Mucormycosis classification: Difference between revisions
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==Overview== | ==Overview== | ||
Mucormycosis may involve various organ systems including brain, lungs, skin, GIT, bones, liver, spleen and can be classified based on the organ system involvement. Disseminated infection is associated with high mortality. | Mucormycosis may involve various [[organ systems]] including [[brain]], [[lungs]], [[skin]], [[Gastrointestinal tract|GIT]], [[bones]], [[liver]], [[spleen]] and can be classified based on the [[organ system]] involvement. [[Disseminated disease|Disseminated infection]] is associated with high [[mortality]]. | ||
==Classification== | ==Classification== | ||
* Mucormycosis may be classified based on the organ system involvement: | * Mucormycosis may be classified based on the [[organ system]] involvement: | ||
===Rhinocerebral mucormycosis=== | ===Rhinocerebral mucormycosis=== | ||
* Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with diabetic ketoacidosis). <ref name="urlRhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1288/00005537-198910000-00006/full |title=Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | * Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with [[diabetic ketoacidosis]]). <ref name="urlRhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1288/00005537-198910000-00006/full |title=Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | ||
* Another patient population that has been found to be susceptible to mucormycosis are those undergoing hematopoietic stem cell transplantation. <ref name="urlEpidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/34/7/909/316117/Epidemiology-and-Outcome-of-Mould-Infections-in |title=Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> | * Another patient population that has been found to be susceptible to mucormycosis are those undergoing [[hematopoietic stem cell]] [[transplantation]]. <ref name="urlEpidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/34/7/909/316117/Epidemiology-and-Outcome-of-Mould-Infections-in |title=Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
* Initial symptoms include eye or facial pain and facial numbness, followed by the onset of conjunctival injection, blurry vision, and soft tissue swelling. <ref name="pmid14723256">{{cite journal |vauthors=Khor BS, Lee MH, Leu HS, Liu JW |title=Rhinocerebral mucormycosis in Taiwan |journal=J Microbiol Immunol Infect |volume=36 |issue=4 |pages=266–9 |year=2003 |pmid=14723256 |doi= |url=}}</ref> <ref name="urlRhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1097/00005537-199707000-00004/full |title=Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | * Initial symptoms include [[eye]] or [[facial]] pain and [[facial]] [[numbness]], followed by the onset of [[conjunctival injection]], [[Blurred vision|blurry vision]], and [[soft tissue]] [[swelling]]. <ref name="pmid14723256">{{cite journal |vauthors=Khor BS, Lee MH, Leu HS, Liu JW |title=Rhinocerebral mucormycosis in Taiwan |journal=J Microbiol Immunol Infect |volume=36 |issue=4 |pages=266–9 |year=2003 |pmid=14723256 |doi= |url=}}</ref> <ref name="urlRhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1097/00005537-199707000-00004/full |title=Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | ||
* If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in loss of extraocular muscle function and proptosis. | * If untreated, [[infection]] usually spreads from the [[ethmoid sinus]] to the orbit, resulting in loss of [[Extraocular muscles|extraocular muscle]] function and [[proptosis]]. | ||
* The infection may rapidly spread into the neighboring tissues. | * The [[infection]] may rapidly spread into the neighboring tissues. | ||
* Onset of signs and symptoms in the contralateral eye, with resulting bilateral proptosis, chemosis, vision loss, and ophthalmoplegia, is a sign that suggests the development of cavernous sinus thrombosis. | * Onset of signs and symptoms in the [[contralateral]] eye, with resulting [[bilateral]] [[proptosis]], [[chemosis]], [[vision loss]], and [[ophthalmoplegia]], is a sign that suggests the development of [[cavernous sinus thrombosis]]. | ||
* Infection can also spread posteriorly from either the orbit or sinuses to the central nervous system. | * [[Infection]] can also spread [[Posterior|posteriorly]] from either the [[Orbit (anatomy)|orbit]] or [[sinuses]] to the [[central nervous system]]. | ||
* A bloody nasal discharge may be the first sign that infection has invaded through the turbinates and into the brain. | * A bloody [[nasal discharge]] may be the first sign that [[infection]] has invaded through the [[turbinates]] and into the [[brain]]. | ||
