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==Overview==
==Overview==
Mucormycosis may be classified according to the [[organ system]] involved including [[brain]], [[lungs]], [[skin]], [[Gastrointestinal tract|GIT]], [[bones]], [[liver]], [[spleen]]. [[Disseminated disease|Disseminated infection]] affects multiple organ systems and is associated with high [[mortality]].
Mucormycosis may be classified according to the [[organ system]] involved including [[brain]], [[lungs]], [[skin]], [[Gastrointestinal tract|GIT]], [[bones]], [[liver]], [[spleen]]. [[Disseminated disease|Disseminated infection]] affects multiple organ systems.


==Classification==
==Classification==
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|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" /> 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 &#124; Clinical Infectious Diseases &#124; Oxford Academic |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> 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 &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref>
*  
* Acquired by:
** Perineural spread
** After proliferation in the nasal cavity, the mucor reaches the pterygo-palatine fossa, inferior orbital fissure and finally the retroglobal space of the orbit, leading to ocular signs
** The facial soft tissues, palate and infratemporal fossa can be infected through connecting pathways from the pterygo-palatine fossa
|
|
* [[eye]] or [[facial]] pain  
* [[eye]] or [[facial]] pain  
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* [[conjunctival injection]]
* [[conjunctival injection]]
* [[Blurred vision|Blurry vision]]
* [[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>
* [[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]]
* [[bilateral]] [[proptosis]]
* [[chemosis]]
* [[chemosis]]
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* Bloody [[nasal discharge]] may be the first sign that [[infection]] has invaded through the [[turbinates]] and into the [[brain]]
* Bloody [[nasal discharge]] may be the first sign that [[infection]] has invaded through the [[turbinates]] and into the [[brain]]
|
|
* Disseminated infection
* Mycotic aneurysms
* Mycotic aneurysms
|-
|-
|Pulmonary mucormycosis
|Pulmonary mucormycosis
|
|
* Most commonly occurs in [[Neutropenia|neutropenic]] and [[stem cell transplant]] patients<sup>[[Mucormycosis classification#cite note-pmid8504272-5|[5]]]</sup>
* Acquired by:
** Inhalation
** Hematogenous spread
** Lymphatic spread
|
|
* [[dyspnea]]
* [[cough]]
* [[chest pain]]
* [[hemoptysis]] (if there is [[Blood vessel|vessel]] involvement through [[vascular]] invasion)<ref name="pmid8166512">{{cite journal |vauthors=Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE |title=Pulmonary mucormycosis: results of medical and surgical therapy |journal=Ann. Thorac. Surg. |volume=57 |issue=4 |pages=1044–50 |year=1994 |pmid=8166512 |doi= |url=}}</ref>
|
|
* Disseminated infection<ref name="urlImproved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7">{{cite web |url=http://www.tandfonline.com/doi/abs/10.1080/10428190310001653691 |title=Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7 |format= |work= |accessdate=}}</ref>
|-
|-
|Cutaneous mucormycosis
|Cutaneous mucormycosis
|
|
* Acquired by disruption of the physiologic [[skin]] barrier:
** [[Physical trauma|Trauma]]
** [[Maceration|Skin maceration]] 
** [[Burn|Burns]]
** Contaminated surgical dressings<ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection &#124; JAMA &#124; The JAMA Network |format= |work= |accessdate=}}</ref>
|
|
* Skin redness
* Numbness
* Warmth
* Skin ulceration and necrosis
|
|
* Disseminated infection<ref name="urlGangrenous 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">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1470.2003.20508.x/full |title=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 |format= |work= |accessdate=}}</ref>
|-
|-
|Gastrointestinal mucormycosis
|Gastrointestinal mucormycosis
|
|
* Rare occurrence
* Usually found in [[malnourished]] individuals, [[AIDS]] patients, [[SLE]] patients, <ref name="urlwww.nature.com">{{cite web |url=https://www.nature.com/ajg/journal/v93/n8/pdf/ajg1998307a.pdf |title=www.nature.com |format= |work= |accessdate=}}</ref> [[organ transplant]] recepients,<ref name="urlGASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation">{{cite web |url=http://journals.lww.com/transplantjournal/Abstract/1998/10150/Gastric_Perforation_Due_To_Mucormycosis_After.21.aspx |title=GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation |format= |work= |accessdate=}}</ref> [[Infant|infants]] and children
* Acquired by:
** Ingestion of Fungi
|
|
* [[abdominal]] distension
* [[pain]]
* [[nausea]]
* [[vomiting]]
* [[hematochezia]].
|
|
* Disseminated infection
|-
|-
|Disseminated mucormycosis
|Disseminated mucormycosis
|
|
* Patients on [[Immunosuppressive drug|immunosupressants]] and [[Antifungal drug|anti-fungal]] [[prophylaxis]] (escpecially [[voriconazole]]) are particularly susceptible to [[Disseminated disease|disseminated infection]]<ref name="urlZygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2004.00945.x/full |title=Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="urlBreakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/39/5/743/364418/Breakthrough-Fungal-Infections-in-Stem-Cell |title=Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref>
* Acquired by:
** Hematogenous spread is usually the most common route of [[Disseminated disease|dissemination]] and [[Lung|pulmonary]] mucormycosis is usually the culprit
|
