Mucormycosis
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PRESENTED BY -DR SANTOSH M NARAYANKAR
MUCORMYCOSIS
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MUCOR MYCOSIS REFERS TO…… infection caused by fungi in order of mucorales .
Most common species are…rhizopus (m c),rhizomucor,cunninghamella,apophysomyces,saksenaea,absidia,muccor,andsyncephalastrum.
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MUCORMYCOSIS
Rhizopus spMucor species
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MAJOR ROUTE OF INFECTION
INHALTION. INGESTION. TRAUMATIC INOCULTION.
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Pathophysiology
Angioinvasion Vessel thrombosis Tissue necrosis
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EPIDEMIOLOGY
INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY.
MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%).
NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT.
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MUCORMYCOSIS CLINICAL PRESNTATION
Five clinical forms of mucormycosis : Rhinocerebral ,pulmonary ,gastrointestinal , primary cutaneouse and disseminated.
Rhinocerebral type has the highest frequency and mortality.
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RELATIONSHIP BETWEEN PREDISPOSING FACTORS AND SITE OF INFECTION DIABETIC KETOACIDISIS- RHINOCEREBRAL. NEUTROPENIA- PULMONARY & DISSEMINATED. STEROIDS-
PULMONARY,RHINOCEREBRAL,DISSEMINATED. MALNUTRION-G I TRACT TRAUMA,CATHETER,SKIN MACERATION-
CUTANEOUS/ SUBCUTANEOUS DEFEROXAMINE-DISSEMINATED
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RHINOCEREBRAL MUCORMYCOSIS
50% of cases occur in patients with DM.
50%CASES OF TOTAL CASES OF MUCOR MYCOSIS.
Usually occurs during an episode of DKA , with disruption of host defense mechanisms ,thereby permitting growth of Rhizopus oryzae. Such growth is inhibited by correction of acidosis.
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RHINOCEREBRAL MUCORMYCOSIS
Clinical features Onset with nasal stuffiness ,epistaxis
and facial pain. Later ,proptosis , chemosis and
ophthalmoplegia. Fever and confusion. Black necrotic eschar on the nasal
turbinates or palate : very characteristic
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RHINOCEREBRAL MUCORMYCOSIS
Complications Cavernous sinus thrombosis. Multiple cranial nerve palsies. Visual loss. Frontal lobe abscess. Carotid artery or jugular vein
thrombosis causing hemiparesis.
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RHINOCEREBRAL MUCORMYCOSIS
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RHINOCEREBRAL MUCORMYCOSIS
Diagnosis Punch biopsy of the lesion followed
by fungal stains and culture. Histological examination reveals the
characteristic broad , branching hyphae of Rhizopus invading the tissue.
CT or MRI of the head reveal air-fluid level in the sinuses and involvement of deep tissues
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RHINOCEREBRAL MUCORMYCOSIS
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Imaging
CT scan coronal cut (posterior)of nose and paranasal sinusesshowing heterodense mass arisingfrom right maxillary sinus erodingthe medial wall of maxilla and presenting inside the nasal cavity.The same mass could also beseen eroding the right side of hardpalate.
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PULMONARY MUCORMYCOSIS
SEEN MOST COMMONLY IN –NEUTROPENIA,PATEINTS ON CHEMOTHERPY,LEUKEMIA.
DYSPONEA ,COUGH& CHEST PAIN &FEVER RADIOLOGICALY-
CONSOLIDATION,ISOLATED MASSES,CAVITAION,WEDGE SHAPED INFARCTS.
CT SCAN BEST METHOD TO DETECT THE EXTENT.
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CUTANEOUS MUCORMYCOSIS
TRAUMA IS THE PREDISPOSING FACTOR.
INVASIVE LOCALLY . MAY LEAD TO NECROTIZING
FASCITES …MORTALITY UPTO 80%. SURGICAL DEBRIDEMENT.
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GASTROINTESTINAL MUCORMYCOSIS RARE,,OCCURS IN EXTREMALY
MALNOURISHED, CHILDREN. STOMACH,COLON&ILEUM ARE MOST
COMMONLY INVOLVED. ABDOMINAL PAIN,NAUSEA VOMITING,
,,,MAY PRESNT AS INTRAABDOMINAL ABSCESS,OR PERFORATION OF THE VISCUS.NEEDS BIOPSY.
PROGNOSIS VERY POOR
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DISSEMINATED MUCORMYCOSIS
HEAMATOGENOUSLY PULMONARY MUCORMYCOSIS HAS
HIGHEST INCIDENCE OF DISSEMINATION.
MOST COMMON SITE OF DISSEMINATION-BRAIN ,,,SPLEEN ,HEART,SKIN, AND OTHER ORGANS.
BRAIN -100%,OTHERS->90%
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MISCALLANEOUS FORMS
ENDOCARDITIS,PYELONEPHRITIS-IN I V DRUG USERS.
BONES,MEDIASTINUM,KIDNEYS,PERITONEUM.IN PATIENTS WITH DIALYSIS
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SOME COMMON DD S
ANTHRAX ASPERGELLOSIS CELLULITIS COLONIC OBSTRUCTION PULMONARY EMBOLISM
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HIGH SUSPICION REQUIRED
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MUCORMYCOSIS WORKUP
BIOPSY-OF INVOLVED TISSUE. SWABS OF TISSUE DISCHARGE ARE
UNRELIABLE. CBC FOR NEUTROPENIA ABG TO CORRECT ACIDOSIS RBS-SUGAR CONTROL
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IMAGING STUDIES
PLAIN X-RAY CT SCAN MRI SCANS CHEST CT/MRI
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OTHER STUDIES
CSF EXAMINATION BRONCHOALVEOLAR LAVAGE
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THANK YOU
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MUCORMYCOSIS
Caused by fungi of the Rhizopus and Mucor species, which are ubiquitous saprophytic organisms, not uncommonly infecting the immunocompromised host.
These fungi have a predilection to invade blood vessels ,causing infarction and necrosis.