Zygomycosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
In most cases, the prognosis of zygomycosis 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 100%. Patients with [[AIDS]] have a mortality rate of almost 100%. Possible complications of mucormycosis include the partial loss of [[neurological]] function, blindness and [[clot]]ting of brain or lung vessels. | |||
==Natural History, | == Natural History<ref name="pmid24371499">{{cite journal |vauthors=Nicolae M, Popescu CR, Popescu B, Grigore R |title=Orbital complications of fungal pan-sinusitis in uncontrolled diabetes |journal=Maedica (Buchar) |volume=8 |issue=3 |pages=276–9 |year=2013 |pmid=24371499 |pmc=3869119 |doi= |url=}}</ref> == | ||
If left untreated, mucormycosis can be fatal. The survival rate of immunosuppressed patients with rhino sinusal mucormycosis without cerebral involvement is between 50-80% and only 10% if the infection spreads into the brain. In uncontrolled diabetes mellitus patients with ketoacidosis that are diagnosed with rhino-orbital mucormycosis we should suspect a cerebral spread of the fungi if after 24 hours since the beginning of treatment. In 70% of cases mucormycosis occurs in diabetics, and the percentage increases if there is concomitant immunosupression and comorbities. | |||
== Complications<ref name="pmid26348693">{{cite journal |vauthors=Dhooria S, Agarwal R, Chakrabarti A |title=Mediastinitis and Bronchial Perforations Due to Mucormycosis |journal=J Bronchology Interv Pulmonol |volume=22 |issue=4 |pages=338–42 |year=2015 |pmid=26348693 |doi=10.1097/LBR.0000000000000170 |url=}}</ref> == | |||
* Patients with mucormycosis may develop the following complications: | |||
** Extensive necrosis | |||
** Fungemia leading to septic shock | |||
** Stroke | |||
** Paralysis | |||
** Ophtalmoplegia | |||
** Intra-cranial hemorrhage | |||
** Mediastinitis | |||
** Bronchial perforation | |||
** Pulmonary gangrene | |||
** Renal mucormycosis | |||
== Prognosis<ref name="pmid3951358">{{cite journal |vauthors=Parfrey NA |title=Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases |journal=Medicine (Baltimore) |volume=65 |issue=2 |pages=113–23 |year=1986 |pmid=3951358 |doi= |url=}}</ref> == | |||
* The overall survival rate of patients with mucormycosis is approximately 50%, although survival rates approaching up to 85% have been reported. | |||
* Differences in prognosis are due to the various forms of the disease. | |||
* Rhinocerebral mucormycosis has a higher survival rate than does pulmonary or disseminated mucormycosis because the rhinocerebral disease can frequently be diagnosed earlier and the most common underlying cause, diabetic ketoacidosis, can be treated readily. | |||
* Pulmonary mucormycosis has a high mortality (around 65 percent at 1 year)<ref name="pmid11880955">{{cite journal |vauthors=Marr KA, Carter RA, Crippa F, Wald A, Corey L |title=Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients |journal=Clin. Infect. Dis. |volume=34 |issue=7 |pages=909–17 |year=2002 |pmid=11880955 |doi=10.1086/339202 |url=}}</ref> | |||
* Mortality in patients with disseminated disease approaches 100%, majorly due to surgical removal of infected tissues is not feasible and in part because these patients are usually most highly immunocompromised.<ref name="pmid16020690">{{cite journal |vauthors=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 |pmc=1195964 |doi=10.1128/CMR.18.3.556-569.2005 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In most cases, the prognosis of zygomycosis 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 100%. Patients with AIDS have a mortality rate of almost 100%. Possible complications of mucormycosis include the partial loss of neurological function, blindness and clotting of brain or lung vessels.
Natural History[1]
If left untreated, mucormycosis can be fatal. The survival rate of immunosuppressed patients with rhino sinusal mucormycosis without cerebral involvement is between 50-80% and only 10% if the infection spreads into the brain. In uncontrolled diabetes mellitus patients with ketoacidosis that are diagnosed with rhino-orbital mucormycosis we should suspect a cerebral spread of the fungi if after 24 hours since the beginning of treatment. In 70% of cases mucormycosis occurs in diabetics, and the percentage increases if there is concomitant immunosupression and comorbities.
Complications[2]
- Patients with mucormycosis may develop the following complications:
- Extensive necrosis
- Fungemia leading to septic shock
- Stroke
- Paralysis
- Ophtalmoplegia
- Intra-cranial hemorrhage
- Mediastinitis
- Bronchial perforation
- Pulmonary gangrene
- Renal mucormycosis
Prognosis[3]
- The overall survival rate of patients with mucormycosis is approximately 50%, although survival rates approaching up to 85% have been reported.
- Differences in prognosis are due to the various forms of the disease.
- Rhinocerebral mucormycosis has a higher survival rate than does pulmonary or disseminated mucormycosis because the rhinocerebral disease can frequently be diagnosed earlier and the most common underlying cause, diabetic ketoacidosis, can be treated readily.
- Pulmonary mucormycosis has a high mortality (around 65 percent at 1 year)[4]
- Mortality in patients with disseminated disease approaches 100%, majorly due to surgical removal of infected tissues is not feasible and in part because these patients are usually most highly immunocompromised.[5]
References
- ↑ Nicolae M, Popescu CR, Popescu B, Grigore R (2013). "Orbital complications of fungal pan-sinusitis in uncontrolled diabetes". Maedica (Buchar). 8 (3): 276–9. PMC 3869119. PMID 24371499.
- ↑ Dhooria S, Agarwal R, Chakrabarti A (2015). "Mediastinitis and Bronchial Perforations Due to Mucormycosis". J Bronchology Interv Pulmonol. 22 (4): 338–42. doi:10.1097/LBR.0000000000000170. PMID 26348693.
- ↑ Parfrey NA (1986). "Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases". Medicine (Baltimore). 65 (2): 113–23. PMID 3951358.
- ↑ Marr KA, Carter RA, Crippa F, Wald A, Corey L (2002). "Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients". Clin. Infect. Dis. 34 (7): 909–17. doi:10.1086/339202. PMID 11880955.
- ↑ Spellberg B, Edwards J, Ibrahim A (2005). "Novel perspectives on mucormycosis: pathophysiology, presentation, and management". Clin. Microbiol. Rev. 18 (3): 556–69. doi:10.1128/CMR.18.3.556-569.2005. PMC 1195964. PMID 16020690.