MUCORMYCOSIS (Black Fungi)
Mucormycosis represents a group of life-threatening infections caused by fungi of the order Mucorales. Among the Mucorales, Rhizopus oryzae , Rhizopus microsporus, Rhizomucor pusillus, Lichtheimia corymbifera common causes of mucormycosis.
PATHOGENESIS
The Mucorales are ubiquitous environmental fungi to which humans are constantly exposed. These fungi cause infection primarily in patients with diabetes, defects in phagocytic function (e.g., neutropenia or glucocorticoid treatment), and/or elevated levels of free iron, which supports fungal growth in serum and tissues
Patients with diabetic ketoacidosis (DKA) are at high risk of developing rhinocerebral mucormycosis. The acidosis causes dissociation of iron from sequestering proteins, resulting in enhanced fungal survival and virulence.
CAUSES
- Diabetes mellitus
- Solid organ or hematopoietic stem cell transplantation
- Prolonged neutropenia
- Malignancy
- Recent glucocorticoid use
- After traumatic implantation of soil or vegetation (e.g., due to natural disasters, motor vehicle accidents, or—in soldiers—severe injuries during combat operations)
- Nosocomial settings via direct access through iv catheters, injections
- Maceration of the skin by a moist dressing
- Damp weather
- Patients receiving antifungal prophylaxis with either itraconazole or voriconazole may be at increased risk of mucormycosis
- Plant material (e.g., a thorn)
- Injections of medications (e.g., insulin)
- Indiscriminate use of steroid therapy
CLINICAL MANIFESTATIONS
1.Rhino-Orbital-Cerebral Disease-the most common form of the disease
- Eye or facial pain and facial numbness
- Conjunctival suffusion
- Blurry vision
- Fever may be absent
- White blood cell counts are typically elevated
- If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in compromise of extraocular muscle function and proptosis
- From the orbit, spread often takes place via hematogenous or contiguous dissemination to the frontal lobe of the brain and/or via venous drainage to the cavernous sinus.
- Vision loss
- Infection can sometimes extend from the sinuses into the mouth and produce painful necrotic ulcerations of the hard palate
2.Pulmonary Disease -second most common manifestation.
- Dyspnea
- Cough
- Chest pain
- Fever
- Hemoptysis
- Cutaneous Disease -result from external implantation of the fungus or from hematogenous dissemination
- Gastrointestinal Disease
- Nonspecific abdominal pain and distention
- Nausea and vomiting
- Gastrointestinal bleeding
- Disseminated and Miscellaneous Forms of Disease
Miscellaneous forms of mucormycosis may affect any body site, including bones, mediastinum, trachea, kidneys, and peritoneum (in association with dialysis)
DIAGNOSIS
Blood CBC,FBS,
Biopsy with histopathologic examination remains the most sensitive and specific modality for definitive diagnosis
CT or MRI of the head or sinuses
TREATMENT
HOMEOPATHY MEDICINE