PRESENTED BY -DR SANTOSH M NARAYANKAR

MUCORMYCOSIS

MUCOR MYCOSIS REFERS TO…… infection caused by fungi in order of mucorales .

Most common species are…rhizopus (m c),rhizomucor,cunninghamella,apophysomyces,saksenaea,absidia,muccor,andsyncephalastrum.

MUCORMYCOSIS

Rhizopus spMucor species

MAJOR ROUTE OF INFECTION

INHALTION. INGESTION. TRAUMATIC INOCULTION.

Pathophysiology

Angioinvasion Vessel thrombosis Tissue necrosis

EPIDEMIOLOGY

INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY.

MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%).

NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT.

MUCORMYCOSIS CLINICAL PRESNTATION

Five clinical forms of mucormycosis : Rhinocerebral ,pulmonary ,gastrointestinal , primary cutaneouse and disseminated.

Rhinocerebral type has the highest frequency and mortality.

RELATIONSHIP BETWEEN PREDISPOSING FACTORS AND SITE OF INFECTION DIABETIC KETOACIDISIS- RHINOCEREBRAL. NEUTROPENIA- PULMONARY & DISSEMINATED. STEROIDS-

PULMONARY,RHINOCEREBRAL,DISSEMINATED. MALNUTRION-G I TRACT TRAUMA,CATHETER,SKIN MACERATION-

CUTANEOUS/ SUBCUTANEOUS DEFEROXAMINE-DISSEMINATED

RHINOCEREBRAL MUCORMYCOSIS

50% of cases occur in patients with DM.

50%CASES OF TOTAL CASES OF MUCOR MYCOSIS.

Usually occurs during an episode of DKA , with disruption of host defense mechanisms ,thereby permitting growth of Rhizopus oryzae. Such growth is inhibited by correction of acidosis.

RHINOCEREBRAL MUCORMYCOSIS

Clinical features Onset with nasal stuffiness ,epistaxis

and facial pain. Later ,proptosis , chemosis and

ophthalmoplegia. Fever and confusion. Black necrotic eschar on the nasal

turbinates or palate : very characteristic

RHINOCEREBRAL MUCORMYCOSIS

Complications Cavernous sinus thrombosis. Multiple cranial nerve palsies. Visual loss. Frontal lobe abscess. Carotid artery or jugular vein

thrombosis causing hemiparesis.

RHINOCEREBRAL MUCORMYCOSIS

RHINOCEREBRAL MUCORMYCOSIS

Diagnosis Punch biopsy of the lesion followed

by fungal stains and culture. Histological examination reveals the

characteristic broad , branching hyphae of Rhizopus invading the tissue.

CT or MRI of the head reveal air-fluid level in the sinuses and involvement of deep tissues

RHINOCEREBRAL MUCORMYCOSIS

Imaging

CT scan coronal cut (posterior)of nose and paranasal sinusesshowing heterodense mass arisingfrom right maxillary sinus erodingthe medial wall of maxilla and presenting inside the nasal cavity.The same mass could also beseen eroding the right side of hardpalate.

PULMONARY MUCORMYCOSIS

SEEN MOST COMMONLY IN –NEUTROPENIA,PATEINTS ON CHEMOTHERPY,LEUKEMIA.

DYSPONEA ,COUGH& CHEST PAIN &FEVER RADIOLOGICALY-

CONSOLIDATION,ISOLATED MASSES,CAVITAION,WEDGE SHAPED INFARCTS.

CT SCAN BEST METHOD TO DETECT THE EXTENT.

CUTANEOUS MUCORMYCOSIS

TRAUMA IS THE PREDISPOSING FACTOR.

INVASIVE LOCALLY . MAY LEAD TO NECROTIZING

FASCITES …MORTALITY UPTO 80%. SURGICAL DEBRIDEMENT.

GASTROINTESTINAL MUCORMYCOSIS RARE,,OCCURS IN EXTREMALY

MALNOURISHED, CHILDREN. STOMACH,COLON&ILEUM ARE MOST

COMMONLY INVOLVED. ABDOMINAL PAIN,NAUSEA VOMITING,

,,,MAY PRESNT AS INTRAABDOMINAL ABSCESS,OR PERFORATION OF THE VISCUS.NEEDS BIOPSY.

PROGNOSIS VERY POOR

DISSEMINATED MUCORMYCOSIS

HEAMATOGENOUSLY PULMONARY MUCORMYCOSIS HAS

HIGHEST INCIDENCE OF DISSEMINATION.

MOST COMMON SITE OF DISSEMINATION-BRAIN ,,,SPLEEN ,HEART,SKIN, AND OTHER ORGANS.

BRAIN -100%,OTHERS->90%

MISCALLANEOUS FORMS

ENDOCARDITIS,PYELONEPHRITIS-IN I V DRUG USERS.

BONES,MEDIASTINUM,KIDNEYS,PERITONEUM.IN PATIENTS WITH DIALYSIS

SOME COMMON DD S

ANTHRAX ASPERGELLOSIS CELLULITIS COLONIC OBSTRUCTION PULMONARY EMBOLISM

HIGH SUSPICION REQUIRED

MUCORMYCOSIS WORKUP

BIOPSY-OF INVOLVED TISSUE. SWABS OF TISSUE DISCHARGE ARE

UNRELIABLE. CBC FOR NEUTROPENIA ABG TO CORRECT ACIDOSIS RBS-SUGAR CONTROL

IMAGING STUDIES

PLAIN X-RAY CT SCAN MRI SCANS CHEST CT/MRI

OTHER STUDIES

CSF EXAMINATION BRONCHOALVEOLAR LAVAGE

THANK YOU

MUCORMYCOSIS

Caused by fungi of the Rhizopus and Mucor species, which are ubiquitous saprophytic organisms, not uncommonly infecting the immunocompromised host.

These fungi have a predilection to invade blood vessels ,causing infarction and necrosis.