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Mucormycosis

The mucormycosis is an opportunistic disease caused by fungi Zygomycetes and usually affects immunocompromised (low defenses) with leukopenia and impaired phagocytic function, especially diabetic and leukemic.

Also called zygomycosis or phyomycosis.

What produces it?

Saprophytic fungi of the class Zygomycetes, of the order of the Mucorales and of the genus of Rhizopus, Absidia, Mucor and Rhizomucor.

The most common agent found in human zygomycosis is Rhizopus arrhizus.

It occurs because these fungi are widely distributed in nature, being detected in the soil as part of the decomposing vegetable matter or organic waste, as well as in fruits or bread, and they are even part of the normal saprophytic flora of skin and mucous membranes in small proportion.

The disease can be acquired by three different mechanisms:

  • inhalation of spores (sporangiospores)
  • traumatic implantation in tissues
  • fungal invasion by breaking barriers

Fungi invade adjacent tissues and can spread hematogenously (through the blood), causing thrombosis, ischemia, and necrosis .

For this disease to occur, some degree of immunosuppression is necessary

  • metabolic acidosis ( diabetes , diarrhea, uremia, ingestion of salicylates …)
  • leukemia, bone marrow transplant, thalassemia, blood dysplasias …
  • cirrhosis , hyperglycemia, burns, malnutrition, alcoholism , dialysis, ADVP, treatment with corticosteroids …

Symptoms of mucormycosis

Rhinocerebral mucormycosis

Severe clinical syndrome common in patients with acidosis and diabetes mellitus. It is caused by inhalation of spores that penetrate the nasal mucosa, paranasal sinuses and palate, causing ulcerative lesions. Once through the mucosa, they progress through tissues, nerves, blood vessels and fasciae, occasionally reaching vital structures at the base of the skull.

Characteristic symptoms: headache , orbital cellulitis , fever , cranial nerve palsy, vascular thrombosis, delirium, and coma.

Pulmonary mucormycosis

More frequent in patients with hematological neoplasia. It originates from inhalation of spores.

Characteristic symptoms: symptoms compatible with nonspecific bronchitis, pneumonia, thrombosis and / or pulmonary infarction.

Gastrointestinal mucormycosis

More common in patients with malnutrition or gastrointestinal disease. It is caused by ingestion of fungi or surgical contamination.

Characteristic symptoms: abdominal pain, diarrhea, hematemesis and bloody stools.

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Cutaneous mucormycosis

More common in patients with a break in the skin. It is caused by injection of spores or by implantation in contaminated bandages or dressings.

Characteristic symptoms: pustules, abscesses and ulcers with evidence of necrosis and hemorrhage.

Disseminated mucormycosis

It is located primarily in the lung, and later it affects the CNS and heart, although any organ can be affected by hematogenous dissemination.

Characteristic symptoms: it depends on the organs that have been invaded by the fungus.

Diagnosis of mucormycosis

The presumptive diagnosis is made by direct examination of the sample obtained (scrapings, imprints, sputum, BAL…) under an optical microscope with 20% potassium hydroxide, observing hyphae without septum.

Periodic acid Schiff, Gomori methenamine-silver, and hematoxylin-eosin stains can also be performed.

The definitive diagnosis is made by histological study of the lesions (the best sample is the surgical biopsy) and by culture.

In histology, the existence of:

  • non-septate wide hyphae
  • branching at right angles
  • vascular invasion, infarction and necrosis

The culture grows readily in 24-48 hours on most common media, and gray or whitish cottony colonies are grossly visible.

Treatment

A combined medical and surgical treatment is necessary.

Medical treatment is based on the administration of conventional amphotericin B-deoxycholate (0.7-1.5 mg / kg / day) or a lipid form (3-5 mg / kg / day). The total dose to be administered is suggested to be 2-4 gr. of the conventional product or, in case of neutropenia, until its disappearance.

Some authors advise the association of rifampicin at a dose of 600 mg / 12 hours with amphotericin B, as well as the use of hyperbaric oxygen.

Surgical treatment consists of removing the greatest amount of necrotic tissue, and reconstructive plastic surgery may be necessary.

To avoid this disease, the fundamental thing is to closely monitor immunosuppressed people who present factors that favor the development of this mycosis (diabetes, hematological diseases, antineoplastic treatment, antibiotics and corticosteroids …)

It is vital to carry out an early diagnosis, which allows to establish early treatment that prevents the invasion and destruction of tissues.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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