Mucormycosis

Ubiquitous in soil,spores are present in air and dust

Invasive disease caused mainly by species of Rhizopus,
Mucor and Leichthemia.
Primary focus in the upper respiratory tract and nasal
cavity, where the spores germinate and the mycelia invade
the adjacent tissues-nasal mucosa, palate, orbit, sinuses ,
face and brain.
Occur mostly in immunocompromised patients particularly
among uncontrolled diabetic patients, patients on
corticosteroids and antibiotics for prolonged duration.
Lung is the primary site of infection, fungi may invade the
arteries to cause thrombosis and infarction

 It occurs occurs due to disruption of normal protective barrier

Local risk factors for mucormycosis include trauma, burns, surgery,
surgical splints, arterial lines, injection sites, biopsy sites, tattoos and
insect or spider bites
Systemic risk factors for mucormycosis are hyperglycemia, malignancy,
leucopenia and immunosuppressive therapy, however, infections in
immunocompetent host is well described
Mucormycetes are upcoming as emerging agents leading to fatal
consequences, if not timely detected.

Clinical Types of Mucormycosis

Rhino-orbito-cerebral: in which nose, nasal sinuses

and orbit are involved is usually a fatal complication of

DM.

Cutaneous : in the skin of burn patients, injuries, wound

Subcutaneous: in the tissues of patients underwent
surgery

Pulmonary,
Disseminated
Gastrointestinal
Renal mucormycosis

Cutaneous mucormycosis

third most common form of mucormycosis among humans

Characterized by necrotizing fasciitis, a soft tissue infection,

requiring surgical debridement of necrosed tissue along with
antifungals.

The main predisposing factors are traumatic injury, iatrogenic

(intramuscular injections, incision and drainage without taking
aseptic precautions), burns.

In Indian patients injection abscess is the highest risk

factor.

found in both immunocompetent and immunocompromised

persons, which may prove to be fatal if there is no timely
intervention

Pulmonary Mucormycosis

bronchopneumonia, cavitation, fungal ball formation,

pleural effusion, vascular invasion, thrombosis,
infarction, haemoptysis, fistulas, etc.

Generally the infection progresses rapidly but it can

be subacute or chronic.

Subacute pulmonary infection may go on for weeks

or months, occurring in diabetics with pulmonary
infiltrates.

Broad Categories of Mucormycetes

Phylum: Glomeromycota (Former Zygomycota)
Subphylum: Mucormycotina
Mucormycetes
Mucorales: Mucormycosis
Acute invasive infection in immunocompromised individuals
Entomophthorales: Entomophthoromycosis
Chronic subcutaneous infections in immunocompetent
patients

Phylum : Glomeromycota (Former Zygomycota)

Subphylum: Mucormycotina - Mucormycetes

Agents of Mucormycosis
Mucorales : Mucormycosis
Rhizopus arrhizus

Rhizopus microsporus var. rhizopodiformis

Lichtheimia (Mycocladus corymbiferus, Absidia corymbifera)
Rhizomucor pusillus
Mucor species
Mortierella species
Cunninghamella species
Apophysomyces elegans, A. variabilis, A. trapeziformis
Saksenaea vasiformis, S. erythrospora, S. oblongispora
Cokeromyces recurvatus and others species

Entomophthorales: Entomophthoromycosis
Conidiobolomycosis Conidiobolus coronatus
Basidiobolomycosis Basidiobolus ranarum

Need for correct laboratory diagnosis

highly
aggressive
fungal
immunocompromised patients,
mortality and morbidity.

infection,
fatal
with high rates

in
of

The diagnosis is very challenging with many misidentified

cases.

associated high mortality and the resistance to the most

widely used antifungal drugs urge the development of
rapid and accurate diagnostic assays as well as effective
antifungal treatments.
Besides, species identification is epidemiologically and
clinically important because it impinges upon the choice
of appropriate antifungal agent in therapy.

Laboratory Diagnosis

Usually done by histological examination of autopsy material.

Wet preparation in 10% KOH: demonstration of broad, aseptate, branching hyphae

with focal bulbous dilatations.

In case of tissue sample and FNAC. Open lung biopsy , H & E stain.

Culture- SDA without cycloheximide.

After 3-4 days incubation at 37oC, colonies look gray white with a thick
cottony fluffy surface.

impossible to distinguish b/w the different species based on their colony

morphology.

Microscopy- Characteristic sac like fruiting structure (sporangium) filled

with spores, and produced at the tip of sporangiophore.

Sporangiosphores are usually connected to each other by septate hyphae

called stolons.

Mucor does not have rhizoids or stolons whereas Rhizopus has

rhizoids that appear at the point where stolon arises.

A case of pulmonary mucormycosis in a diabetic patient who

had been misdiagnosed as invasive pulmonary aspergillosis

Therapy

Amphotericin B
Itraconazole
Posaconazole
Combination therapy
Surgical debridement
Surgical debridement with administration of systemic
antifungals.
Voriconazole has high MICs.
Echinocandins have no activity.