Mucormycosis differential diagnosis: Difference between revisions

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==Differential diagnosis==
==Differential diagnosis==
Mucormycosis must be differentiated from other conditions with similar presentation, for example:
Mucormycosis must be differentiated from other conditions with similar presentation. [[Invasive (medical)|Invasive]] fungal disease should be considered in any immunocompromised patient presenting with a new [[cranial]] [[neuropathy]] or [[ocular]] [[motility]] abnormality<ref name="pmid261128692">{{cite journal |vauthors=Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK |title=Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus |journal=Br J Ophthalmol |volume=100 |issue=2 |pages=184–8 |year=2016 |pmid=26112869 |doi=10.1136/bjophthalmol-2015-306945 |url=}}</ref> for example:
*Aspergillosis
*Invasive aspergillosis
Other differential diagnoses which may involve progressive facial swelling, ulceration and destruction and resemble mucormycosis include:
*Orbital cellulitis
*Orbital cellulitis
*Extra nodal T cell lymphoma
*Extra nodal T cell lymphoma
Line 15: Line 16:
*Pancreatic panniculitis
*Pancreatic panniculitis
*Gouty panniculitis
*Gouty panniculitis
{| class="wikitable"
!Disease
!Differentiating Features
|-
|Invasive aspergillosis
|
* The reverse halo sign on CT scan (characterized by central ground-glass opacity (GGO) which is surrounded by a partial or complete rim of consolidation)<ref name="pmid23683872">{{cite journal |vauthors=Okubo Y, Ishiwatari T, Izumi H, Sato F, Aki K, Sasai D, Ando T, Shinozaki M, Natori K, Tochigi N, Wakayama M, Hata Y, Nakayama H, Nemoto T, Shibuya K |title=Pathophysiological implication of reversed CT halo sign in invasive pulmonary mucormycosis: a rare case report |journal=Diagn Pathol |volume=8 |issue= |pages=82 |year=2013 |pmid=23683872 |pmc=3658989 |doi=10.1186/1746-1596-8-82 |url=}}</ref> is more common in patients with pulmonary mucormycosis  than in those with invasive pulmonary aspergillosis<ref name="pmid25882362">{{cite journal |vauthors=Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH |title=Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis |journal=Clin. Microbiol. Infect. |volume=21 |issue=7 |pages=684.e11–8 |year=2015 |pmid=25882362 |doi=10.1016/j.cmi.2015.03.019 |url=}}</ref>
* Airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, are more common in patients with invasive pulmonary aspergillosis<ref name="pmid258823622">{{cite journal |vauthors=Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH |title=Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis |journal=Clin. Microbiol. Infect. |volume=21 |issue=7 |pages=684.e11–8 |year=2015 |pmid=25882362 |doi=10.1016/j.cmi.2015.03.019 |url=}}</ref>
* Patients with orbital fungal infections are more likely to be infected with mucormycosis compared with Aspergillus<ref name="pmid26112869">{{cite journal |vauthors=Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK |title=Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus |journal=Br J Ophthalmol |volume=100 |issue=2 |pages=184–8 |year=2016 |pmid=26112869 |doi=10.1136/bjophthalmol-2015-306945 |url=}}</ref>
* Microscopic observation under ultraviolet light shows that the hyphae of aspergillus have characteristic dichotomous branching, parallel walls, and numerous septa. These septa structure is clearly different from those of the mucor. 
* Unlike pulmonary aspergillosis, the prognosis of pulmonary mucormycosis has not improved significantly over the last ten years, mainly because of challenges in early diagnosis and the limited activity of current antifungal agents against Mucorales<ref name="pmid22167397">{{cite journal |vauthors=Hamilos G, Samonis G, Kontoyiannis DP |title=Pulmonary mucormycosis |journal=Semin Respir Crit Care Med |volume=32 |issue=6 |pages=693–702 |year=2011 |pmid=22167397 |doi=10.1055/s-0031-1295717 |url=}}</ref>
|-
|Orbital cellulitis
|
|-
|Extra nodal T cell lymphoma
|
* These tumors are more clearly classified as nasal-type extranodal T-cell/natural killer (T/NK) cell lymphoma and natural killer cell leukemia
* They are characterized immunophenotypically by the expression of CD2, CD3ϵ (but not CD3 and the T-cell receptor), and CD56<ref name="pmid27178138">{{cite journal |vauthors=Zhang Y, Wang T, Liu GL, Li J, Gao SQ, Wan L |title=Mucormycosis or extranodal natural killer/T cell lymphoma, similar symptoms but different diagnosis |journal=J Mycol Med |volume=26 |issue=3 |pages=277–82 |year=2016 |pmid=27178138 |doi=10.1016/j.mycmed.2016.04.005 |url=}}</ref> 
* The lesion produced are destructive and involve the nasal cavity, oropharynx, upper palate, and larynx
* Immunophenotyping shows these lesions to be lymphoid in nature
|}

