Mucormycosis: Fungal Infections You Need to Know
Protect Yourself from Mucormycosis Today! Understand the Symptoms and Treatment
Mucormycosis is a fungal infection caused by fungi known as Mucorales. These organisms are ubiquitous in nature and have been isolated from soil, water, air, animals, and humans. Mucorales are saprophytic (living off decaying matter) and can cause disease in immunocompromised individuals. Mucorales have been associated with human infections including rhinocerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and cerebral forms.
The most common form of mucormycosis is zygomycosis, which occurs when spores enter the body through cuts, wounds, burns, or inhalation. Zygomycosis may occur in patients who have diabetes mellitus, leukemia, lymphoma, organ transplant recipients, or those receiving chemotherapy. Patients with hematologic malignancies are at increased risk for mucormycosis due to neutropenia and thrombocytopenia. Other predisposing factors include corticosteroid use, malnutrition, trauma, and surgery.
The presentation of mucormycosis infections varies greatly. Most commonly, patients present with localized cutaneous lesions, such as cellulitis, necrosis, or abscesses. A less frequent presentation includes rhinocerebral infection, where the fungus enters the nasal cavity and infects the brain.
Infections in the lung may also develop, leading to pneumonia. In rare instances, infections enter the bloodstream, causing disseminated disease. Mucormycosis is a rare fungal infection that occurs in people who are immunocompromised. As a result, the fungus grows unchecked and spreads throughout the body.
How do I get infected?
The most common way to contract mucormycosis is through inhalation of spores. Spores are small, microscopic, and easily spread through the air. Once inhaled, the spores germinate and begin to infect the lungs. If left untreated, the infection can spread to the brain, heart, liver, kidneys, skin, eyes, and gastrointestinal tract.
There are over 200 species of the Mucorales. Most species were once classified as members of Rhizopus. Among these are the following:
Dichotomospora – includes species now placed in Circinella
Echinocandidosporium – includes species formerly assigned to Rhizopus
Fusarium – includes fungi previously identified as Mucor
Geotrichum – includes species formerly assigned as Geotrichum
Gymnoascus – includes species formerly placed in Rhizopus
In 2004, the International Association of Medical Mycology created a new classification system based on phylogenetic analysis.
What is the best way to diagnose Mucormycosis?
The early diagnosis of this condition is difficult and relies heavily upon clinical presentation. Blood cultures are negative 90% of the time, making it impossible to detect the infection in its earliest stages. There are many diagnostic testing methods, but they still cannot identify the pathogen at the beginning of infection.
The clinical manifestations of mucormycotic infections depend upon the site of involvement. Rhinocerebral mucormicosis presents as a fulminating necrotizing rhinosinusitis. While the exact pathogenesis of mucormycosis remains unknown, it is believed that host factors play a major role in determining susceptibility to infection. Patients with uncontrolled diabetes, neutropenia, thalassemia, iron overload, renal failure, and alcoholism are predisposed to developing mucormycosis.
The following are some ways to diagnose mucormycosis:
- A biopsy of the infected tissue shows hyphae (thread-like structures) of mucor.
- Blood tests show elevated levels of creatinine kinase (CK), lactate dehydrogenase (LDH), and creatine phosphokinase (CPK).
- Sputum culture grows mucor.
- Imaging studies show cavities filled with fluid in the lungs.
- Serology testing shows increased levels of antibodies against mucor antigens.
- Histopathologic examination of the infected tissue shows broad, non-septated hyphae of mucor.
What are the symptoms of mucormycosis?
The first symptom of mucormycosis is often a cutaneous lesion (a small sore) at the site where the fungus entered the body. If left untreated, the infection may spread throughout the body causing damage to internal organs. The following are some of the symptoms of mucormycosis:
- Severe headache
- Shortness of breath
- Muscle pain
- Skin rash
- Changes in mental status
- Loss of appetite
However, patients who develop rhinocerebral infections tend to have neurological symptoms, such as altered mental status, focal neurologic deficits, cranial nerve palsies, and visual disturbances.
