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Mucormycosis - Zygomycosis


Mucormycosis - Mucormycosis
also known as Zygomycosis or Phycomycosis, is caused by Phycomycetes fungi (Mucorales) found in the soil and in decaying vegetation. The structure of these fungi is characteristic - the hyphae are broad, branch at ninety degrees, and are non-septate. All of us are exposed to these fungi all the time but immune- compromised people are susceptible to this infection.

Predisposing Factors -
-Poorly controled diabetics
-with long standing acidosis
-specially if the persion is iron loaded. (The fungal hyphae produce a substance called rhizoferrin, which binds iron when it come in contact with it. The iron-rhizoferrin complex is taken back inside the cell, and the iron becomes available for vital intracellular functions.)
-persons on deferoxamine(DFO) therapy. DFO provides iron to the fungus for its growth
-immunosuppressed patients (chronic steroid use, organ transplantation, leukemia/lymphoma, and AIDS)

Mucormycosis is a fungal infection of -
- sinuses and brain. Most cases involve the paranasal sinuses, spreading rapidly to the eye and the brain
- Pulmonary mucormycosis,
- skin

Rarely -
-gastrointestinal tract

As the infection spreads, blood vessels get thrombosed and the tissue gets necrosed. Mucormycosis is a rapidly spreading infection and can be fatal if not treated aggressively.

Symptoms -
Rhinocerebral mucormycosis (Sinus and brain)- Fever, acute sinusitis, swelling and protrusion of eye orbit (proptosis), dark nasal discharge and swelling and redness of skin overlying sinuses (cellulitis)
Pulmonary mucormycosis (Lung)- Fever, cough, blood in sputum, shortness of breath
Gastrointestinal mucormycosis- Abdominal pain, vomiting blood
Renal mucormycosis (Kidney)- Flank pain, fever
Cutaneous mucormycosis (skin)- painful with burning sensation, red coloured firm area on skin with central darker area.
For diagnosis, CT Scan or MRI of the site involved, may be performed.

Treatment- As the disease spread is rapid, aggressive treatment is required. Radical surgery to remove all the dead tissues done. Which may lead to disfigurement because of removal of the eye even with good vision, nose, palate or part of face etc. Without this type of surgery, chances of survival are very, very less. Side by side FUNGISOME (1-3 mg) is recommended. In cases of Rhinocerebral mucormycosis, Amphotericin B can be given intrathecical or intraventricular. Amphotericin B can also be given interstitially. Even after aggressive treatment, mortality rate is up to 80%.
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