II. Pathophysiology
- Opportunistic Fungal Infection
- Caused by filamentous molds of the order Mucorales (phyllum Zygomycota), ubiquitous in the environment
- Rhizopus
- Rhizomucor
- Mucor
- Lichtheimia
- Vascular invasion
- Risk of thrombosis and tissue infarction
- Transmission
- Contaminated food
- Spore inhalation (nose, lungs)
- Skin Wounds
III. Risk Factors
- Otherwise healthy patients represent <10% of cases
- Severe Immunocompromised State (developed countries)
- Hematologic Malignancy
- Organ Transplant
- Neutropenia
- Autoimmune disorders
- Defuroxamine Use (for iron chelation)
- Other associated conditions (esp. developing countries)
- Poorly controlled Diabetes Mellitus
- Trauma or Burn Injury
IV. Types: Based on Distribution
- Rhino-orbital-cerebral Mucormycosis (ROCM)
- Most common type in Diabetes Mellitus
- Aggressive invasion of sinuses, cranial bones and vasculature
- Pulmonary Mucormycosis
- Common type in Hematologic Malignancy
- Uncommon type in Diabetes Mellitus
- Cutaneous Mucormycosis
- Gastrointestinal Mucormycosis
- Disseminated Mucormycosis
- Common type in Hematologic Malignancy
- Mucormycosis of uncommon sites
V. Diagnosis
- Diagnosis is based on lesion histopathology, PCR and culture
- Mucorales are irregular, nonseptate hyphae and with branching at right angles
- Blood Cultures are typically negative
VI. Management
- Precautions
- Prompt management is critical to survival
- Mucormycosis may be rapidly progressive
- Prognosis may worsen with each day of delayed diagnosis
- First-Line Antifungals
- Amphotericin BLipid Formulation (LFAB)
- Alternative Antifungals (Triazoles)
- Posaconazole (POSA)
- Isavuconazole (ISAV)
- Surgical management (adjunctive)
- Surgical Debridement or excision
VII. Prognosis
- Localized, cutaneous Mucormycosis: 10-30% mortality
- Invasive Mucormycosis: 30-50% mortality
- Disseminated Mucormycosis: 90% mortality