What is Mucormycosis ?
Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or other type of skin injury(1).
Mucormycosis is not so common but serious fungal infection that complicates the course of severe COVID-19.
What causes mucormycosis ?
Fungi of the Mucor genus are conditional pathogens that rarely cause disease in healthy individuals (2).
How does it spread ?
Inhalation of the pathogenous spores may result in disease in subjects with impaired immune function. It spreads through paranasal sinuses and respiratory system, or by the hematogenous or lymphatic route (2).
What are the risk factors ?
The majority of patients with mucormycosis present one or more risk factors, including hematopoietic malignancies, treatment with immune inhibitors or diabetes mellitus.
Type 2 diabetes mellitus
Hypertension,
Ischemic cardiomyopathy
End-stage renal disease
In addition, a low neutrophil count is an independent risk factor for Mucor infection. Pulmonary mucormycosis accounts for ~25% of cases of mucormycosis, followed by nasal and brain mucormycosis. Furthermore, pulmonary mucormycosis has a fatality rate of >50%. Pulmonary mucormycosis develops quickly and is characteristically a subacute condition(2).
Clinical manifestations
non-specific
commonly include fever, cough, chest pain,
dyspnea (diffculty in breathing)
hemoptysis (coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs) since these pathogens can erode blood vessels(2).
Types (depending on the site of involvement):
Rhino-Orbito-Cerebral Mucormycosis (ROCM)
Severe, emergent and fatal infection requiring multidisciplinary management. It may often present with OAS initially. For ophthalmologist, mucormycosis must be considered in immunocompromised patients presenting with OAS initially, and anterior rhinoscopy is imperative before hormonotherapy, even in the cases absent of ketoacidosis induced by diabetes mellitus(3).
Pre-operative aspect of patient exhibiting bilateral periorbital edema with facial swelling, exophthalmia, blepharoptosis,and Ocular purulent secretion
Pulmonary Mucormycosis
Pulmonary mucormycosis, a relatively rare pulmonary fungal disease, is difficult to diagnose and lacks effective treatment. With the increasing use of broad-spectrum antibiotics, chemicals, immunosuppressive agents and organ transplantation, the incidence of invasive pulmonary fungal infections has increased in recent years. Susceptible individuals inhale fungal spores in the air or paranasal sinus, resulting in pulmonary mucormycosis via blood-borne or lymphatic dissemination. The clinical characteristics of pulmonary mucormycosis are non-specificity pneumonia. The most common symptom persistent high fever (>38°C), cough, hemoptysis and chest pain (4)
Plain computed tomography scan upon admission to the hospital, demonstrating patchy and macular lesions in the patient's bilateral pulmonary lobe, and macular lesions in right lower lobe were observed.
Radiological manifestations
include infiltrates, exudation, consolidation, cavities and nodules
while the disease typically has a predilection for the upper lobes(2)
References
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