* Hematogenous spread may lead to development of mycotic aneurysms. | * Hematogenous spread may lead to development of [[mycotic]] [[Aneurysm|aneurysms]]. | ||
===Pulmonary mucormycosis=== | ===Pulmonary mucormycosis=== | ||
* Pumlonary mucormycosis most commonly occurs in neutropenic and stem cell transplant patients. <ref name="pmid8504272">{{cite journal |vauthors=Morrison VA, McGlave PB |title=Mucormycosis in the BMT population |journal=Bone Marrow Transplant. |volume=11 |issue=5 |pages=383–8 |year=1993 |pmid=8504272 |doi= |url=}}</ref> | * [[Lungs|Pumlonary]] mucormycosis most commonly occurs in [[Neutropenia|neutropenic]] and [[stem cell transplant]] patients. <ref name="pmid8504272">{{cite journal |vauthors=Morrison VA, McGlave PB |title=Mucormycosis in the BMT population |journal=Bone Marrow Transplant. |volume=11 |issue=5 |pages=383–8 |year=1993 |pmid=8504272 |doi= |url=}}</ref> | ||
* It develops as a result of inhalation or by hematogenous or lymphatic spread. | * It develops as a result of [[inhalation]] or by hematogenous or [[Lymphatic System|lymphatic]] spread. | ||
* Symptoms include dyspnea, cough, chest pain and hemoptysis (if there is vessel involvement through vascular invasion) <ref name="pmid8166512">{{cite journal |vauthors=Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE |title=Pulmonary mucormycosis: results of medical and surgical therapy |journal=Ann. Thorac. Surg. |volume=57 |issue=4 |pages=1044–50 |year=1994 |pmid=8166512 |doi= |url=}}</ref> | * [[Symptom|Symptoms]] include [[dyspnea]], [[cough]], [[chest pain]] and [[hemoptysis]] (if there is [[Blood vessel|vessel]] involvement through [[vascular]] invasion) <ref name="pmid8166512">{{cite journal |vauthors=Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE |title=Pulmonary mucormycosis: results of medical and surgical therapy |journal=Ann. Thorac. Surg. |volume=57 |issue=4 |pages=1044–50 |year=1994 |pmid=8166512 |doi= |url=}}</ref> | ||
* Disseminated disease leads to a poorer prognosis. <ref name="urlImproved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7">{{cite web |url=http://www.tandfonline.com/doi/abs/10.1080/10428190310001653691 |title=Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7 |format= |work= |accessdate=}}</ref> | * [[Disseminated disease|Disseminated]] disease leads to a poorer [[prognosis]]. <ref name="urlImproved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7">{{cite web |url=http://www.tandfonline.com/doi/abs/10.1080/10428190310001653691 |title=Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7 |format= |work= |accessdate=}}</ref> | ||
===Cutaneous mucormycosis=== | ===Cutaneous mucormycosis=== | ||
* Disruption of the physiologic skin barrier may lead to invasion of the fungi causing mucormycosis and development of disease. | * Disruption of the physiologic [[skin]] barrier may lead to invasion of the [[fungi]] causing mucormycosis and development of disease. | ||
* Agents responsible for mucormycosis are not capable of penetrating the skin, however, trauma, skin maceration or burns may lead to disruption of the normal barrier. | * Agents responsible for mucormycosis are not capable of penetrating the [[skin]], however, [[Physical trauma|trauma]], [[Maceration|skin maceration]] or [[Burn|burns]] may lead to disruption of the normal barrier. | ||
* Contaminated surgical dressings may also lead to development of mucormycosis. <ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection | JAMA | The JAMA Network |format= |work= |accessdate=}}</ref> | * Contaminated surgical dressings may also lead to development of mucormycosis. <ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection | JAMA | The JAMA Network |format= |work= |accessdate=}}</ref> | ||
* Disseminated disease may result if infection from the skin penetrates into subcutaneous tissues, fat and bones. <ref name="urlGangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1470.2003.20508.x/full |title=Gangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library |format= |work= |accessdate=}}</ref> | * [[Disseminated disease]] may result if [[infection]] from the [[skin]] penetrates into [[Subcutaneous tissue|subcutaneous tissues]], [[fat]] and [[bones]]. <ref name="urlGangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1470.2003.20508.x/full |title=Gangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library |format= |work= |accessdate=}}</ref> | ||
===Gastrointestinal mucormycosis=== | ===Gastrointestinal mucormycosis=== | ||
