycosis : Article by Nancy F Crum-Cianflone, MD MPH". Retrieved 2007-09-30.
  2. 2.0 2.1 2.2 2.3
  3. 3.0 3.1
  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. PMID 16020690. PMC 1195964
  5. 5.0 5.1
  6. Hensel P, Greene C, Medleau L, Latimer K, Mendoza L (2003). "Immunotherapy for treatment of multicentric cutaneous pythiosis in a dog". J Am Vet Med Assoc. 223 (2): 215–8, 197. doi:10.2460/javma.2003.223.215. PMID 12875449.
  7. Rebecca J. Frey, PhD. "Mucormycosis". Health A to Z. Retrieved 2008-05-19.
  8. Van den berk GEL, Noorduyn LA, van Ketel RJ; et al. (2006). "A fatal pseudo-tumour: Disseminated basidiobolomycosis". BMC Infect Dis. 6: 140. doi:10.1186/1471-2334-6-140.
  9. 9.0 9.1 Zavasky DM, Samowitz W, Loftus T, Segal H, Carroll K (1999). "Gastrointestinal zygomycotic infection caused by Basidiobolus ranarum: case report and review". Clin Infect Dis. 28 (6): 1244&ndash, 8. doi:10.1086/514781.

External links

Cost Effectiveness of Mucormycosis

| group5 = Clinical Trials Involving Mucormycosis | list5 = Ongoing Trials on Mucormycosis at Clinical Trials.govTrial results on MucormycosisClinical Trials on Mucormycosis at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Mucormycosis | list6 = US National Guidelines Clearinghouse on MucormycosisNICE Guidance on MucormycosisNHS PRODIGY GuidanceFDA on MucormycosisCDC on Mucormycosis


| group7 = Textbook Information on Mucormycosis | list7 = Books and Textbook Information on Mucormycosis


| group8 = Pharmacology Resources on Mucormycosis | list8 = AND (Dose)}} Dosing of MucormycosisAND (drug interactions)}} Drug interactions with MucormycosisAND (side effects)}} Side effects of MucormycosisAND (Allergy)}} Allergic reactions to MucormycosisAND (overdose)}} Overdose information on MucormycosisAND (carcinogenicity)}} Carcinogenicity information on MucormycosisAND (pregnancy)}} Mucormycosis in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Mucormycosis


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Mucormycosis | list9 = AND (pharmacogenomics)}} Genetics of MucormycosisAND (pharmacogenomics)}} Pharmacogenomics of MucormycosisAND (proteomics)}} Proteomics of Mucormycosis


| group10 = Newstories on Mucormycosis | list10 = Mucormycosis in the newsBe alerted to news on MucormycosisNews trends on Mucormycosis


| group11 = Commentary on Mucormycosis | list11 = Blogs on Mucormycosis

| group12 = Patient Resources on Mucormycosis | list12 = Patient resources on MucormycosisDiscussion groups on MucormycosisPatient Handouts on MucormycosisDirections to Hospitals Treating MucormycosisRisk calculators and risk factors for Mucormycosis


| group13 = Healthcare Provider Resources on Mucormycosis | list13 = Symptoms of MucormycosisCauses & Risk Factors for MucormycosisDiagnostic studies for MucormycosisTreatment of Mucormycosis

| group14 = Continuing Medical Education (CME) Programs on Mucormycosis | list14 = CME Programs on Mucormycosis

| group15 = International Resources on Mucormycosis | list15 = Mucormycosis en EspanolMucormycosis en Francais

| group16 = Business Resources on Mucormycosis | list16 = Mucormycosis in the MarketplacePatents on Mucormycosis

| group17 = Informatics Resources on Mucormycosis | list17 = List of terms related to Mucormycosis


}}



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