|
* [[Brain]] is the most common site of [[Disseminated disease|dissemination]] leading to:
** Seizures
** Stroke
** Paralysis
** Abscess formation
* Splenic infarction
* Myocardial necrosis
* [[liver]]
* [[skin]]
|
|
* High case fatality rate<ref name="pmid13984484">{{cite journal |vauthors=STRAATSMA BR, ZIMMERMAN LE, GASS JD |title=Phycomycosis. A clinicopathologic study of fifty-one cases |journal=Lab. Invest. |volume=11 |issue= |pages=963–85 |year=1962 |pmid=13984484 |doi= |url=}}</ref>
|}
|}
===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>
* 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 muscles|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 [[Posterior|posteriorly]] from either the [[Orbit (anatomy)|orbit]] or [[sinuses]] to the [[central nervous system]].
* A.
* Hematogenous spread may lead to development of [[mycotic]] [[Aneurysm|aneurysms]].
===Pulmonary mucormycosis===
* [[Lungs|Pumlonary]] mucormycosis most commonly occurs in [[Neutropenia|neutropenic]] and [[stem cell transplant]] patients. <ref name="pmid8504272">{{cite journal |vauthors=Morrison VA, McGlave PB |title=Mucormycosis in the BMT population |journal=Bone Marrow Transplant. |volume=11 |issue=5 |pages=383–8 |year=1993 |pmid=8504272 |doi= |url=}}</ref>
* It develops as a result of [[inhalation]] or by hematogenous or [[Lymphatic System|lymphatic]] spread.
* [[Symptom|Symptoms]] include [[dyspnea]], [[cough]], [[chest pain]] and [[hemoptysis]] (if there is [[Blood vessel|vessel]] involvement through [[vascular]] invasion) <ref name="pmid8166512">{{cite journal |vauthors=Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE |title=Pulmonary mucormycosis: results of medical and surgical therapy |journal=Ann. Thorac. Surg. |volume=57 |issue=4 |pages=1044–50 |year=1994 |pmid=8166512 |doi= |url=}}</ref>
* [[Disseminated disease|Disseminated]] disease leads to a poorer [[prognosis]]. <ref name="urlImproved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7">{{cite web |url=http://www.tandfonline.com/doi/abs/10.1080/10428190310001653691 |title=Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7 |format= |work= |accessdate=}}</ref>
===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, [[Physical trauma|trauma]], [[Maceration|skin maceration]] or [[Burn|burns]] may lead to disruption of the normal barrier.
* Contaminated surgical dressings may also lead to development of mucormycosis. <ref name="urlCutaneous Rhizopus Infection | JAMA | The JAMA Network">{{cite web |url=http://jamanetwork.com/journals/jama/article-abstract/365825 |title=Cutaneous Rhizopus Infection &#124; JAMA &#124; The JAMA Network |format= |work= |accessdate=}}</ref>
* [[Disseminated disease]] may result if [[infection]] from the [[skin]] penetrates into [[Subcutaneous tissue|subcutaneous tissues]], [[fat]] and [[bones]]. <ref name="urlGangrenous 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">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1470.2003.20508.x/full |title=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 |format= |work= |accessdate=}}</ref>
===Gastrointestinal mucormycosis===
* [[Gastrointestinal tract|Gastrointestinal]] mucormycosis is a rare occurrence and is usually found in [[malnourished]] individuals, [[AIDS]] patients, [[SLE]] patients, <ref name="urlwww.nature.com">{{cite web |url=https://www.nature.com/ajg/journal/v93/n8/pdf/ajg1998307a.pdf |title=www.nature.com |format= |work= |accessdate=}}</ref> [[organ transplant]] recepients,<ref name="urlGASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation">{{cite web |url=http://journals.lww.com/transplantjournal/Abstract/1998/10150/Gastric_Perforation_Due_To_Mucormycosis_After.21.aspx |title=GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation |format= |work= |accessdate=}}</ref> [[Infant|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 [[Disseminated disease|dissemination]] and [[Lung|pulmonary]] mucormycosis is usually the culprit.
* [[Brain]] is the most common site of [[Disseminated disease|dissemination]] but other organs may also be involved, including [[spleen]], [[heart]] , [[liver]] and [[skin]].
* [[Cerebral]] dissemination may result is [[abscess]] formation.
* [[Disseminated disease|Disseminated infection]] is associated with a high [[case fatality rate]] (may approach 100 %) <ref name="pmid13984484">{{cite journal |vauthors=STRAATSMA BR, ZIMMERMAN LE, GASS JD |title=Phycomycosis. A clinicopathologic study of fifty-one cases |journal=Lab. Invest. |volume=11 |issue= |pages=963–85 |year=1962 |pmid=13984484 |doi= |url=}}</ref>
* Patients on [[Immunosuppressive drug|immunosupressants]] and [[Antifungal drug|anti-fungal]] [[prophylaxis]] (escpecially [[voriconazole]]) are particularly susceptible to [[Disseminated disease|disseminated infection]]. <ref name="urlZygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2004.00945.x/full |title=Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library |format= |work= |accessdate=}}</ref> <ref name="urlBreakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic">{{cite web |url=https://academic.oup.com/cid/article/39/5/743/364418/Breakthrough-Fungal-Infections-in-Stem-Cell |title=Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole &#124; Clinical Infectious Diseases &#124; Oxford Academic |format= |work= |accessdate=}}</ref>
* [[Infarction|Infarctions]] in multiple organs in an [[Immunosuppression|immunosuppressed]] patient points towards [[Disseminated disease|disseminated]] mucormycosis.


