Mucormycosis

Presentation :

• Often associated with uncontrolled hyperglycemia (particularly DKA), neutropenia/immunosuppression, iron overload/deferoxamine usage, and acidosis
• Rhino-orbital-cerebral mucormycosis:
  • Most common presentation
  • Typically presents w/ fever, nasal congestion/discharge, facial/sinus pain, periorbital/facial swelling, headache, vision changes or ophthalmoplegia
  • Most often caused by Rizopus oryzae

Pathophysiology :

• Most often caused by infection with fungal organisms of the Order Mucorales _(Genera Rhizopus, Mucor, and Rhizomucor)
• Risk factors:
  • Excess glucose and iron alone cause increased fungal growth
  • Metabolic acidosis (such as DKA) impairs the ability of transferrin to chelate iron causing excess free iron for fungal growth

Diagnostic Testing:

• Gold standard: identification of organisms in tissue by histopathology with culture confirmation
• Note: Fungal blood tests (beta-D-glucan and Aspergillus galactomannan will be negative)

Treatment :

• First line antifungal = Ambisome (liposomal)
• Also important is management of predisposing conditions
  • Maintain normoglycemia

Prognosis:

References:

• Baldin, Clara, and Ashraf S. Ibrahim. "Molecular mechanisms of mucormycosis—The bitter and the sweet." PLoS pathogens 13, no. 8 (2017): e1006408.