Mucormycosis

SEMINAR PRESENTED BY
DR SANTOSH NARAYANKAR
AT NSCBMCH JABALPUR

1. PRESENTED BY -DR SANTOSH M NARAYANKAR MUCORMYCOSIS

2. MUCOR MYCOSIS REFERS TO…… infection caused by fungi in order of mucorales . Most common species are… rhizopus (m c),rhizomucor,cunninghamella,apophysomyces,saksenaea,absidia,muccor,andsyncephalastrum.

3. MUCORMYCOSIS Rhizopus sp Mucor species

4. MAJOR ROUTE OF INFECTION INHALTION. INGESTION. TRAUMATIC INOCULTION.

5. Pathophysiology Angioinvasion Vessel thrombosis Tissue necrosis

6. EPIDEMIOLOGY INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY. MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%). NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT.

7. MUCORMYCOSIS CLINICAL PRESNTATION Five clinical forms of mucormycosis : Rhinocerebral ,pulmonary ,gastrointestinal , primary cutaneouse and disseminated. Rhinocerebral type has the highest frequency and mortality.

8. RELATIONSHIP BETWEEN PREDISPOSING FACTORS AND SITE OF INFECTION DIABETIC KETOACIDISIS- RHINOCEREBRAL. NEUTROPENIA- PULMONARY & DISSEMINATED. STEROIDS- PULMONARY,RHINOCEREBRAL,DISSEMINATED. MALNUTRION-G I TRACT TRAUMA,CATHETER,SKIN MACERATION-CUTANEOUS/ SUBCUTANEOUS DEFEROXAMINE-DISSEMINATED

9. RHINOCEREBRAL MUCORMYCOSIS 50% of cases occur in patients with DM . 50%CASES OF TOTAL CASES OF MUCOR MYCOSIS. Usually occurs during an episode of DKA , with disruption of host defense mechanisms ,thereby permitting growth of Rhizopus oryzae . Such growth is inhibited by correction of acidosis.

10. RHINOCEREBRAL MUCORMYCOSIS Clinical features Onset with nasal stuffiness ,epistaxis and facial pain. Later ,proptosis , chemosis and ophthalmoplegia. Fever and confusion. Black necrotic eschar on the nasal turbinates or palate : very characteristic

11. RHINOCEREBRAL MUCORMYCOSIS Complications Cavernous sinus thrombosis. Multiple cranial nerve palsies. Visual loss. Frontal lobe abscess. Carotid artery or jugular vein thrombosis causing hemiparesis.

12. RHINOCEREBRAL MUCORMYCOSIS

13. RHINOCEREBRAL MUCORMYCOSIS Diagnosis Punch biopsy of the lesion followed by fungal stains and culture. Histological examination reveals the characteristic broad , branching hyphae of Rhizopus invading the tissue. CT or MRI of the head reveal air-fluid level in the sinuses and involvement of deep tissues

14. RHINOCEREBRAL MUCORMYCOSIS

15. Imaging CT scan coronal cut (posterior) of nose and paranasal sinuses showing heterodense mass arising from right maxillary sinus eroding the medial wall of maxilla and  presenting inside the nasal cavity. The same mass could also be seen eroding the right side of hard palate.

16. PULMONARY MUCORMYCOSIS SEEN MOST COMMONLY IN –NEUTROPENIA,PATEINTS ON CHEMOTHERPY,LEUKEMIA. DYSPONEA ,COUGH& CHEST PAIN &FEVER RADIOLOGICALY-CONSOLIDATION,ISOLATED MASSES,CAVITAION,WEDGE SHAPED INFARCTS. CT SCAN BEST METHOD TO DETECT THE EXTENT.

17. CUTANEOUS MUCORMYCOSIS TRAUMA IS THE PREDISPOSING FACTOR. INVASIVE LOCALLY . MAY LEAD TO NECROTIZING FASCITES …MORTALITY UPTO 80%. SURGICAL DEBRIDEMENT.

18. GASTROINTESTINAL MUCORMYCOSIS RARE,,OCCURS IN EXTREMALY MALNOURISHED, CHILDREN. STOMACH,COLON&ILEUM ARE MOST COMMONLY INVOLVED. ABDOMINAL PAIN,NAUSEA VOMITING, ,,,MAY PRESNT AS INTRAABDOMINAL ABSCESS,OR PERFORATION OF THE VISCUS.NEEDS BIOPSY. PROGNOSIS VERY POOR

19. DISSEMINATED MUCORMYCOSIS HEAMATOGENOUSLY PULMONARY MUCORMYCOSIS HAS HIGHEST INCIDENCE OF DISSEMINATION. MOST COMMON SITE OF DISSEMINATION-BRAIN ,,,SPLEEN ,HEART,SKIN, AND OTHER ORGANS. BRAIN -100%,OTHERS->90%

20. MISCALLANEOUS FORMS ENDOCARDITIS,PYELONEPHRITIS-IN I V DRUG USERS. BONES,MEDIASTINUM,KIDNEYS,PERITONEUM.IN PATIENTS WITH DIALYSIS

21. SOME COMMON DD S ANTHRAX ASPERGELLOSIS CELLULITIS COLONIC OBSTRUCTION PULMONARY EMBOLISM

22. HIGH SUSPICION REQUIRED

23. MUCORMYCOSIS WORKUP BIOPSY-OF INVOLVED TISSUE. SWABS OF TISSUE DISCHARGE ARE UNRELIABLE. CBC FOR NEUTROPENIA ABG TO CORRECT ACIDOSIS RBS-SUGAR CONTROL

24. IMAGING STUDIES PLAIN X-RAY CT SCAN MRI SCANS CHEST CT/MRI

25. OTHER STUDIES CSF EXAMINATION BRONCHOALVEOLAR LAVAGE

26. THANK YOU

27. MUCORMYCOSIS Caused by fungi of the Rhizopus and Mucor species, which are ubiquitous saprophytic organisms, not uncommonly infecting the immunocompromised host. These fungi have a predilection to invade blood vessels ,causing infarction and necrosis.