What are the treatment options for mucormycosis?
Treatment of mucormycotic infections varies based on the location of the infection. Whereas, treatment of nasal infections involves surgical removal of the affected area. Treatment of eye infections includes topical antifungals and systemic antifungals. Likewise, treatment of intestinal infections includes surgery to remove the diseased portion of the intestine. Treatment of urinary tract infections requires surgery to remove the disease portion of the bladder.
There are three types of treatment for mucormycosis: antifungal therapy, surgical removal of infected tissue, and supportive care. Treatment of mucormycotic infections involves removing the infected area and draining it to prevent further spread. Antifungal therapy includes amphotericin B, posaconazole, caspofungin, micafungin, voriconazole, and/or liposomal amphotericin B.
Surgical removal of infected tissue involves removing the affected area(s) of the body. Supportive care includes treating any underlying medical condition that may be contributing to the patient’s illness. Pulmonary mucormycosis manifests as pneumonia and/or empyema.
Who Is at Risk with Mucormycosis?
The risk factors for developing mucormycosis include diabetes mellitus, neutropenia, hematologic malignancies, solid organ transplantation, iron overload, malnutrition, and immunosuppression. Patients who are undergoing chemotherapy or radiation therapy are at increased risk for mucormycosis due to their suppressed immune system.
People who have weakened immune systems, including those taking immunosuppressive drugs, HIV/AIDS patients, organ transplant recipients, and chemotherapy patients or radiation therapy. People who inhale mold spores from contaminated air. Airborne spores from the fungus can cause disease in people who are susceptible to infection.
There have been cases where individuals get mucormycosis after being due to contaminated buildings, swimming pools, and even recreational marijuana. Immune-compromised patients do not receive adequate treatment and care for their condition.
What are the prospects?
In humans, mucormycosis are opportunistic pathogens that cause disease only if the immune system is compromised. Most commonly, these infections occur in patients who are immunocompromised due to diabetes mellitus, hematologic malignancies, neutropenia, organ transplantation, or corticosteroid therapy.
The incidence of mucormycosis has increased over the past decade, especially among patients with hematological malignancies undergoing chemotherapy. Patients with hematological malignant conditions are at high risk for developing mucormycosis because their immune systems don’t allow them. However, the mortality rate associated with mucormycosis remains high (40-60%).
Lung infection occurs through inhalation of spores. Spores germinate and invade the pulmonary vasculature, causing thrombotic occlusion of small vessels. As the fungus spreads throughout the body, it may lead to dissemination to the brain, skin, gastrointestinal tract, heart, liver, kidney, bone marrow, and eyes.
The overall mortality rate associated with mucormycosis remains high at approximately 50%. However, outcomes have improved over recent years, due largely to earlier diagnosis and aggressive antifungal therapy. Newer diagnostic tools allow for earlier recognition of the disease, resulting in earlier initiation of treatment.
Mucorales fungi are ubiquitous saprophytic organisms that are present in the environment. Cutaneous lesions appear after trauma or invasive procedures involving contaminated materials. In the case of Mucormycosis, one should consider any case of persistent skin lesion that fails to improve after appropriate medical management. Prompt diagnosis and early initiation of proper medical therapy are paramount to increasing survival rates.
Is mucormycosis contagious?
As a matter of fact, Mucorales are known to spread via airborne spores. Due to this, they are able to travel long distances before infecting a new host. If you think you might have mucormycosis, contact your doctor immediately. Treatment requires prolonged use of antifungal medication. If you have been diagnosed with mucormycotic infections, here are some ways you can help prevent further infections:
Avoid contact with soil or any material containing fungus.
- Clean your home regularly. Remove mold and mildew from surfaces using soap and water.
- Keep your home clean and dry.
- Wear protective clothing when working outside.
- Do not smoke cigarettes.
- Practice good hygiene habits. Wash your hands frequently.
- Have regular checkups with your doctor.
- Be aware of symptoms.