Mucormycosis classification

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

Mucormycosis can be classified according to the organ system involved including brain, lungs, skin, GIT, bones, liver, spleen. Disseminated infection affects multiple organ systems.

Classification

Mucormycosis may be classified based on the organ system involvement as follows:

Type	High risk group	Transmission	Signs and Symptoms	Complications
Rhinocerebral mucormycosis	It occurs most commonly in debilitated patients (specially those presenting with diabetic ketoacidosis) and those undergoing hematopoietic stem cell transplantation	Rhinocerebral mucormycosis is by far the most common form of the disease. Acquired by: Perineural spread After proliferation in the nasal cavity, the mucor reaches the pterygo-palatine fossa, inferior orbital fissure and finally the retroglobal space of the orbit, leading to ocular signs The facial soft tissues, palate and infratemporal fossa can be infected through connecting pathways from the pterygo-palatine fossa	Eye or facial pain Facial numbness Facial ulceration and necrosis Conjunctival injection Blurry vision Soft tissue swelling Bilateral proptosis Chemosis Vision loss Ophthalmoplegia Cavernous sinus thrombosis Bloody nasal discharge may be the first sign that infection has invaded through the turbinates and into the brain	Disseminated infection Mycotic aneurysms
Pulmonary mucormycosis	Most commonly occurs in neutropenic and stem cell transplant patients[5]	Acquired by: Inhalation Hematogenous spread Lymphatic spread	Dyspnea Cough Chest pain Hemoptysis (if there is vessel involvement through vascular invasion)	Disseminated infection
Cutaneous mucormycosis		Acquired by disruption of the physiologic skin barrier: Trauma Skin maceration Burns Contaminated surgical dressings	Skin redness Numbness Warmth Skin ulceration and necrosis	Disseminated infection
Gastrointestinal mucormycosis	Usually found in malnourished individuals, AIDS patients, SLE patients, organ transplant recepients, infants and children	Rare occurrence Acquired by: Ingestion of Fungi	Abdominal distension Pain Nausea Vomiting Hematochezia	Disseminated infection
Disseminated mucormycosis	Patients on immunosupressants and anti-fungal prophylaxis (escpecially voriconazole) are particularly susceptible to disseminated infection	Acquired by: Hematogenous spread is usually the most common route of dissemination and pulmonary mucormycosis is usually the culprit	Brain is the most common site of dissemination leading to: Seizures Stroke Paralysis Abscess formation Splenic infarction Myocardial necrosis liver skin	High case fatality rate