Mucormycosis classification: Difference between revisions
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===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> | |||
===Cutaneous mucormycosis=== | ===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. <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> | |||
===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. 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. | |||
===Disseminated mucormycosis=== | ===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 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 | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> Infarctions in multiple organs in an immunosuppressed patient points towards disseminated mucormycosis. | |||
Revision as of 15:42, 26 May 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 terbinates 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 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.
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 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 %) [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".