Summary
Definition
History and exam
Key diagnostic factors
- sinus and facial pain
- eye pain, blurred vision
- proptosis
- cranial nerve palsies
- dry cough, with or without dyspnea
- skin nodules
Other diagnostic factors
- fever
- periorbital cellulitis
- viscid, dark brown-black nasal discharge
- focal sensory/motor neurologic deficits and altered mental status
- necrotic eschar
- hemoptysis
- abdominal pain and distension
- gastrointestinal bleeding
- peritonitis
Risk factors
- diabetes mellitus ± diabetic ketoacidosis
- hematologic malignancy
- neutropenia
- iron overload or use of deferoxamine
- use of corticosteroids
- hematopoietic and solid organ transplantation, graft-versus-host disease
- breakdown of skin and soft tissue
- malnutrition
- prematurity
- liver cirrhosis
Diagnostic tests
1st tests to order
- CBC
- basic metabolic profile
- ABG
- urinalysis
- serum ketone level
- CT sinuses and brain
- MRI sinuses and brain
- CT chest with contrast
- nasal endoscopy
- gastrointestinal endoscopy
Tests to consider
- bronchoscopy with bronchoalveolar lavage and/or transbronchial biopsy fungal culture
- histopathology of biopsy
- microbiology of biopsy
Emerging tests
- polymerase chain reaction (PCR)
Treatment algorithm
suitable for surgery
unsuitable for surgery
treatment failure
Contributors
Authors
Rachana M. Palnitkar, MD
Infectious Diseases
Private Practice
Los Gatos
CA
Disclosures
RMP declares that she has no competing interests.
Michael Sands, MD, MPH & TM, FIDSA
Professor of Medicine
College of Medicine
University of Florida
Jacksonville
FL
Disclosures
MS declares that he has no competing interests.
Peer reviewers
Michail Lionakis, MD, ScD
Infectious Diseases Fellow
Laboratory of Molecular Immunology
National Institute of Allergy and Infectious Diseases
NIH
Bethesda
MD
Disclosures
ML declares that he has no competing interests.
Rachael Morris-Jones, PhD, FRCP, PCME
Dermatology Consultant and Honorary Senior Lecturer
Kings College Hospital
London
UK
Disclosures
RMJ declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Pham D, Howard-Jones AR, Sparks R, et al. Epidemiology, modern diagnostics, and the management of mucorales infections. J Fungi (Basel). 2023 Jun 12;9(6):659.Full text Abstract
Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005 Jul;18(3):556-69.Full text Abstract
Centers for Disease Control and Prevention. Mucormycosis: clinical overview of mucormycosis. Apr 2024 [internet publication].Full text
Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec;19(12):e405-21.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Aspergillosis
- Bacterial sinusitis
- Bacterial periorbital cellulitis
More DifferentialsGuidelines
- Global guideline for the diagnosis and management of mucormycosis
- Global guideline for the diagnosis and management of mucormycosis
More Guidelines
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