Mucormycosis classification: Difference between revisions
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==Classification== | ==Classification== | ||
Mucormycosis may be classified based on the [[organ system]] involvement as follows: | Mucormycosis may be classified based on the [[organ system]] involvement as follows: | ||
{| class="wikitable" | |||
!Type | |||
!Transmission | |||
!Signs and Symptoms | |||
!Complications | |||
|- | |||
|Rhinocerebral mucormycosis | |||
| | |||
* Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with [[diabetic ketoacidosis]]) <ref name="urlRhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library" /> and those undergoing [[hematopoietic stem cell]] [[transplantation]]. <ref name="urlEpidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/34/7/909/316117/Epidemiology-and-Outcome-of-Mould-Infections-in |title=Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic |format= |work= |accessdate=}}</ref> | |||
* | |||
| | |||
* [[eye]] or [[facial]] pain | |||
* [[facial]] [[numbness]] | |||
* Facial ulceration and necrosis | |||
* [[conjunctival injection]] | |||
* [[Blurred vision|Blurry vision]] | |||
* [[soft tissue]] [[swelling]]. <ref name="pmid14723256">{{cite journal |vauthors=Khor BS, Lee MH, Leu HS, Liu JW |title=Rhinocerebral mucormycosis in Taiwan |journal=J Microbiol Immunol Infect |volume=36 |issue=4 |pages=266–9 |year=2003 |pmid=14723256 |doi= |url=}}</ref> <ref name="urlRhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1097/00005537-199707000-00004/full |title=Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | |||
* [[bilateral]] [[proptosis]] | |||
* [[chemosis]] | |||
* [[vision loss]] | |||
* [[ophthalmoplegia]] | |||
* [[cavernous sinus thrombosis]] | |||
* Bloody [[nasal discharge]] may be the first sign that [[infection]] has invaded through the [[turbinates]] and into the [[brain]] | |||
| | |||
* Mycotic aneurysms | |||
|- | |||
|Pulmonary mucormycosis | |||
| | |||
| | |||
| | |||
|- | |||
|Cutaneous mucormycosis | |||
| | |||
| | |||
| | |||
|- | |||
|Gastrointestinal mucormycosis | |||
| | |||
| | |||
| | |||
|- | |||
|Disseminated mucormycosis | |||
| | |||
| | |||
| | |||
|} | |||
===Rhinocerebral mucormycosis=== | ===Rhinocerebral mucormycosis=== | ||
* Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with [[diabetic ketoacidosis]]). <ref name="urlRhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1288/00005537-198910000-00006/full |title=Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | * Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with [[diabetic ketoacidosis]]). <ref name="urlRhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1288/00005537-198910000-00006/full |title=Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library |format= |work= |accessdate=}}</ref> | ||
* Another patient population that has been found to be susceptible to mucormycosis are | * Another patient population that has been found to be susceptible to mucormycosis are | ||
* Initial symptoms include | * Initial symptoms include | ||
* If untreated, [[infection]] usually spreads from the [[ethmoid sinus]] to the orbit, resulting in loss of [[Extraocular muscles|extraocular muscle]] function and [[proptosis]]. | * If untreated, [[infection]] usually spreads from the [[ethmoid sinus]] to the orbit, resulting in loss of [[Extraocular muscles|extraocular muscle]] function and [[proptosis]]. | ||
* The [[infection]] may rapidly spread into the neighboring tissues. | * The [[infection]] may rapidly spread into the neighboring tissues. | ||
* Onset of signs and symptoms in the [[contralateral]] eye, with resulting | * Onset of signs and symptoms in the [[contralateral]] eye, with resulting is a sign that suggests the development of. | ||
* [[Infection]] can also spread [[Posterior|posteriorly]] from either the [[Orbit (anatomy)|orbit]] or [[sinuses]] to the [[central nervous system]]. | * [[Infection]] can also spread [[Posterior|posteriorly]] from either the [[Orbit (anatomy)|orbit]] or [[sinuses]] to the [[central nervous system]]. | ||
* A | * A. | ||
* Hematogenous spread may lead to development of [[mycotic]] [[Aneurysm|aneurysms]]. | * Hematogenous spread may lead to development of [[mycotic]] [[Aneurysm|aneurysms]]. | ||
Revision as of 23:53, 18 June 2017
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Mucormycosis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Mucormycosis may be classified according to the organ system involved including brain, lungs, skin, GIT, bones, liver, spleen. Disseminated infection affects multiple organ systems and is associated with high mortality.
