INTRODUCTION:

Definition:

Mucormycosis is any fungal infection caused by fungi in the order Mucorales.¹

It is characterized by hyphae growing in and around blood vessels and can be potentially life-threatening in diabetic or severely immunocompromised persons.

Epidemiology:

· It is a rare infection

· In western countries, it was found in 0.7% of autopsies and approximately 20 patients in every one lakh admission⁸

· In US, Mucormycosis was most commonly found in rhino cerebral form (Always patient with hyperglycemia and metabolic acidosis)⁶

· In most cases, the patient is immunocompromised. Usually due to traumatic inoculation of fungal spores.

· Internationally, it was found in 1% of patients with acute leukemia²

Risk Factors:

· HIV/AIDS

· Uncontrolled diabetes mellitus

· Lymphomas

· Renal failure

· Organ transplant

· Long term steroid therapy and immunosuppressive therapy

· Cirrhosis of Liver

· Malnutrition^2,3

· Deferoxamine therapy

Outbreaks:

· 2011- A cluster of infections occurred in the wake of the Joplin tornado. 18 cases were suspected with cutaneous mucormycosis, in those cases 10 patients required intensive care and 5 cases died.^11,12

· 2014-details of a lethal mucormycosis outbreak, stated that contaminated hospital linen was found to be spreading the infection⁹

· 2018- A study found many freshly laundered hospital linens delivered to US transplant hospitals were contaminated with Mucorales¹⁰

Signs and Symptoms:

· Frequently affects the sinuses, brain or lungs

· Infection of the oral cavity or brain–most common forms.

· Also infect the areas of GI tract, skin and other organ systems²

· Rarely, affect the maxilla because of rich blood vessel supply³

· Brain involvement–one sided headache behind the eyes, facial pain, fever, nasal congestion and acute sinusitis with eye swelling ⁵

· Cutaneous infections- skin becomes reddened and swollen, turns into black due to tissue death⁴

· Other forms of infection–Lungs, skin or be widespread throughout the body

· Dyspnea

· Persistent cough

· Nausea and vomiting

· Hemoptysis and abdominal pain²^,⁵

Diagnostic Evaluations:

· Swabs of tissue or discharge- it is unreliable

· Biopsy specimen of the involved tissue

Pharmacological Treatment:

· Amphotericin B therapy–should be administered immediately

· It is usually administered for an additional 4-6 weeks after initial therapy

· Isavuconazole was recently FDA approved to treat invasive and non-invasive aspergillosis⁷

Surgical Treatment:

· Removal of fungus ball²^,⁸

· Involved the nasal cavity and the brain, removal of infected brain tissue

· Some cases- Removal of the palate, nasal cavity or eye structures

· Hyperbaric oxygen–Beneficial to kill the organisms⁴

Complications:

· Partial loss of neurological function

· Blindness

· Clotting of brain or lung vessels⁵

Prognosis:

· In rhino-cerebral form, the mortality rate is between 30%,

· Diffuse forms of infection- it was up to 90%⁴

· Patient with AIDS, it was almost 100% ⁸

REFERENCES:

1. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.

2. Ran Yuping (2016). "Observation of Fungi, Bacteria, and Parasites in Clinical Skin Samples Using Scanning Electron Microscopy". In Janecek, Milos; Kral, Robert (eds.). Modern Electron Microscopy in Physical and Life Sciences. InTech. doi:10.5772/61850. ISBN 978-953-51-2252-4

3. Staff Springfield News-Leader (June 10, 2011) "Aggressive fungus strikes Joplin tornado victims" Seattle PI, Hearst Communications Inc.

4. Spellberg B, Edwards J, Ibrahim A (2005). "Novel perspectives on mucormycosis: pathophysiology, presentation, and management". Clin. Microbiol. Rev. 18 (3): 556–69. doi:10.1128/CMR.18.3.556-569.2005. PMC 1195964. PMID 16020690

5. "MedlinePlus Medical Encyclopedia: Mucormycosis". Retrieved May 19, 2008.

6. Roden MM, Zaoutis TE, Buchanan WL, et al. (September 2005). "Epidemiology and outcome of Mucormycosis: a review of 929 reported cases". Clin. Infect. Dis. 41 (5): 634–53. doi:10.1086/432579. PMID 16080086

7. Lyndsay Mayer. "Mucormycosis". Food and Drug Administration. Retrieved April 5, 2017.

8. Rebecca J. Frey. "Mucormycosis". Health A to Z. Retrieved May 19, 2008.

9. Catalanello, Rebecca (April 16, 2014). "Mother believes her newborn was the first to die from fungus at Children's Hospital in 2008". NOLA.com.

10. Sundermann, Alexander; et al. (2018). "How Clean Is the Linen at My Hospital? The Mucorales on Unclean Linen Discovery Study of Large United States Transplant and Cancer Centers". Clinical Infectious Diseases. 68 (5): 850–853. doi:10.1093/cid/ciy669. PMID 30299481.

11. Williams, Timothy (June 10, 2011) Rare Infection Strikes Victims of a Tornado in Missouri. New York Times.

12. Neblett Fanfair, Robyn; Benedict, Kaitlin; Bos, John; Bennett, Sarah D.; Lo, Yi-Chun; Adebanjo, Tolu; Etienne, Kizee; Deak, Eszter; Derado, Gordana; Shieh, Wun-Ju; Drew, Clifton; Zaki, Sherif; Sugerman, David; Gade, Lalitha; Thompson, Elizabeth H.; Sutton, Deanna A.; Park, Benjamin J. (2012). "Necrotizing Cutaneous Mucormycosis after a Tornado in Joplin, Missouri, in 2011". New England Journal of Medicine. 367 (23): 2214–25. doi:10.1056/NEJMoa1204781. PMID 23215557.

Received on 23.01.2020 Modified on 14.04.2020

Asian J. Nursing Education and Research. 2021; 11(3):425-426.

DOI: 10.52711/2349-2996.2021.00102