Fungus

Mucormycosis

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Mucormycosis, Zygomycosis

See Also

Fungal Infection

Pathophysiology

Opportunistic Fungal Infection
Caused by filamentous molds of the order Mucorales (phyllum Zygomycota), ubiquitous in the environment
1. Rhizopus
2. Rhizomucor
3. Mucor
4. Lichtheimia
Vascular invasion
1. Risk of thrombosis and tissue infarction
Transmission
1. Contaminated food
2. Spore inhalation (nose, lungs)
3. Skin Wounds

Risk Factors

Otherwise healthy patients represent <10% of cases
Severe Immunocompromised State (developed countries)
1. Hematologic Malignancy
2. Organ Transplant
3. Neutropenia
4. Autoimmune disorders
5. Defuroxamine Use (for iron chelation)
Other associated conditions (esp. developing countries)
1. Poorly controlled Diabetes Mellitus
2. Trauma or Burn Injury

Types
Based on Distribution

Rhino-orbital-cerebral Mucormycosis (ROCM)
1. Most common type in Diabetes Mellitus
2. Aggressive invasion of sinuses, cranial bones and vasculature
Pulmonary Mucormycosis
1. Common type in Hematologic Malignancy
2. Uncommon type in Diabetes Mellitus
Cutaneous Mucormycosis
Gastrointestinal Mucormycosis
Disseminated Mucormycosis
1. Common type in Hematologic Malignancy
Mucormycosis of uncommon sites

Diagnosis

Diagnosis is based on lesion histopathology, PCR and culture
1. Mucorales are irregular, nonseptate hyphae and with branching at right angles
Blood Cultures are typically negative

Management

Precautions
1. Prompt management is critical to survival
2. Mucormycosis may be rapidly progressive
3. Prognosis may worsen with each day of delayed diagnosis
First-Line Antifungals
1. Amphotericin B Lipid Formulation (LFAB)
Alternative Antifungals (Triazoles)
1. Posaconazole (POSA)
2. Isavuconazole (ISAV)
Surgical management (adjunctive)
1. Surgical Debridement or excision

Prognosis

Localized, cutaneous Mucormycosis: 10-30% mortality
Invasive Mucormycosis: 30-50% mortality
Disseminated Mucormycosis: 90% mortality

References