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| | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Mucormycosis | | | Name = Zygomycosis | |
| Image = Periorbital fungal infection known as mucormycosis, or phycomycosis PHIL 2831 lores.jpg | | | Image = Periorbital fungal infection known as mucormycosis, or phycomycosis PHIL 2831 lores.jpg | |
| Caption = Periorbital fungal infection known as mucormycosis, or phycomycosis| | | Caption = Periorbital fungal infection known as mucormycosis, or phycomycosis| |
| DiseasesDB = 31759, 31329 |
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| ICD10 = {{ICD10|B|46|0|b|35}}-{{ICD10|B|46|5|b|35}} |
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| ICD9 = {{ICD9|117.7}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000649 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| eMedicine_mult = |
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| MeshID = D009091, D020096 |
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| }} | | }} |
| {{DiseaseDisorder infobox | | | {{Zygomycosis}} |
| Name = Phycomycosis |
| | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} |
| Image = |
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| Caption = |
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| ICD10 = {{ICD10|B|46||b|35}} |
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| ICD9 = {{ICD9|117.7}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 31329 |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D020096 |
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| }}
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| {{Infobox_Disease |
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| Name = Basidiobolomycosis |
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| Image = |
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| Caption = |
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| DiseasesDB = |
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| ICD10 = {{ICD10|B|46||b|35}} |
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| ICD9 = {{ICD9|117.7}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000649 |
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| eMedicineSubj = med |
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| eMedicineTopic = 2735 |
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| eMedicine_mult = {{eMedicine2|med|1513}} |
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| MeshName = Mucormycosis |
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| MeshNumber = D009091 |
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| {{SI}} | |
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| {{CMG}} | | {{SK}} Zygomycosis |
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| ==Overview== | | ==[[Zygomycosis overview|Overview]]== |
| '''Mucormycosis''' (also known as '''zygomycosis'''<ref name="micol">{{cite journal |author=Toro C, Del Palacio A, Alvarez C, ''et al'' |title=[Cutaneous zygomycosis caused by Rhizopus arrhizus in a surgical wound.] |language=Spanish; Castilian |journal=[[Rev Iberoam Micol]] |volume=15 |issue=2 |pages=94–6 |year=1998 |pmid=17655419 |doi= |url=http://www.reviberoammicol.com/pubmed_linkout.php?15p94 |accessdate=2008-04-20}}</ref> or '''phycomycosis'''<ref name="maxilla"/>) is a rare yet life threatening and serious infection of fungi, usually affecting the face or oropharyngeal cavity.<ref name=Emedicine>{{cite web |url=http://www.emedicine.com/med/topic1513.htm |title= Mucormycosis |author= Nancy F Crum-Cianflone, MD MPH |publisher=eMedicine|accessdate=2008-01-20 |format= |work=}}</ref> Occasionally, when caused by [[Pythium]] or other similar [[fungus|fungi]], the condition may affect the [[gastrointestinal tract]] or the [[skin]]. It usually begins in the nose and paranasal [[sinuses]] and is one of the most rapidly spreading fungal infections in humans.<ref name="maxilla">{{cite journal |author=Auluck A |title=Maxillary necrosis by mucormycosis. a case report and literature review |journal=Med Oral Patol Oral Cir Bucal |volume=12 |issue=5 |pages=E360–4 |year=2007 |pmid=17767099 |doi= |url=http://www.medicinaoral.com/medoralfree01/v12i5/medoralv12i5p360.pdf |accessdate=2008-04-20}}</ref> The most common fungi responsible for mucormycosis in humans are ''[[Mucor]]'' and ''[[Rhizopus]]''. Other fungi include ''[[Apophysomyces]]'', ''[[Absidia]]'', ''[[Mortierella]]'', ''Cunninghamella'', ''Saksenaea'', ''Syncephalastrum'' and ''Cokeromyces'',<ref name=Emedicine/> although the spectrum is far wider and can also contain [[Entomophthorales]] or [[Mucorales]].<ref name=Ettinger_1995>{{cite book|author=Ettinger, Stephen J.;Feldman, Edward C.|title=Textbook of Veterinary Internal Medicine|edition=4th ed.|publisher=W.B. Saunders Company|year=1995|id=ISBN 0-7216-6795-3}}</ref> It usually affects patients who are [[immunocompromised]].<ref name="maxilla"/>
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| '''Basidiobolomycosis''' is a rare disease caused by the [[fungus]] [[Basidiobolus ranarum]], member of the class [[Zygomycota|Zygomycetes]], order [[Entomophthorales]], found worldwide. Usually basidiobolomycosis is a subcutaneous infection but it has been associated with gastrointestinal disease.
