Mucormycosis is a fungal infection that can be caused by many different species of molds.
The infection usually develops after spores produced by the mold are inhaled or, much less commonly, when they enter the body through a cut or other break in the skin.
The infection causes pain, fever, and sometimes cough and can destroy structures in the face.
Doctors diagnose the infection by identifying the fungus in tissue samples.
Most people are given high doses of amphotericin B intravenously, and surgery is done to remove infected and dead tissue.
(See also Overview of Fungal Infections.)
Mucormycosis most commonly occurs when people inhale the spores produced by the molds. It can also develop if the spores enter through a break in or injury to the skin.
Many different species of fungi can cause mucormycosis. These species belong to a large group of molds called Mucorales. These molds include Rhizopus, Rhizomucor, and Mucor. Each species causes similar symptoms.
These molds are commonly found in soil, fallen leaves, compost, animal waste, and air and include many common bread molds. People probably breathe in the spores of these molds all the time. However, these molds usually do not cause infection in people with a healthy immune system.
Mucormycosis is most common among people have a weakened immune system such as people who:
Do not have well-controlled diabetes
Have an immune system weakened by medications that suppress the immune system, such as steroids (also sometimes called glucocorticoids or corticosteroids) or by leukemia or other disorders that weaken the immune system
Take the medication deferoxamine to treat Take the medication deferoxamine to treatiron overload
When the infection results from breathing in the spores, the nose, sinuses, and eyes are most often infected. The infection can spread to the brain, causing rhino-orbital-cerebral mucormycosis. The spores can enter the lungs, causing pulmonary mucormycosis. When spores inhaled into the mouth are swallowed, the digestive tract can be infected, causing gastrointestinal mucormycosis.
When the infection results from spores entering through a break in or injury to the skin, it causes cutaneous mucormycosis. This form can occur in people with a healthy immune system if soil containing spores comes in contact with a wound, as may occur during earthquakes or other natural disasters or in people injured in blast injuries during combat.
The fungus tends to invade arteries. As a result, blood clots form in the arteries, blood flow to tissues is blocked, and tissue dies. The fungus grows uncontrolled in the dead tissue, which turns black. The surrounding area may bleed.
Symptoms of Mucormycosis
Rhino-orbital-cerebral mucormycosis may cause pain, fever, sinus pain, and, if the eye socket is infected (called orbital cellulitis), bulging of the affected eye (proptosis). Vision may be lost.
The roof of the mouth (palate), the facial bones surrounding the eye socket or sinuses, or the divider between the nostrils (septum) may be destroyed by the infection. The dead tissue turns black.
Infection in the brain may cause difficulty using and understanding language, seizures, partial paralysis, and coma.
In rhino-orbital mucormycosis, people inhale certain fungi, which infect the nose, sinuses, and eyes. When the eyes are infected, the tissue of the orbit may die as shown in this photo.
Pulmonary mucormycosis causes severe symptoms, including high fever, cough, and difficulty breathing. Without treatment, pulmonary mucormycosis is fatal.
In cutaneous mucormycosis, the area around the break in the skin may be warm, red, swollen, and painful. People may have a fever. Ulcers or blisters may form, and the infected tissue may turn black.
Diagnosis of Mucormycosis
Culture and examination of samples of infected tissue
Tests to detect DNA of the fungus
To diagnose mucormycosis, a doctor takes samples of infected tissue and sends them to a laboratory to be grown (cultured) and examined under a microscope. The diagnosis is made when the fungus is identified in the samples. However, sometimes these tests do not clearly show the fungus.
Tests that detect genetic material in microorganisms, such as the PCR test, can be done. The PCR test is used to produce many copies of a gene from the fungus, making the fungus much easier to identify.
Doctors may do computed tomography (CT) scans or x-rays to check for damage to facial structures.
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Treatment of Mucormycosis
Antifungal medications
Treatment of the underlying condition
Surgery to remove infected and dead tissue
Early diagnosis and treatment of mucormycosis are important to prevent death or to avoid extensive surgery, which often causes disfigurement. Thus, treatment is started as soon as this infection is diagnosed or suspected.
Most people with mucormycosis or suspected mucormycosis are treated with high doses of the antifungal medication amphotericin B given intravenously. Isavuconazonium, taken by mouth or given intravenously, is an alternative. Another antifungal medication called posaconazole may also be given.Most people with mucormycosis or suspected mucormycosis are treated with high doses of the antifungal medication amphotericin B given intravenously. Isavuconazonium, taken by mouth or given intravenously, is an alternative. Another antifungal medication called posaconazole may also be given.
Controlling the underlying condition is very important. For example, people taking deferoxamine may be able to stop taking that medication. People with uncontrolled diabetes are given insulin to lower blood sugar levels.may be able to stop taking that medication. People with uncontrolled diabetes are given insulin to lower blood sugar levels.
Infected tissue and especially dead tissue must be removed by surgery.
Prognosis for Mucormycosis
Mucormycosis is very serious. Even when as much infected and dead tissue as possible is removed and antifungal medications are used appropriately, this infection is fatal for many people.
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