* Gastrointestinal mucormycosis is a rare occurrence and is usually found in malnourished individuals, AIDS patients, SLE patients, <ref name="urlwww.nature.com">{{cite web |url=https://www.nature.com/ajg/journal/v93/n8/pdf/ajg1998307a.pdf |title=www.nature.com |format= |work= |accessdate=}}</ref> organ transplant recepients,<ref name="urlGASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation">{{cite web |url=http://journals.lww.com/transplantjournal/Abstract/1998/10150/Gastric_Perforation_Due_To_Mucormycosis_After.21.aspx |title=GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation |format= |work= |accessdate=}}</ref> infants and children. | * [[Gastrointestinal tract|Gastrointestinal]] mucormycosis is a rare occurrence and is usually found in [[malnourished]] individuals, [[AIDS]] patients, [[SLE]] patients, <ref name="urlwww.nature.com">{{cite web |url=https://www.nature.com/ajg/journal/v93/n8/pdf/ajg1998307a.pdf |title=www.nature.com |format= |work= |accessdate=}}</ref> [[organ transplant]] recepients,<ref name="urlGASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation">{{cite web |url=http://journals.lww.com/transplantjournal/Abstract/1998/10150/Gastric_Perforation_Due_To_Mucormycosis_After.21.aspx |title=GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation |format= |work= |accessdate=}}</ref> [[Infant|infants]] and children. | ||
* Ingestion of the fungi is the most common route of transmission. | * [[Ingestion]] of the [[fungi]] is the most common route of transmission. | ||
* Symptoms include abdominal distension, pain, nausea, vomiting and hematochezia. | * Symptoms include [[abdominal]] distension, [[pain]], [[nausea]], [[vomiting]] and [[hematochezia]]. | ||
* Biopsy via endoscopy is required to confirm the diagnosis. | * [[Biopsy]] via [[endoscopy]] is required to confirm the [[diagnosis]]. | ||
===Disseminated mucormycosis=== | ===Disseminated mucormycosis=== | ||
* Hematogenous spread is usually the most common route of dissemination and pulmonary mucormycosis is usually the culprit. | * Hematogenous spread is usually the most common route of [[Disseminated disease|dissemination]] and [[Lung|pulmonary]] mucormycosis is usually the culprit. | ||
* Brain is the most common site of dissemination but other organs may also be | * [[Brain]] is the most common site of [[Disseminated disease|dissemination]] but other organs may also be involved, including [[spleen]], [[heart]] , [[liver]] and [[skin]]. | ||
* Cerebral dissemination may result is abscess formation. | * [[Cerebral]] dissemination may result is abscess formation. | ||
* Disseminated infection is associated with a high mortality rate (may approach 100 %) <ref name="pmid13984484">{{cite journal |vauthors=STRAATSMA BR, ZIMMERMAN LE, GASS JD |title=Phycomycosis. A clinicopathologic study of fifty-one cases |journal=Lab. Invest. |volume=11 |issue= |pages=963–85 |year=1962 |pmid=13984484 |doi= |url=}}</ref> | * Disseminated infection is associated with a high mortality rate (may approach 100 %) <ref name="pmid13984484">{{cite journal |vauthors=STRAATSMA BR, ZIMMERMAN LE, GASS JD |title=Phycomycosis. A clinicopathologic study of fifty-one cases |journal=Lab. Invest. |volume=11 |issue= |pages=963–85 |year=1962 |pmid=13984484 |doi= |url=}}</ref> | ||
* Patients on immunosupressants and anti-fungal prophylaxis (escpecially voriconazole) are particularly susceptible to disseminated infection. <ref name="urlZygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2004.00945.x/full |title=Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library |format= |work= |accessdate=}}</ref> <ref name="urlBreakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/39/5/743/364418/Breakthrough-Fungal-Infections-in-Stem-Cell |title=Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> | * Patients on immunosupressants and anti-fungal prophylaxis (escpecially voriconazole) are particularly susceptible to disseminated infection. <ref name="urlZygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2004.00945.x/full |title=Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library |format= |work= |accessdate=}}</ref> <ref name="urlBreakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/39/5/743/364418/Breakthrough-Fungal-Infections-in-Stem-Cell |title=Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
Revision as of 20:34, 12 June 2017
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Mucormycosis Microchapters |
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Diagnosis |
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Treatment |
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 may involve various organ systems including brain, lungs, skin, GIT, bones, liver, spleen and can be classified based on the organ system involvement. Disseminated infection is associated with high mortality.