| | ==[[Zygomycosis historical perspective|Historical Perspective]]== |
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| ==Cause== | | ==[[Zygomycosis pathophysiology|Pathophysiology]]== |
| Mucormycosis is often caused by common fungi which can be found in soil and decaying vegetation. While most individuals are exposed to the fungi on a regular basis those with immune disorders are more prone to an infection.<ref name=medplus>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000649.htm |title=MedlinePlus Medical Encyclopedia: Mucormycosis |format= |work= |accessdate=2008-04-21}}</ref>
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| ==Signs and symptoms== | | ==[[Zygomycosis causes|Causes]]== |
| Mucormycosis frequently involves the [[Paranasal sinus|sinuses]], [[brain]], or [[lungs]] as the sites of infection. Whilst orbitorhinocerebral mucormycosis is the most common type of the disease, this infection can also manifest in the [[gastrointestinal tract]], [[skin]], and in other organ systems.<ref name=Emedicine/> The clinical [[hallmark]] of mucormycosis is [[vascular]] invasion resulting in [[thrombosis]] and tissue [[infarction]]/[[necrosis]].<ref name=cmrasm/>
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| If rhinocerebral disease is the cause of the infection, symptoms may include [[unilateral]], retro-orbital [[headache]], facial pain, [[fevers]], nasal stuffiness that progresses to black [[discharge]], acute sinusitis, and eye swelling along with protrusion of eye orbit.<ref name=medplus/> In addition, affected skin may appear relatively normal during the earliest stages of infection. This skin quickly progresses to an [[erythemic]] (reddening, occasionally with [[edema]]) stage, before eventually turning black due to necrosis.<ref name=cmrasm>{{cite journal |author=Spellberg B, Edwards J, Ibrahim A |title=Novel perspectives on mucormycosis: pathophysiology, presentation, and management |journal=Clin. Microbiol. Rev. |volume=18 |issue=3 |pages=556–69 |year=2005 |pmid=16020690 |doi=10.1128/CMR.18.3.556-569.2005| url=http://cmr.asm.org/cgi/content/full/18/3/556}} {{PMC|1195964}}</ref> However, in other forms of mucormycosis (such as pulmonary, cutaneous or disseminated mucormycosis), symptoms may also include [[dyspnea]], persistent [[cough]], [[hemoptysis]] (in cases of necrosis and [[nausea]]/[[vomiting]]), coughing blood, and abdominal pain..<ref name=Emedicine/><ref name=medplus/>
| | ==[[Zygomycosis differential diagnosis|Differentiating Zygomycosis from other Diseases]]== |
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| Rarely, [[maxilla]] may be affected by mucormycosis.<ref name="maxilla"/> The lack of case reports regarding maxillofacial mucormycosis lies in the rich vascularity of the maxillofacial areas preventing fungal infections, although this can be overcome by more prevalent fungi, bacteria or viruses such as those responsible for mucormycosis.<ref name="maxilla"/>
| | ==[[Zygomycosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| Predisposing factors for mucormycosis include [[AIDS]], malignancies such as [[lymphoma]]s and [[leukemia]]s, [[renal failure]], [[organ transplant]], long term [[corticosteroid]] and immunosuppressive therapy, [[cirrhosis]], [[burns]] and energy [[malnutrition]].<ref name="maxilla"/>
| | ==[[Zygomycosis risk factors|Risk Factors]]== |
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| Possible complications of mucormycosis include the partial loss of neurological function, blindness and clotting of brain or lung vessels.<ref name=medplus/>
| | ==[[Zygomycosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Basidiobolomycosis is usually a superficial infection of skin, but may very rarely cause lesions of the bowel or liver, mimicking bowel cancer,<ref>{{cite journal | title=A fatal pseudo-tumour: disseminated basidiobolomycosis | author=Van den berk GEL, Noorduyn LA, van Ketel RJ, ''et al.'' | journal=BMC Infect Dis | year=2006 | volume=6 | pages=140 | doi=10.1186/1471-2334-6-140 }}</ref> or [[Crohn's disease]].<ref>{{cite journal | journal=Clin Infect Dis | year=1999 | volume=28 | issue=6 | pages=1244–8 | title=Gastrointestinal zygomycotic infection caused by ''Basidiobolus ranarum:'' case report and review | author=Zavasky DM, Samowitz W, Loftus T, Segal H, Carroll K }}</ref> In patients with deep involvement, the [[eosinophil]] count may be raised, falsely suggesting a parasitic infection.
