Mucormycosis differential diagnosis: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Disease
! rowspan="2" |Disease
! colspan="4" |Signs and Symptoms
! rowspan="2" |General features
! colspan="3" |Signs and Symptoms
! rowspan="2" |Radiological abnormalities
! rowspan="2" |Radiological abnormalities
! rowspan="2" |Histopathological abnormalities
! rowspan="2" |Histopathological abnormalities
! rowspan="2" |Other differentiating characters
! rowspan="2" |Other differentiating characters
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|Facial swelling and ulceration
|Facial swelling and ulceration
|Cranial neuropathy
|Cranial neuropathy
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* Mucosal thickening on the paranasal sinuses is '''more common in '''Rhino-cerebral mucormycosis''' (ROCM)''' than BOC<ref name="pmid275010443">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
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|Limited eye movement is '''more common in patients with Rhino-cerebral mucormycosis (ROCM)''' than in those with bacterial orbital cellulitis<ref name="pmid275010442">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
|Limited eye movement is '''more common in patients with Rhino-cerebral mucormycosis (ROCM)''' than in those with bacterial orbital cellulitis<ref name="pmid275010442">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
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|Invasive aspergillosis
|Invasive aspergillosis
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* Airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, are more common in patients with invasive pulmonary aspergillosis<ref name="pmid258823622">{{cite journal |vauthors=Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH |title=Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis |journal=Clin. Microbiol. Infect. |volume=21 |issue=7 |pages=684.e11–8 |year=2015 |pmid=25882362 |doi=10.1016/j.cmi.2015.03.019 |url=}}</ref>
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* Microscopic observation under ultraviolet light shows that the hyphae of aspergillus have characteristic dichotomous branching, parallel walls, and numerous septa. These septa structure is clearly different from those of the mucor.
* Microscopic observation under ultraviolet light shows that the hyphae of aspergillus have characteristic dichotomous branching, parallel walls, and numerous septa. These septa structure is clearly different from those of the mucor
* Airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, are more common in patients with invasive pulmonary aspergillosis<ref name="pmid258823622">{{cite journal |vauthors=Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH |title=Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis |journal=Clin. Microbiol. Infect. |volume=21 |issue=7 |pages=684.e11–8 |year=2015 |pmid=25882362 |doi=10.1016/j.cmi.2015.03.019 |url=}}</ref>
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* Eyelid swelling was '''less common in patients with ROCM''' than in those with bacterial orbital cellulitis due to cavernous sinus involvement<ref name="pmid27501044">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
* Mucosal thickening on the paranasal sinuses is '''more common in ROCM''' than BOC<ref name="pmid275010443">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
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|The ocular symptoms of bacterial orbital cellulitis (BOC) , such as facial edema, pain, and blepharoptosis, are similar to those of rhino-cerebral mucormycosis (ROCM) soon after infection onset, therefore it maybe difficult to distinguish the two during the initial phase of infection
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* The ocular symptoms of bacterial orbital cellulitis (BOC) , such as facial edema, pain, and blepharoptosis, are similar to those of rhino-cerebral mucormycosis (ROCM) soon after infection onset, therefore it maybe difficult to distinguish the two during the initial phase of infection
* Eye lid swelling is more common in BOC than ROCM<ref name="pmid27501044">{{cite journal |vauthors=Son JH, Lim HB, Lee SH, Yang JW, Lee SB |title=Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings |journal=PLoS ONE |volume=11 |issue=8 |pages=e0160897 |year=2016 |pmid=27501044 |pmc=4976984 |doi=10.1371/journal.pone.0160897 |url=}}</ref>
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Revision as of 20:54, 2 June 2017

Mucormycosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mucormycosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Differential diagnosis

Mucormycosis must be differentiated from other conditions with similar presentation. Invasive fungal disease should be considered in any immunocompromised patient presenting with a new cranial neuropathy or ocular motility abnormality[1] for example:

  • Invasive aspergillosis

Other differential diagnoses which may involve progressive facial swelling, ulceration and destruction and resemble mucormycosis include:

Histopathologically, mucormycosis may resemble:

