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EPIDEMIOLOGY OF MUCORMYCOSIS

EPIDEMIOLOGY OF MUCORMYCOSIS

ABSTRACT

Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited.

CHAPTER ONE

INTRODUCTION

Mucormycosis is any fungal infection caused by fungi in the order Mucorales.[1]:328 Generally, species in the Mucor, Rhizopus, Absidia, and Cunninghamella genera are most often implicated. This disease is often characterized by hyphae growing in and around vessels.

“Mucormycosis” and “zygomycosis” are sometimes used interchangeably. However, zygomycota has been identified as polyphyletic, and is not included in modern fungal classification systems.

Also, while Zygomycosis includes Entomophthorales, mucormycosis excludes this group.

Mucormycosis refers to several different diseases caused by infection with fungi in the order of Mucorales. Rhizopus species are the most common causative organisms. In descending order, the other genera with mucormycosis-causing species include Mucor, Cunninghamella, Apophysomyces, Absidia, Saksenaea, Rhizomucor, and other species.[1, 2]

Most mucormycosis infections are life-threatening, and risk factors, such as diabetic ketoacidosis and neutropenia, are present in most cases. Severe infection of the facial sinuses, which may extend into the brain, is the most common presentation. Pulmonary, cutaneous, and gastrointestinal (GI) infections are also recognized.

Successful mucormycosis treatment requires correction of the underlying risk factor(s), antifungal therapy with liposomal amphotericin B, and aggressive surgery.

The following is a postmortem image of a patient who had diabetic ketoacidosis and left rhinocerebral mucormycosis.

SIGNS AND SYMPTOMS

Mucormycosis frequently involves the sinuses, brain, or lungs as the areas of infection. While oral or cerebral mucormycosis are the most common types of the disease, this infection can also manifest in the gastrointestinal tract, skin, and in other organ systems.[6] In rare cases, the maxilla may be affected by mucormycosis. The rich vascularity of maxillofacial areas usually prevents fungal infections, although more virulent fungi, such as those responsible for mucormycosis, can often overcome this difficulty.

There are several key signs which point towards mucormycosis. One such sign is fungal invasion into the vascular network which results in thrombosis and death of surrounding tissue by loss of blood supply. If the disease involves the brain then symptoms may include a one-sided headache behind the eyes, facial pain, fevers, nasal stuffiness that progresses to black discharge, and acute sinusitis along with swelling of the eye  Affected skin may appear relatively normal during the earliest stages of infection. This skin quickly progresses to an erythemic (reddening, occasionally with edema) stage, before eventually turning black due to necrosis.[8] In other forms of mucormycosis, such as pulmonary, cutaneous, or disseminated mucormycosis, symptoms may also include dyspnea (difficulty breathing), and persistent cough; in cases of necrosis, symptoms include nausea and vomiting, coughing blood, and abdominal pain.

EPIDEMIOLOGY OF MUCORMYCOSIS

 

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