Mucormycosis in Adult
Mucormycosis can cause serious life-threatening infection in compromised hosts. While rhinocerebral mucormycosis is the most common form of the disease, mucormycosis can involve the skin, pulmonary, renal, and gastrointestinal organs, or it can disseminate. The underlying risk factor can influence the clinical manifestation; rhinocerebral disease is common in diabetics, whereas patients with hematological malignancies or neutropenia usually have pulmonary disease.
- Pulmonary disease typically manifests as cough, dyspnea, and unremitting fever despite broad-spectrum antibiotics. Hemoptysis occurs as a result of tissue necrosis and angio-invasion and, rarely, can be fatal. Physical examination findings are nonspecific and include tachypnea, crackles, decreased breath sounds, and wheezing.
- Patients with rhinocerebral disease present with facial pain, headaches, fever, orbital cellulitis, and black, necrotic ulcerations usually involving the palate. Infection can erode locally and spread to the cavernous sinus, the internal carotid artery, and the brain.
- Orbitorhinocerebral mucormycosis generally occurs in conjunction with sinus or nasal involvement and is an acute and often fatal infection. Permanent residual effects such as blindness and cranial nerve defects occur up to 70% of the time. Common clinical findings include rhinitis, periorbital and facial swelling, facial and mucosal necrosis, ophthalmoplegia, multiple cranial nerve palsies, facial pain, and headache. These patients may present with only a central retinal artery occlusion.
- Cutaneous infection may be associated with trauma, burns, and surgical wounds. Dissemination is rare.
- Gastrointestinal mucor is mainly seen in extreme cases of malnutrition.
In immunocompetent hosts, epidemic mucormycosis has been associated with penetrating and non-penetrating trauma caused by natural disasters, eg, the tornado in Joplin, MO, in 2011. DNA analysis in that case showed an Apophysomyces trapeziformis species.
For discussion of diseases caused by fungi belonging to the order of Entomophthorales, see Cutaneous basidiobolomycosis, Disseminated basidiobolomycosis, and Rhinofacial conidiobolomycosis.
B46.3 – Cutaneous mucormycosis
76627001 – Mucormycosis
- Ecthyma gangrenosum in patients who are immunocompromised.
- The clinical manifestations of mucormycosis are similar to that of other invasive fungi like Aspergillus, Fusarium, and Pseudallescheria spp. Mucor appears as broad, non-septate hyphae with branches occurring at right angles; rarely, septa may be seen. The other fungi have thinner, septate hyphae with frequent, acute-angled branching.
- Leishmaniasis (Old World and New World)
- Candida sepsis