Disease General features Signs and Symptoms Radiological abnormalities Histopathological abnormalities Other differentiating characters
Facial swelling and ulceration Cranial neuropathy Disturbance in ocular motility
Mucormycosis
  • Mucosal thickening on the paranasal sinuses is more common in Rhino-cerebral mucormycosis (ROCM) than BOC[2]
 Limited eye movement is more common in patients with Rhino-cerebral mucormycosis (ROCM) than in those with bacterial orbital cellulitis[3]
  • The reverse halo sign on CT scan (characterized by central ground-glass opacity (GGO) which is surrounded by a partial or complete rim of consolidation)The opening <ref> tag is malformed or has a bad name is more common in patients with pulmonary mucormycosis than in those with invasive pulmonary aspergillosisThe opening <ref> tag is malformed or has a bad name
  • Mucormycosis is generally more commonly observed in immunocompromised patients
  • Patients with orbital fungal infections are more likely to be infected with mucormycosis compared with Aspergillus[4]
  • the prognosis of pulmonary mucormycosis has not improved significantly over the last ten years, mainly because of challenges in early diagnosis and the limited activity of current antifungal agents against Mucorales[5]
Invasive aspergillosis
  • Microscopic observation under ultraviolet light shows that the hyphae of aspergillus have characteristic dichotomous branching, parallel walls, and numerous septa. These septa structure is clearly different from those of the mucor
  • Airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, are more common in patients with invasive pulmonary aspergillosis[6]
Orbital cellulitis
  • The ocular symptoms of bacterial orbital cellulitis (BOC) , such as facial edema, pain, and blepharoptosis, are similar to those of rhino-cerebral mucormycosis (ROCM) soon after infection onset, therefore it maybe difficult to distinguish the two during the initial phase of infection
  • Eye lid swelling is more common in BOC than ROCM[7]
Extra nodal T cell lymphoma
  • These tumors are more clearly classified as nasal-type extranodal T-cell/natural killer (T/NK) cell lymphoma and natural killer cell leukemia
  • They are characterized immunophenotypically by the expression of CD2, CD3ϵ (but not CD3 and the T-cell receptor), and CD56[8]
  • The lesion produced are destructive and involve the nasal cavity, oropharynx, upper palate, and larynx
  • Immunophenotyping shows these lesions to be lymphoid in nature
Cutaneous Anthrax
  • Cutaneous anthrax is extremely rare in developed countries
  • Usually patient history points towards the diagnosis of cutaneous anthrax
  • Patient develops a painless ulcer with vesicles, edema, and has a history of exposure to animals or animal products[9]; whereas patients with cutaneous mucormycosis are mainly debilitated (diabetics, hematological malignancies, organ transplant recepients) and present as a black necrotic eschar[10]
  1. ↑ Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK (2016). "Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus". Br J Ophthalmol. 100 (2): 184–8. doi:10.1136/bjophthalmol-2015-306945. PMID 26112869.
  2. ↑ Son JH, Lim HB, Lee SH, Yang JW, Lee SB (2016). "Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings". PLoS ONE. 11 (8): e0160897. doi:10.1371/journal.pone.0160897. PMC 4976984. PMID 27501044.
  3. ↑ Son JH, Lim HB, Lee SH, Yang JW, Lee SB (2016). "Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings". PLoS ONE. 11 (8): e0160897. doi:10.1371/journal.pone.0160897. PMC 4976984. PMID 27501044.
  4. ↑ Trief D, Gray ST, Jakobiec FA, Durand ML, Fay A, Freitag SK, Lee NG, Lefebvre DR, Holbrook E, Bleier B, Sadow P, Rashid A, Chhabra N, Yoon MK (2016). "Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus". Br J Ophthalmol. 100 (2): 184–8. doi:10.1136/bjophthalmol-2015-306945. PMID 26112869.
  5. ↑ Hamilos G, Samonis G, Kontoyiannis DP (2011). "Pulmonary mucormycosis". Semin Respir Crit Care Med. 32 (6): 693–702. doi:10.1055/s-0031-1295717. PMID 22167397.
  6. ↑ Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2015). "Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis". Clin. Microbiol. Infect. 21 (7): 684.e11–8. doi:10.1016/j.cmi.2015.03.019. PMID 25882362.
  7. ↑ Son JH, Lim HB, Lee SH, Yang JW, Lee SB (2016). "Early Differential Diagnosis of Rhino-Orbito-Cerebral Mucormycosis and Bacterial Orbital Cellulitis: Based on Computed Tomography Findings". PLoS ONE. 11 (8): e0160897. doi:10.1371/journal.pone.0160897. PMC 4976984. PMID 27501044.
  8. ↑ Zhang Y, Wang T, Liu GL, Li J, Gao SQ, Wan L (2016). "Mucormycosis or extranodal natural killer/T cell lymphoma, similar symptoms but different diagnosis". J Mycol Med. 26 (3): 277–82. doi:10.1016/j.mycmed.2016.04.005. PMID 27178138.
  9. ↑ Mallon E, McKee PH (1997). "Extraordinary case report: cutaneous anthrax". Am J Dermatopathol. 19 (1): 79–82. PMID 9056659.
  10. ↑ Skiada A, Petrikkos G (2013). "Cutaneous mucormycosis". Skinmed. 11 (3): 155–9, quiz 159–60. PMID 23930354.
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