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| ==Diagnosis== | | ==Diagnosis== |
| [[Image:PHIL 3960 highres.jpg|thumb|left|200px|This photomicrograph reveals a mature sporangium of a Mucor sp. fungus, which can be responsible for mucormycosis]]
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| As [[swab]]s of tissue or discharge are generally unreliable, the diagnosis of mucormycosis tends to be established by a [[biopsy]] specimen of the involved tissue. Computerised imaging techniques such as [[MRI]]s, [[CT scan]]s and [[X-ray]]s may be useful in the diagnosis of specific areas.<ref name=Emedicine/><ref name=HealthAtoZ>{{cite web|title=Mucormycosis|author=Rebecca J. Frey, PhD|url=http://www.healthatoz.com/healthatoz/Atoz/Atoz/ency/mucormycosis.jsp|publisher=Health A to Z|accessdate=2008-01-20}}</ref> Differentials to consider in diagnosis of the infection include [[anthrax]], [[aspergillosis]] and [[cellulitis]].<ref name=Emedicine/>
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| Diagnosis for phycomycosis is through a [[biopsy]] or [[microbiological culture|culture]], although an [[ELISA]] test has been developed for ''Pythium insidiosum'' in animals.<ref name=Hensel>{{cite journal |author=Hensel P, Greene C, Medleau L, Latimer K, Mendoza L |title=Immunotherapy for treatment of multicentric cutaneous pythiosis in a dog |journal=J Am Vet Med Assoc |volume=223 |issue=2 |pages=215-8, 197 |year=2003 |id=PMID 12875449}}</ref>
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| Diagnosis for basidiobolomycosis is by laboratory culture of the organism, usually from pieces of tissue taken from the patient. It grows easily on most media, but risks being discarded as irrelevant or being reported as a contaminant because laboratory staff are unfamiliar with it.
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| Diagnosis is often difficult because basidiobolomycosis is a rare disease and therefore often not recognised. The lesions often look like tumours rather than infection, so often no sample is sent for microbiology, however, the histopathology is characteristic: the [[Splendore-Hoeppli phenomenon]] describes the presence of fungal hyphae (which may exist only as ghosts on the slide) surrounded by eosinophilic material.
| | [[Zygomycosis history and symptoms|History and Symptoms]] | [[Zygomycosis physical examination|Physical Examination]] | [[Zygomycosis laboratory findings|Laboratory Findings]] | [[Zygomycosis x ray|X Ray]] | [[Zygomycosis CT|CT]] | [[Zygomycosis MRI|MRI]] | [[Zygomycosis other imaging findings|Other Imaging Findings]] | [[Zygomycosis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| If mucormycosis is suspected, prompt [[amphotericin B]] therapy should be administered due to the rapid spread and mortality rate of the disease. Amphotericin B (which works by damaging the [[cell wall]]s of the fungi) is usually administered for a further 4-6 weeks after initial therapy begins to ensure eradication of the infection. [[Posaconazole]] has been shown to be effective against mucormycosis, perhaps more so than amphotericin B, but has not yet replaced it as the standard of care. After administration the patient must then be admitted to surgery for removal of the "[[fungus ball]]". The disease must be monitored carefully for any signs of reemergence.<ref name=HealthAtoZ/>
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| Surgical therapy can be very drastic, and in some cases of Rhinocerebral disease removal of infected brain tissue may be required. In some cases surgery may be disfiguring because it may involve removal of the [[palate]], [[nasal cavity]], or [[Eye#Three_layers|eye structure]]s.<ref name=medplus/> Surgery may be extended to more than one operation.<ref name=Emedicine/> It has been hypothesised that [[hyperbaric]] [[oxygen]] may be beneficial as an adjunctive therapy because higher oxygen [[pressure]] increases the ability of [[Neutrophil granulocyte|neutrophils]] to kill the organism.<ref name="cmrasm"/>
| | [[Zygomycosis medical therapy|Medical Therapy]] | [[Zygomycosis surgery|Surgery]] | [[Zygomycosis primary prevention|Primary Prevention]] | [[Zygomycosis secondary prevention|Secondary Prevention]] | [[Zygomycosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Zygomycosis future or investigational therapies|Future or Investigational Therapies]] |