Classification
- Mucormycosis may be classified based on the organ system involvement:
Rhinocerebral mucormycosis
- Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with diabetic ketoacidosis). [1]
- Another patient population that has been found to be susceptible to mucormycosis are those undergoing hematopoietic stem cell transplantation. [2]
- Initial symptoms include eye or facial pain and facial numbness, followed by the onset of conjunctival injection, blurry vision, and soft tissue swelling. [3] [4]
- If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in loss of extraocular muscle function and proptosis.
- The infection may rapidly spread into the neighboring tissues.
- Onset of signs and symptoms in the contralateral eye, with resulting bilateral proptosis, chemosis, vision loss, and ophthalmoplegia, is a sign that suggests the development of cavernous sinus thrombosis.
- Infection can also spread posteriorly from either the orbit or sinuses to the central nervous system.
- A bloody nasal discharge may be the first sign that infection has invaded through the turbinates and into the brain.
- Hematogenous spread may lead to development of mycotic aneurysms.
Pulmonary mucormycosis
- Pumlonary mucormycosis most commonly occurs in neutropenic and stem cell transplant patients. [5]
- It develops as a result of inhalation or by hematogenous or lymphatic spread.
- Symptoms include dyspnea, cough, chest pain and hemoptysis (if there is vessel involvement through vascular invasion) [6]
- Disseminated disease leads to a poorer prognosis. [7]
Cutaneous mucormycosis
- Disruption of the physiologic skin barrier may lead to invasion of the fungi causing mucormycosis and development of disease.
- Agents responsible for mucormycosis are not capable of penetrating the skin, however, trauma, skin maceration or burns may lead to disruption of the normal barrier.
- Contaminated surgical dressings may also lead to development of mucormycosis. [8]
- Disseminated disease may result if infection from the skin penetrates into subcutaneous tissues, fat and bones. [9]
Gastrointestinal mucormycosis
- Gastrointestinal mucormycosis is a rare occurrence and is usually found in malnourished individuals, AIDS patients, SLE patients, [10] organ transplant recepients,[11] infants and children.
- Ingestion of the fungi is the most common route of transmission.
- Symptoms include abdominal distension, pain, nausea, vomiting and hematochezia.
- Biopsy via endoscopy is required to confirm the diagnosis.
Disseminated mucormycosis
- 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 but other organs may also be involved, including spleen, heart , liver and skin.
- Cerebral dissemination may result is abscess formation.
- Disseminated infection is associated with a high mortality rate (may approach 100 %) [12]
- Patients on immunosupressants and anti-fungal prophylaxis (escpecially voriconazole) are particularly susceptible to disseminated infection. [13] [14]
- Infarctions in multiple organs in an immunosuppressed patient points towards disseminated mucormycosis.
References
- ↑ "Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library".
- ↑ "Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic".
- ↑ Khor BS, Lee MH, Leu HS, Liu JW (2003). "Rhinocerebral mucormycosis in Taiwan". J Microbiol Immunol Infect. 36 (4): 266–9. PMID 14723256.
- ↑ "Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library".
- ↑ Morrison VA, McGlave PB (1993). "Mucormycosis in the BMT population". Bone Marrow Transplant. 11 (5): 383–8. PMID 8504272.
- ↑ Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE (1994). "Pulmonary mucormycosis: results of medical and surgical therapy". Ann. Thorac. Surg. 57 (4): 1044–50. PMID 8166512.
- ↑ "Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7".
- ↑ "Cutaneous Rhizopus Infection | JAMA | The JAMA Network".
- ↑ "Gangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library".
- ↑ "www.nature.com" (PDF).
- ↑ "GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation".
- ↑ STRAATSMA BR, ZIMMERMAN LE, GASS JD (1962). "Phycomycosis. A clinicopathologic study of fifty-one cases". Lab. Invest. 11: 963–85. PMID 13984484.
- ↑ "Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library".
- ↑ "Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic".