Mucormycosis
Reviewed and revised 29 July 2015
OVERVIEW
- Mucormycosis is the unifying term used to describe infections caused by fungi belonging to the order Mucorales (e.g. Rhizopus, Rhizomucor, Mucor, and Absidia).
- Rhinocerebral mucormycosis is severe sinusitis with caused by a non-Aspergillus mold, most commonly Rhizopus arrhizus
CLINICAL FEATURES
Rhinocerebral mucormycosis
- headache
- facial pain
- confusion
- fever
- purulent nasal discharge (black)
Other manifestations:
- pneumonia (associated with prolonged neutropenia): dyspnea, cough, hemoptysis
- cutaneous (black lesions)
- GI
- CNS
Complications
- intraorbital extension
- intracranial extension (e.g. leptomeningeal enhancement, intracranial granuloma, epidural abscess)
- vascular invasion (e.g. cavernous or venous sinus thrombosis, mycotic aneurysm formation, cerebral infarction or haemorrhage, systemic dissemination)
RISK FACTORS
- diabetes mellitus (especially wit ketoacidosis)
- burns
- chronic renal failure
- cirrhosis
- immunosuppression
- iron overload and desferrioxamine treatment (iron chelator)
INVESTIGATIONS
- blood cultures
- tissue biopsies
Pulmonary mucormycosis
- CXR and CT Chest – lobar consolidation, isolated masses, nodular disease, cavitation, or wedge-shaped infarcts (angioinvasive disease); reversed halo sign on CT (a focus of ground glass surrounded by a solid ring of consolidation)
- BAL
Rhinocerebral mucormycosis
- CT:
- mucosal thickening (hypoattenuating; e.g. black turbinate sign)
- opacification of the sinus (in acute fungal sinusitis, unlike in chronic infection, hyperdense material may not be seen in the sinus cavity)
- bone destruction
- stranding of fat on the outside of the sinus
- MRI is the modality of choice for demonstrating soft tissue involvement
MANAGEMENT
General
- resuscitation
- supportive care and monitoring
- treat underlying cause and complications (e.g. DKA, immunosuppression, nutrition, GCSF)
Specific
- surgical debridement
- amphotericin B
- consider hyperbaric oxygen
PROGNOSIS
- depending on comorbidities and underlying immunosuppression, mortality may range from ~ 20-80%
References and Links
Journal articles
- Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011 Aug 4;118(5):1216-24. PMC3292433.
- Pak J, Tucci VT, Vincent AL, Sandin RL, Greene JN. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock. 2008 Jul;1(2):106-13. PMC2700608.
- Quan C, Spellberg B. Mucormycosis, pseudallescheriasis, and other uncommon mold infections. Proc Am Thorac Soc. 2010 May;7(3):210-5. PMC3266012.
FOAM and web resources
- Radiopaedia — Pulmonary mucormycosis, Rhinocerebral mucormycosis,
- Radiology signs — Black turbinate sign
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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