Mucormycosis

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Last reviewed: December 2018

Last updated: January 2018

Summary

Predominantly a disease of immunocompromised patients. Its incidence has been increasing over the past 20 years.

Five types are commonly described: rhino-orbito-cerebral (most common), pulmonary, cutaneous, disseminated, and GI (rare).

Histopathology of affected tissue is key to obtaining a definitive diagnosis.

Rhinocerebral mucormycosis commonly occurs in patients with diabetes and presents with headache, visual changes, sinusitis, and, later, proptosis.

Pulmonary mucormycosis commonly presents as a cough in patients with underlying malignancy or transplant (bone marrow or solid organ). Late diagnosis may result in dissemination, leading to high mortality.

High level of suspicion and early institution of combined medical therapy with amphotericin B, surgical treatment, and immune restoration is essential for good outcomes.

Definition

Mucormycosis is a group of mold infections caused by fungi in the class previously known as Zygomycetes, now renamed Glomeromycetes. The most common manifestations are rhino-orbito-cerebral infections followed by pulmonary, cutaneous, disseminated, and GI infections. [1]

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

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Other diagnostic factors

fever
periorbital cellulitis
focal sensory/motor neurologic deficits and altered mental status
necrotic eschar
hemoptysis
abdominal pain and distension
GI bleeding
peritonitis

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Risk factors

diabetes ± DKA
neutropenia
iron overload
corticosteroids
hematopoietic and solid organ transplantation, graft-versus-host disease
breakdown of skin and soft tissue
malnutrition
prematurity
liver cirrhosis

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Diagnostic investigations

1st investigations to order

CBC
basic metabolic profile
ABG
urinalysis
serum ketone level
CT sinuses and brain
CT chest with contrast
nasal endoscopy
GI endoscopy

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Investigations to consider

MRI sinuses and brain
bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy
histopathology of biopsy
microbiology of biopsy

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Emerging tests

PCR

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Treatment algorithm

ACUTE

all patients

Contributors

Authors VIEW ALL 

Rachana M. Palnitkar, MD

Rachana M. Palnitkar

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 VIEW ALL 

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.

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