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==Overview==
==Overview==
Mucormycosis can be classified according to the [[organ system]] involved including [[brain]], [[lungs]], [[skin]], [[Gastrointestinal tract|GIT]], [[bones]], [[liver]], [[spleen]]. [[Disseminated disease|Disseminated infection]] affects multiple organ systems.


==Classification==
==Classification==
* Mucormycosis may be classified based on the organ system involvement:  
Mucormycosis may be classified based on the [[organ system]] involvement as follows:
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type
! align="center" style="background:#4479BA; color: #FFFFFF;" + |High risk group
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Transmission
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Complications
|-
|Rhinocerebral mucormycosis
|
*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> and 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 &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref>
|
* Rhinocerebral mucormycosis is by far the most common form of the disease.
* Acquired by:
** Perineural spread<ref name="pmid17667114">{{cite journal |vauthors=Margo CE, Linden C, Strickland-Marmol LB, Denietolis AL, McCaffrey JC, Kirk N |title=Rhinocerebral mucormycosis with perineural spread |journal=Ophthal Plast Reconstr Surg |volume=23 |issue=4 |pages=326–7 |year=2007 |pmid=17667114 |doi=10.1097/IOP.0b013e318070855b |url=}}</ref>
** After proliferation in the [[nasal cavity]], the [[Mucoraceae|mucor]] reaches the pterygo-palatine fossa, [[inferior orbital fissure]] and finally the retroglobal space of the orbit, leading to [[ocular]] signs
** The [[facial]] [[Soft tissue|soft tissues]], [[palate]] and [[infratemporal fossa]] can be infected through connecting pathways from the pterygo-palatine fossa<ref name="pmid15891927">{{cite journal |vauthors=Hosseini SM, Borghei P |title=Rhinocerebral mucormycosis: pathways of spread |journal=Eur Arch Otorhinolaryngol |volume=262 |issue=11 |pages=932–8 |year=2005 |pmid=15891927 |doi=10.1007/s00405-005-0919-0 |url=}}</ref>
|
* [[Eye]] or [[facial]] pain
* [[Facial]] [[numbness]]
* [[Facial]] [[ulceration]] and [[necrosis]]
* [[Red eye (medicine)|Conjunctival injection]]
* [[Blurry vision]]
* [[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>
* [[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 disease|Disseminated infection]]


===Rhinocerebral mucormycosis===
* [[Mycotic]] [[Aneurysm|aneurysms]]
  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 &#124; Clinical Infectious Diseases &#124; 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> 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 terbinates and into the brain. Hematogenous spread may lead to development of mycotic 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> 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) <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>
* Most commonly occurs in [[Neutropenia|neutropenic]] and [[stem cell transplant]] patients<sup>[[Mucormycosis classification#cite note-pmid8504272-5|[5]]]</sup>
 
|
===Cutaneous mucormycosis===
* Acquired by:
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. <ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection &#124; JAMA &#124; 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>
** Inhalation
 
** Hematogenous spread
===Gastrointestinal mucormycosis===
** Lymphatic spread
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. Ingestion of the fungi are the most common route of transmission. Symptoms include abdominal distension, pain, nausea, vomiting and hematochezia. Biopsy via endoscopy is required to confirm the diagnosis.
|
 
* [[Dyspnea]]
===Disseminated mucormycosis===
* [[Cough]]
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 involoved 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 %) <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 &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref> Infarctions in multiple organs in an immunosuppressed patient points towards disseminated mucormycosis.
* Chest pain  
* [[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|Disseminated infection]]<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
|


|
* Acquired by disruption of the physiologic [[skin]] barrier:
** [[Physical trauma|Trauma]]
** [[Maceration|Skin maceration]] 
** [[Burn|Burns]]
** Contaminated surgical dressings<ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection &#124; JAMA &#124; The JAMA Network |format= |work= |accessdate=}}</ref>
|
* Skin redness
* Numbness
* Warmth


* Skin ulceration and necrosis
|
* [[Disseminated disease|Disseminated infection]]<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
|
*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
|
* Rare occurrence
* Acquired by:
** Ingestion of [[Fungus|Fungi]]
|
* [[Abdomen|Abdominal]] distension
* [[Pain]]
* [[Nausea]]
* [[Vomiting]]
* [[Hematochezia]]
|
* [[Disseminated disease|Disseminated infection]]
|-
|[[Disseminated disease|Disseminated]] mucormycosis
|
*Patients on [[Immunosuppressive drug|immunosupressants]] and [[Antifungal drug|anti-fungal]] [[prophylaxis]] (escpecially [[voriconazole]]) are particularly susceptible to [[Disseminated disease|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 &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref>
|
* Acquired by:
** 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 [[Disseminated disease|dissemination]] leading to:
** [[Seizure|Seizures]]
** [[Stroke]]
** [[Paralysis]]
** [[Abscess]] formation
* [[Spleen|Splenic]] [[infarction]]
* [[Myocardial]] [[necrosis]]
* [[liver]]
* [[skin]]
|
* High [[case fatality rate]]<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>
|}


==References==
==References==
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{{WH}}
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{{WS}}
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[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Otolaryngology]]
[[Category:Nephrology]]
[[Category:Dermatology]]
[[Category:Pulmonology]]

Latest revision as of 22:45, 29 July 2020

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
Pulmonary mucormycosis
  • Acquired by:
    • Inhalation
    • Hematogenous spread
    • Lymphatic spread
Cutaneous mucormycosis
  • Skin redness
  • Numbness
  • Warmth
  • Skin ulceration and necrosis
Gastrointestinal mucormycosis
  • Rare occurrence
  • Acquired by:
Disseminated mucormycosis
  • Acquired by:
    • Hematogenous spread is usually the most common route of dissemination and pulmonary mucormycosis is usually the culprit

References

  1. ↑ "Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library".
  2. ↑ "Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic".
  3. ↑ Margo CE, Linden C, Strickland-Marmol LB, Denietolis AL, McCaffrey JC, Kirk N (2007). "Rhinocerebral mucormycosis with perineural spread". Ophthal Plast Reconstr Surg. 23 (4): 326–7. doi:10.1097/IOP.0b013e318070855b. PMID 17667114.
  4. ↑ Hosseini SM, Borghei P (2005). "Rhinocerebral mucormycosis: pathways of spread". Eur Arch Otorhinolaryngol. 262 (11): 932–8. doi:10.1007/s00405-005-0919-0. PMID 15891927.
  5. ↑ Khor BS, Lee MH, Leu HS, Liu JW (2003). "Rhinocerebral mucormycosis in Taiwan". J Microbiol Immunol Infect. 36 (4): 266–9. PMID 14723256.
  6. ↑ "Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library".
  7. ↑ 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.
  8. ↑ "Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7".
  9. ↑ "Cutaneous Rhizopus Infection | JAMA | The JAMA Network".
  10. ↑ "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".
  11. ↑ "www.nature.com" (PDF).
  12. ↑ "GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation".
  13. ↑ "Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library".
  14. ↑ "Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic".
  15. ↑ STRAATSMA BR, ZIMMERMAN LE, GASS JD (1962). "Phycomycosis. A clinicopathologic study of fifty-one cases". Lab. Invest. 11: 963–85. PMID 13984484.

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