Mucormycosis

Abstract

Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

Epidemiology of Mucormycosis in India

“…The clinical presentations of mucormycosis are classified on the basis of anatomic localisation, such as rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and disseminated mucormycosis [ 2 , 3 ]. Patients with diabetes mellitus, haematological malignancy and chemotherapy, haematopoietic stem cells, and solid-organ transplant recipients on immunosuppressive therapy, with iron overload, on peritoneal dialysis, extensive skin injury, human immunodeficiency virus (HIV) infection, and voriconazole therapy are at increased risk of acquiring mucormycosis [ 2 , 3 , 4 ]. A considerable number of mucormycosis cases are reported in immunocompetent hosts [ 5 , 6 , 7 ].…”

A Rare Case of Invasive Mucormycosis in a Diabetic Patient Treated with a Short Course of Dexamethasone

“…The mortality rate with localized cutaneous mucormycosis is 10% to 30%, whereas disseminated mucormycosis carries a much higher rate (50% to 90%), depending upon organ involvement [ 9 – 11 ]. One study comparing treatment modalities indicated that the lowest mortality rate was associated with amphotericin B plus surgery (18.8% to 43.7%) [ 12 ].…”

Mucormycosis, The Black Fungus alarming Coinfections in Covid-19 Patients

“…Some pulmonary and gastrointestinal mucormycosis cases have also been reported (do Monte et al, 2020;Garg et al, 2021). The exact cause of increased mucormycosis infection cases in COVID-19 patients is still unknown, but certain factors could have played the role, such as; immunocompromised conditions due to the pre-existing diseases, immunosuppressive drug therapy, immune alterations by the SARS-CoV-2, and pre-existing poor lung conditions (Reid et al,2020). In India, people have also used cow dung as a part of treatment for Covid-19.…”