Classification
Mucormycosis may be classified based on the organ system involvement as follows:
| Type | Transmission | Signs and Symptoms | Complications |
|---|---|---|---|
| Rhinocerebral mucormycosis |
|
|
|
| Pulmonary mucormycosis | |||
| Cutaneous mucormycosis | |||
| Gastrointestinal mucormycosis | |||
| Disseminated mucormycosis |
Rhinocerebral mucormycosis
- Rhinocerebral mucormycosis is by far the most common form of the disease. It occurs most commonly in debilitated patients (specially those presenting with diabetic ketoacidosis). [1]
- Another patient population that has been found to be susceptible to mucormycosis are
- Initial symptoms include
- If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in loss of extraocular muscle function and proptosis.
- The infection may rapidly spread into the neighboring tissues.
- Onset of signs and symptoms in the contralateral eye, with resulting is a sign that suggests the development of.
- Infection can also spread posteriorly from either the orbit or sinuses to the central nervous system.
- A.
- Hematogenous spread may lead to development of mycotic aneurysms.
Pulmonary mucormycosis
- Pumlonary mucormycosis most commonly occurs in neutropenic and stem cell transplant patients. [5]
- It develops as a result of inhalation or by hematogenous or lymphatic spread.
- Symptoms include dyspnea, cough, chest pain and hemoptysis (if there is vessel involvement through vascular invasion) [6]
- Disseminated disease leads to a poorer prognosis. [7]
Cutaneous mucormycosis
- Disruption of the physiologic skin barrier may lead to invasion of the fungi causing mucormycosis and development of disease.
- Agents responsible for mucormycosis are not capable of penetrating the skin, however, trauma, skin maceration or burns may lead to disruption of the normal barrier.
- Contaminated surgical dressings may also lead to development of mucormycosis. [8]
- Disseminated disease may result if infection from the skin penetrates into subcutaneous tissues, fat and bones. [9]
Gastrointestinal mucormycosis
- Gastrointestinal mucormycosis is a rare occurrence and is usually found in malnourished individuals, AIDS patients, SLE patients, [10] organ transplant recepients,[11] infants and children.
- Ingestion of the fungi is the most common route of transmission.
- Symptoms include abdominal distension, pain, nausea, vomiting and hematochezia.
- Biopsy via endoscopy is required to confirm the diagnosis.
Disseminated mucormycosis
- Hematogenous spread is usually the most common route of dissemination and pulmonary mucormycosis is usually the culprit.
- Brain is the most common site of dissemination but other organs may also be involved, including spleen, heart , liver and skin.
- Cerebral dissemination may result is abscess formation.
- Disseminated infection is associated with a high case fatality rate (may approach 100 %) [12]
- Patients on immunosupressants and anti-fungal prophylaxis (escpecially voriconazole) are particularly susceptible to disseminated infection. [13] [14]
- Infarctions in multiple organs in an immunosuppressed patient points towards disseminated mucormycosis.
References
- ↑ 1.0 1.1 "Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library".
- ↑ "Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic".
- ↑ Khor BS, Lee MH, Leu HS, Liu JW (2003). "Rhinocerebral mucormycosis in Taiwan". J Microbiol Immunol Infect. 36 (4): 266–9. PMID 14723256.
- ↑ "Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library".
- ↑ Morrison VA, McGlave PB (1993). "Mucormycosis in the BMT population". Bone Marrow Transplant. 11 (5): 383–8. PMID 8504272.
- ↑ Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE (1994). "Pulmonary mucormycosis: results of medical and surgical therapy". Ann. Thorac. Surg. 57 (4): 1044–50. PMID 8166512.
- ↑ "Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7".
- ↑ "Cutaneous Rhizopus Infection | JAMA | The JAMA Network".
- ↑ "Gangrenous Cutaneous Mucormycosis in a Child with a Solid Organ Transplant: A Case Report and Review of the Literature - Boyd - 2003 - Pediatric Dermatology - Wiley Online Library".
- ↑ "www.nature.com" (PDF).
- ↑ "GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation".
- ↑ STRAATSMA BR, ZIMMERMAN LE, GASS JD (1962). "Phycomycosis. A clinicopathologic study of fifty-one cases". Lab. Invest. 11: 963–85. PMID 13984484.
- ↑ "Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library".
- ↑ "Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic".