Mucormycosis

GENERAL PRINCIPLES

• Zygomycetes are a class of ubiquitous environmental fungi found in decaying organic substrates. They have been reclassified into two orders, Mucorales and Entomophthorales.

• Mucorales contains the genera most commonly involved in human disease. These include Mucor spp., Rhizopus spp., and Cunninghamella spp. Disease manifestations vary depending on the affected organ, but the main clinical presentations include sinus (rhino-orbital or rhinocerebral), pulmonary, cutaneous, gastrointestinal, and disseminated infections. Angioinvasion and multiorgan infarction are rapidly progressive. Risk factors include immunosuppression, iron overload, high-dose glucocorticoid therapy, penetrating trauma, and poorly controlled diabetes, especially in the setting of ketoacidosis.

DIAGNOSIS

• Clinical manifestations vary depending on which organ is affected. Invasive mucormycosis is devastating with rapid development of tissue necrosis from vascular invasion and thrombosis.

• Diagnosis requires tissue culture and silver stain with care to avoid disrupting fungal architecture.

• Head CT or MRI is helpful in head and neck disease to identify involved structures.

• Sinus endoscopy should be performed if there is concern for invasive fungal sinusitis.

TREATMENT

See Table 14-13.