Mucormycosis is an opportunistic fungal infection.
Caused by fungus molds which belong to -
Class: Mucormycetes,
Order: Mucorales,
Genera: Rhizopus, Mucor, Rhizomucor.
Route of infection: Inhalation of fungal spores.
Symptoms:
Pain under the eyes
One-sided facial swelling, facial pain, local pain on the cheekbone.
Nasal Congestion, purulent nasal discharge.
Black lesions on nasal bridge, nasal ulcerations
Stuffy or bleeding nose
Toothache or loosening of teeth, jaw involvement
Blurred vision, double vision, partial loss of vision with pain.
Skin lesions
Fever, headache
TYPES
Rhinocerebral (sinus and brain) mucormycosis: Commonly seen in uncontrolled diabetics. Most fatal of all.
Pulmonary (lung) mucormycosis: Commonly associated with hematological malignancies, treatment with glucocorticoids and deferoxamine, solid organ transplantation.
Gastrointestinal mucormycosis is more common among young children than adults. Presents with abdominal pain and hematemesis.
Cutaneous (skin) mucormycosis: This is the most common in people who do not have weakened immune systems. Appears as a single, painful, indurated area of cellulitis that develops into an ecthyma-like lesion. [Ecthyma is a skin infection characterised by crusted sores beneath which ulcers form. It is a deep form of impetigo, as the same bacteria causing the infection are involved. Ecthyma causes deeper erosions of the skin into the dermis] Mostly associated with trauma, burns.
Disseminated mucormycosis: Spreads through the bloodstream. Affects the brain, spleen, heart, and skin.
Risk factors:
Uncontrolled diabetes mellitus, Immunosuppression by steroids, Prolonged ICU stay,
Co-morbidities – post-transplant/malignancy, severe malnutrition, deferoxamine usage.
A review of 179 cases of rhino-orbital-cerebral mucormycosis found that 126 (70 percent) of the patients had diabetes mellitus and that most had ketoacidosis at the time of presentation. [1]
Q. When everyone is getting exposed to the fungal spores in environment, then why do only a few people contract the disease?
Intact immunity fights back, neutrophils and macrophages kill hyphae and spores respectively, hence they cause no harm to immunocompetent individuals. But people in whom immunity is compromised, spore germination can't be prevented, so the disease manifests.
In severe neutropenia, and diabetic ketoacidosis(it is a complication of diabetes) leads to abnormal neutrophilic function, so it rapidly progresses as it invades the blood vessels and causes thrombosis which in turn leads to necrosis. This is the reason why it's now most commonly seen in COVID patients with co-morbidities like diabetes.
Q. How can it be prevented?
Being aware of warning symptoms and reaching out to the doctor early.
Monitor and control glucose levels in patients post-COVID-19 discharge and in diabetics.
No unnecessary use of antibiotics
Avoid steroid overuse- right time, right duration play a crucial role.
Hygienic oxygen, clean concentrators, clean water for humidifier.
Investigations:
Sputum or Bronchoalveolar lavage examination
KOH staining and microscopy
Culture and sensitivity from biopsy
CT, MRI
Interpretation: On microscopy, presence of characteristic hyphae which are irregular, broad,
non-septate, branching at wide angles provides a presumptive diagnosis.
Treatment
Surgical removal of all dead and infected tissues.
Antifungal injections - IV Amphotericin, Posaconazole, Isavuconazole.
Expensive treatment- infection may require 4-10 vials for 10 days. Each vial costing 3000-7000/-
So, a minimum of 40 vials would cost 1,20,000/-
DISCLAIMER : This article is intended for educational purposes only. It is not a substitute for a physician's judgement.
REFERENCES :
1.McNulty JS. Rhinocerebral mucormycosis: predisposing factors. Laryngoscope 1982; 92:1140.
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