Revision as of 21:14, 1 June 2017

Mucormycosis Microchapters

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

Overview

Differential diagnosis

Mucormycosis must be differentiated from other conditions with similar presentation. Invasive fungal disease should be considered in any immunocompromised patient presenting with a new cranial neuropathy or ocular motility abnormality[1] for example:

  • Invasive aspergillosis

Other differential diagnoses which may involve progressive facial swelling, ulceration and destruction and resemble mucormycosis include:

  • Orbital cellulitis
  • Extra nodal T cell lymphoma
  • Cutaneous Anthrax

Histopathologically, mucormycosis may resemble:

  • Pancreatic panniculitis
  • Gouty panniculitis
Disease Differentiating Features
Invasive aspergillosis
  • The reverse halo sign on CT scan (characterized by central ground-glass opacity (GGO) which is surrounded by a partial or complete rim of consolidation)[2] is more common in patients with pulmonary mucormycosis than in those with invasive pulmonary aspergillosis[3]
  • Airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, are more common in patients with invasive pulmonary aspergillosis[4]
  • Patients with orbital fungal infections are more likely to be infected with mucormycosis compared with Aspergillus[5]
  • Microscopic observation under ultraviolet light shows that the hyphae of aspergillus have characteristic dichotomous branching, parallel walls, and numerous septa. These septa structure is clearly different from those of the mucor.
  • Unlike pulmonary aspergillosis, the prognosis of pulmonary mucormycosis has not improved significantly over the last ten years, mainly because of challenges in early diagnosis and the limited activity of current antifungal agents against Mucorales[6]
Orbital cellulitis
Extra nodal T cell lymphoma
  • These tumors are more clearly classified as nasal-type extranodal T-cell/natural killer (T/NK) cell lymphoma and natural killer cell leukemia
  • They are characterized immunophenotypically by the expression of CD2, CD3ϵ (but not CD3 and the T-cell receptor), and CD56[7]
  • The lesion produced are destructive and involve the nasal cavity, oropharynx, upper palate, and larynx
  • Immunophenotyping shows these lesions to be lymphoid in nature
  1. ↑ Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK (2016). "Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus". Br J Ophthalmol. 100 (2): 184–8. doi:10.1136/bjophthalmol-2015-306945. PMID 26112869.
  2. ↑ Okubo Y, Ishiwatari T, Izumi H, Sato F, Aki K, Sasai D, Ando T, Shinozaki M, Natori K, Tochigi N, Wakayama M, Hata Y, Nakayama H, Nemoto T, Shibuya K (2013). "Pathophysiological implication of reversed CT halo sign in invasive pulmonary mucormycosis: a rare case report". Diagn Pathol. 8: 82. doi:10.1186/1746-1596-8-82. PMC 3658989. PMID 23683872.
  3. ↑ Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2015). "Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis". Clin. Microbiol. Infect. 21 (7): 684.e11–8. doi:10.1016/j.cmi.2015.03.019. PMID 25882362.
  4. ↑ Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2015). "Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis". Clin. Microbiol. Infect. 21 (7): 684.e11–8. doi:10.1016/j.cmi.2015.03.019. PMID 25882362.
  5. ↑ Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK (2016). "Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus". Br J Ophthalmol. 100 (2): 184–8. doi:10.1136/bjophthalmol-2015-306945. PMID 26112869.
  6. ↑ Hamilos G, Samonis G, Kontoyiannis DP (2011). "Pulmonary mucormycosis". Semin Respir Crit Care Med. 32 (6): 693–702. doi:10.1055/s-0031-1295717. PMID 22167397.
  7. ↑ Zhang Y, Wang T, Liu GL, Li J, Gao SQ, Wan L (2016). "Mucormycosis or extranodal natural killer/T cell lymphoma, similar symptoms but different diagnosis". J Mycol Med. 26 (3): 277–82. doi:10.1016/j.mycmed.2016.04.005. PMID 27178138.
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