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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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