==References==
==References==

Revision as of 00:18, 19 June 2017

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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.

Classification

Mucormycosis may be classified based on the organ system involvement as follows:

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)[1] and those undergoing hematopoietic stem cell transplantation[2]
  • Acquired by:
    • Perineural spread
    • After proliferation in the nasal cavity, the mucor reaches the pterygo-palatine fossa, inferior orbital fissure and finally the retroglobal space of the orbit, leading to ocular signs
    • The facial soft tissues, palate and infratemporal fossa can be infected through connecting pathways from the pterygo-palatine fossa
  • Disseminated infection
  • Mycotic aneurysms
Pulmonary mucormycosis
  • Acquired by:
    • Inhalation
    • Hematogenous spread
    • Lymphatic spread
  • Disseminated infection[6]
Cutaneous mucormycosis
  • Skin redness
  • Numbness
  • Warmth
  • Skin ulceration and necrosis
  • Disseminated infection[8]
Gastrointestinal mucormycosis
  • Disseminated infection
Disseminated mucormycosis
  • Acquired by:
    • 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 leading to:
    • Seizures
    • Stroke
    • Paralysis
    • Abscess formation
  • Splenic infarction
  • Myocardial necrosis
  • liver
  • skin
  • High case fatality rate[13]

References

  1. ↑ "Rhinocerebral mucormycosis: Predisposing factors - Mcnulty - 1982 - The Laryngoscope - Wiley Online Library".
  2. ↑ "Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients | Clinical Infectious Diseases | Oxford Academic".
  3. ↑ Khor BS, Lee MH, Leu HS, Liu JW (2003). "Rhinocerebral mucormycosis in Taiwan". J Microbiol Immunol Infect. 36 (4): 266–9. PMID 14723256.
  4. ↑ "Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options - Peterson - 1997 - The Laryngoscope - Wiley Online Library".
  5. ↑ 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.
  6. ↑ "Improved Outcome of Zygomycosis in Patients with Hematological Diseases?: Leukemia & Lymphoma: Vol 45, No 7".
  7. ↑ "Cutaneous Rhizopus Infection | JAMA | The JAMA Network".
  8. ↑ "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".
  9. ↑ "www.nature.com" (PDF).
  10. ↑ "GASTRIC PERFORATION DUE TO MUCORMYCOSIS AFTER HEART-LUNG AND... : Transplantation".
  11. ↑ "Zygomycosis in neutropenic patients with past Aspergillus infection: a role for posaconazole? - Ide - 2004 - Clinical Microbiology and Infection - Wiley Online Library".
  12. ↑ "Breakthrough Fungal Infections in Stem Cell Transplant Recipients Receiving Voriconazole | Clinical Infectious Diseases | Oxford Academic".
  13. ↑ STRAATSMA BR, ZIMMERMAN LE, GASS JD (1962). "Phycomycosis. A clinicopathologic study of fifty-one cases". Lab. Invest. 11: 963–85. PMID 13984484.

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