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| Treatment for Phycomycosis is very difficult and includes [[surgery]] when possible. Postoperative recurrence is common. [[Antifungal drug]]s show only limited effect on the disease, but [[itraconazole]] and [[terbinafine|terbinafine hydrochloride]] are often used for two to three months following surgery.<ref name=Grooters_2003/> Humans with ''Basidiobolus'' infections have been treated with [[amphotericin B]] and [[potassium iodide]].<ref name=Greene/> For pythiosis and lagenidiosis, a new drug targeting water moulds called [[caspofungin]] is available, but it is very expensive.<ref name=Grooters_2003/> [[Immunotherapy]] has been used successfully in humans and horses with pythiosis.<ref name=Hensel/>
| | ==Case Studies== |
| | | [[Zygomycosis case study one|Case #1]] |
| Treatment for skin lesions is traditionally with [[potassium iodide]],<ref>{{cite journal | journal=Ann Trop Paediatr | year=1997 | volume=17 | issue=2 | pages=161–4 | title=Invasive retroperitoneal infection due to ''Basidiobolus ranarum'' with response to potassium iodide—case report and review of the literature | author=Nazir Z, Hasan R, Pervaiz S, Alam M, Moazam F. | id=PMID 9230980 }}</ref> but [[itraconazole]] has also been used successfully.<ref>{{cite journal | title=Invasive gastrointestinal Basidiobolus ranarum infection in an immunocompetent child (brief report) | journal=Ped Infect Dis J | volume=22 | issue=3 | pages=281–82 | year=2003
| | ==Related Chapters== |
| | author=Yusuf NW, Assaf HM, Rotowa N | url=http://www.pidj.org/pt/re/pidj/abstract.00006454-200303000-00017.htm;jsessionid=FTfGLBRhv2R67Pf9kryJv3wqjTGmvvMXQpXG4qdjMJZThvwyDQ2L!1671728877!-949856145!8091!-1 }}</ref><ref>{{cite journal | author=Mathew RM, Kumaravel S, Kuruvilla S, ''et al.'' | title=Successful treatment of extensive basidiobolomycosis with oral itraconazole in a child | journal=Int J Dermatol | volume=44 | issue=7 | year=2005 | pages=572–75 }}</ref>
| | *[[Phycomycosis]] |
| | | {{Mycoses}} |
| ==Prognosis==
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| In most cases, the prognosis of mucormycosis is poor and has varied mortality rates depending on its form and severity. In the Rhinocerebral form, the mortality rate is between 30% and 70%, whereas disseminated mucormycosis presents with the highest mortality rate in an otherwise healthy patient with a mortality rate of up to 90%.<ref name=cmrasm/> Patients with [[AIDS]] have a mortality rate of almost 100%.<ref name=HealthAtoZ/>
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| ==Pythiosis==
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| [[Image:Pythiosis 2.jpg|thumb|left|Ulcerative and destructive skin lesion on a dog caused by Pythium insidiosum]]
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| Pythiosis is caused by ''[[Pythium insidiosum]]'' and occurs most commonly in dogs and [[horse]]s, but is also found in [[cat]]s, [[cow|cattle]], and humans. In the United States it is most commonly found in the Gulf states, especially [[Louisiana]], but has been found in midwest and eastern states. It is also found in [[southeast Asia]], eastern [[Australia]], [[New Zealand]], and [[South America]]. Pythiosis occurs in areas with mild winters due to the organism surviving in standing water that does not reach freezing temperatures.<ref name=Helman>{{cite journal |author=Helman R, Oliver J |title=Pythiosis of the digestive tract in dogs from Oklahoma |journal=J Am Anim Hosp Assoc |volume=35 |issue=2 |pages=111-4 |year=1999 |id=PMID 10102178}}</ref> ''Pythium'' occupies swamps in late summer and infects dogs who drink water containing it. The disease is typically found in young, large breed dogs.<ref name=Ettinger_1995/>
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| It is suspected that pythiosis is caused by invasion of the organism into wounds, either in the skin or in the gastrointestinal tract.<ref name=Helman/> The disease grows slowly in the [[stomach]] and [[small intestine]], eventually forming large lumps of [[granulation tissue]]. It can also invade surrounding [[lymph node]]s. Symptoms include vomiting, diarrhea, depression, weight loss, and a mass in the abdomen. Pythiosis of the skin in dogs is very rare, and appears as [[ulcer]]ated lumps. Primary infection can also occur in the bones and lungs.
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| [[Image:Pythiosis hyphae.jpg|thumb|left|''Pythium'' hyphae]]
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| In horses, [[subcutis|subcutaneous]] pythiosis is the most common form and infection occurs through a wound while standing in water containing the pathogen.<ref name=Liljebjelke>{{cite journal |author=Liljebjelke K, Abramson C, Brockus C, Greene C |title=Duodenal obstruction caused by infection with Pythium insidiosum in a 12-week-old puppy |journal=J Am Vet Med Assoc |volume=220 |issue=8 |pages=1188-91, 1162 |year=2002 |id=PMID 11990966}}</ref> The disease is also known as '''leeches''', '''swamp cancer''', and '''bursatti'''. Lesions are most commonly found on the lower limbs, abdomen, chest, and genitals. They are [[granuloma]]tous and itchy, and may be ulcerated or [[fistula]]ted. The lesions often contain yellow, firm masses of dead tissue known as '''kunkers'''.<ref name=Merck_oo>{{cite web | title = Oomycosis | work = The Merck Veterinary Manual | date = 2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51112.htm | accessdate = 2007-02-03 }}</ref> It is possible with chronic infection for the disease to spread to underlying bone.<ref>{{cite journal |author=Worster A, Lillich J, Cox J, Rush B |title=Pythiosis with bone lesions in a pregnant mare |journal=J Am Vet Med Assoc |volume=216 |issue=11 |pages=1795-8, 1760 |year=2000 |id=PMID 10844973}}</ref>
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| In humans it can cause [[arteritis]], [[keratitis]], and [[periorbital]] [[cellulitis]].<ref name=Grooters_2003>{{cite journal |author=Grooters A |title=Pythiosis, lagenidiosis, and zygomycosis in small animals |journal=Vet Clin North Am Small Anim Pract |volume=33 |issue=4 |pages=695-720, v |year=2003 |id=PMID 12910739}}</ref>
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| In cats pythioisis is almost always confined to the skin as hairless and edematous lesions. It is usually found on the limbs, [[perineum]], and at the base of the tail.<ref name=Wolf_2005>{{cite book|editor=August, John R. (ed.)|chapter=Opportunistic fungal infections|author=Wolf, Alice|title=Consultations in Feline Internal Medicine Vol. 5|publisher=Elsevier Saunders|year=2005|id=ISBN 0-7216-0423-4}}</ref> Lesions may also develop in the [[nasopharynx]].<ref name=Merck_oo/>
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| ''Pythium insidiosum'' is different from other members of the genus in that human and horse hair, skin, and decaying animal tissue are [[chemoattractant]]s for its [[zoospore]]s, in addition to decaying plant tissue.<ref name=Liljebjelke/>
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| ==Zygomycosis==
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| Zygomycosis usually is a disease of the skin, but can also occur in the sinuses or gastrointestinal tract. In humans it is most prevalent in immunocompromised patients ([[AIDS|HIV/AIDS]], the [[old age|elderly]], [[Severe combined immunodeficiency|SCID]], etc) and patients in acidosis (diabetes, burns), particularly after barrier injury to the skin or mucus membranes. Zygomycosis caused by ''Mucorales'' causes a rapidly progressing disease of sudden onset in sick or [[immunodeficiency|immunocompromised]] animals. ''Entomophthorales'' cause chronic, local infections in otherwise healthy animals. The important species that cause '''entomophthoromycosis''' are ''Conidiobolus coronatus'', ''C. incongruous'', and ''[[Basidiobolus ranarum]]''. ''Conidiobolus'' infections of the upper respiratory system have been reported in humans, sheep, horses, and dogs, and ''Basidiobolus'' has been reported less commonly in humans and dogs.<ref name=Greene>{{cite journal |author=Greene C, Brockus C, Currin M, Jones C |title=Infection with Basidiobolus ranarum in two dogs |journal=J Am Vet Med Assoc |volume=221 |issue=4 |pages=528-32, 500 |year=2002 |id=PMID 12184703}}</ref> Horses are one of the most common domestic animals to be affected by entomophthoromycosis. ''C. coronatus'' causes lesions in the nasal and oral [[mucous membrane|mucosa]] of horses that may cause nasal discharge or difficulty breathing. ''B. ranarum'' causes large circular nodules on the upper body and neck of horses.<ref>{{cite web | title = Zygomycosis | work = The Merck Veterinary Manual | date = 2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51118.htm | accessdate = 2007-02-03 }}</ref> ''Entomophthorales'' is found in soil and decaying plant matter, and specifically ''Basidiobolus'' can be contracted from insects and the feces of reptiles or amphibians.<ref name=Grooters_2003/>
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| Zygomycosis of the sinuses can extend from the sinuses into the orbit and the cranial vault, leading to rhinocerebral mucormycosis.
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| ==Lagenidiosis==
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| The best known species of ''Lagenidium'' is ''[[Lagenidium giganteum]]'', a parasite of ''mosquito'' larvae used in [[biological pest control|biological control]] of mosquitoes. Two different species cause disease exclusively in dogs: ''L. caninum'' and ''L. karlingii''. Lagenidiosis is found in the southeastern United States in lakes and ponds. It causes progressive skin and subcutaneous lesions in the legs, groin, trunk, and near the tail. The lesions are firm nodules or ulcerated regions with [[draining tract]]s. Regional lymph nodes are usually swollen. Spread of the disease to distant lymph nodes, large blood vessels, and the lungs may occur.<ref name=Grooters_2003/> An [[aneurysm]] of a [[great vessels|great vessel]] can rupture and cause sudden death.<ref name=Merck_oo/> ''L. caninum'' is the more aggressive species and is more likely to spread to other organs than ''L. karlingii''.<ref name=forum>{{cite journal | last = Todd-Jenkins | first = Karen | coauthors = | title = A new disease: clinically interesting for all the right reasons | journal = Veterinary Forum | volume = 24 | issue = 9 | pages = 18-20 | publisher = Veterinary Learning Systems | date = September 2007 }}</ref>
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| ==Epidemiology==
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| Mucormycosis is a very rare infection, and as such it is hard to note histories of patients and incidence of the infection.<ref name=Emedicine/> However, one American oncology center revealed that mucormycosis was found in 0.7% of [[autopsy|autopsies]] and roughly 20 patients per every 100,000 admissions to that center.<ref name=HealthAtoZ/> In the [[United States]], mucormycosis was most commonly found in the form of Rhinocerebral disease. In most cases the patient is immunocompromised, although rare cases have occurred in which the subject was not immunocompromised, most often due to a [[Physical trauma|traumatic]] [[inoculation]] of fungal [[spores]]. Internationally, mucormycosis was found in 1% of patients with [[acute]] [[leukemia]] in an [[Italy|Italian]] review.<ref name=Emedicine/>
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| Some 50-75% of patients diagnosed with mucormycosis are estimated to have underlying poorly controlled [[diabetes mellitus]] and [[ketoacidosis]].
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| ==References==
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| {{reflist|2}}
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| {{SIB}}
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| {{Mycoses}}
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| [[Category:Infectious disease]] | | [[Category:Fungal diseases]] |
| [[Category:Parasitic fungi]] | | [[Category:Parasitic fungi]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Chapter:Disease state]] | | [[Category:Disease]] |
| [[Category:Mature chapter]] | | [[Category:Mature chapter]] |
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