Opportunistic Fungal Infection

1. Kanika Sharma BDS 3rd year
Phycomycosis

2. Phycomycosis
Also called as Mucormycosis, Zygomycosis.
Fungal infection caused by the order mucorals.
Worldwide in distribution and normally present in
soil, manure fruits and in decaying matter.
Also present in the nasal passages and oral cavity of
normal person

3. An Opportunistic Infection
Associated with,
Debilitation , more frequent in cancer patients , especially
lymphomas.
Diabetes mellitus, especially those with ketoacidosis,
immunosuppressed patients (50% cases).
Burns or open wounds , after administration of steroids
and chemotherapeutic antimetabolites.
Severe malnutrition.
Renal failure, organ transplant, AIDS and cirrhosis.

4. The Three Most Important Type Causing
Infection In Man are
Rhizopus
Mucor
Absidia

5. Major Route Of Infection
Inhalation
Traumatic Inoculation
Ingestion

6. Clinical Features
Two main type of
infections are
present in human
beings
Superficial
Visceral
Sometimes also
classified as
Localized
Disseminated

7. Superficial Infections
Includes
External ear
The fingernails
The skin

8. Visceral Infection
Pulmonary
Gastrointestinal
Rhinocerebral

9. Rhinocerebral
Greatest interest to the dental profession
Characterised by the classical syndrome of
uncontrolled diabetes, cellulitis, ophthalmoplegia
and meningoencephalitis.
The infection enter the tissue through nasal mucosa
and extends to the paranasal sinuses, pharynx,
palate, orbit, and brain.

10. Clinical Features
 The appearance of a reddish black nasal turbinate (nasal
conchae) and septum with nasal discharge.
 Maxillary sinus may present clinically as a mass of the antrum
and radiography may support the latter diagnosis.
 Surgical exploration , however will reveal only masses of
necrotic tissue in which the organisms can be demonstrated
histologically.

11. Complications
Cavernous sinus thrombosis
Multiple cranial nerve palsy
Visual loss
Frontal lobe abscess
Carotid artery or jugular vein thrombosis

12. Maxillary sinus infection

13. Black discoloration in inferior nasal
turbinate

14. Pulmonary
Seen most commonly in neutropenia, patents
on chemotherapy and leukemia.
Dyspnea, cough, chest pain and fever.
Radiologically:-
Consolidation, isolated masses, cavitation, wedge
shaped infarcts.

15. Gastrointestinal
Rare, occurs in extremally malnourished
children.
Stomach, colon and ileum are most commonly
involved.
Abdominal pain, nausea, vomiting.
Prognosis very poor.

16. Cutaneous
Trauma is the predisposing factor.
Invasive locally.
May lead to necrotizing fasciitis.
Mortality upto 80%.

17. Disseminated
Hematogenous.
Pulmonary Mucormycosis has highest
incidences of dissemination.
Most common sites of dissemination are
brain, spleen, heart, skin and other organs.
Mortality rate brain- 100%, others>90%.

18. Histologic Features
Shows a variable amount of necrosis.
This fungus has apparent predilection for blood
vessels ; it is able to penetrate there walls and can
produce thrombosis.
The organisms appears as large, non-septate, hyphae
with branching at obtuse angles.
Round or ovoid sporangia are also frequently seen in
the tissue section.

19. Broad nonseptate hyphae, H&E 20X

20. Branched nonseptate hyphae,
GMC(Grocott or Gomori’s methenamine
silver) at 100x.

21. A special stain like grocott’s silver
methenamine stain may use to confirm
the diagnosis.
It can be cultured on SDA at 25-37C.
Cream colored colonies are produced in
3-4 day or in some cases overnight.

22. Treatment And Prognosis
Control of predisposing factors such as
diabetes.
Surgical excision if the lesion is localized.
Administration of amphotericin-B , since it is
the only drug with proven efficacy.

23. THANK YOU