mucormycosis is an opportunistic fungal infection in immuno compromised individuals

1. MUCORMYCOSIS
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. MUCORMYCOSIS
• Mucormycosis is an opportunistic, fulminating
fungal infection, caused by Rhizopus species of
order of mucorales, frequently seen in
immunocompromised patients.

3. MUCORMYCOSIS
Mucormycosis is most frequently
 sinonasal (39%)
 pulmonary (24%)
 cutaneous (19%)
 cerebral (9%)
 gastro-intestinal (7%)
 other (6%)
 disseminated (6%)

4. MUCORMYCOSIS
High Risk Candidates
• Poorly Controlled Diabetes Mellitus especially
with Ketoacidosis & Juvenile Diabetics
• Organ Transplant Recipients
• Long term Corticosteroid therapy
• Neutropenia in settings of haematological
malignancies.
• Patients on Chemotherapy
• Burns
• Other Immuno compromised states

5. MUCORMYCOSIS
• Continuous severe
usually unilateral
headache
• blood stained nasal
discharge
• retro- or peri-orbital
pain,
• Peri orbital swelling

6. MUCORMYCOSIS
Cutaneous Mucor in Post Renal
Transplant
Blackening of Left Midddle
turbinte

7. • The entry point is through nose by spore
inhalation
• more rarely by digestion or percutaneous
inoculation
MUCORMYCOSIS

8. MUCORMYCOSIS
• The fungus attaches to the nasal mucosa where
massive spore formation occurs
• it directly invades the blood vessels, causes
• arterial thrombosis and ischemic necrosis of the
affected part.
• Extension of disease into maxillary and ethmoid
sinuses can lead to orbital involvement.
• Intracranial spread can occur through ophthalmic
artery, superior orbital fissure or
• cribriform plate.

9. Clinical Features Mucormycosis

10. Evaluation of Mucor Patient
• Detailed history
• ENT, ophthalmic and neurological examination to
assess the extent of disease.
• Complete blood counts, blood urea, s. creatinine, bl.
Glucose, blood gas
• Analysis of urine for ketone bodies
• Diagnostic nasal endoscopy with biopsy.
• histopathological examination and KOH preparation.
• CT scan of PNS and brain -to assess the extent of
disease.

11. MUCORMYCOSIS
CT determines lesion extension towards the orbit
and brain.
MRI is more effective in assessing vascular
(cavernous sinus
or internal carotid thrombosis) and cerebral
invasion, and
can screen for cerebral involvement before onset of
clinical signs

12. Evaluation of Mucor Patient
• Nasal endoscopy with biopsy from the ethmoids
• CT scan of the Paranasal findings may be
disproportionate to the clinical features
• Fungal staining (a 10% KOH mount would give an early
• result),
• Fungal culture on Sabroud’s medium and
histopathology.
• The hall mark sign of ‘Black necrosis of the turbinate’

13. MUCORMYCOSIS
Blackened Left Middle Turbinate
Blackened Right Middle
Turbinate

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Palatal necrosis in a Diabetic patient due
to Mucor

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• Left peri orbital swelling
in an uncontrolled
Diabetic patient since 4
days

16. MUCORMYCOSIS
Right PeriOrbital swellingsince4
days in first time detected DM CT Scan is not that bad

17. MUCORMYCOSIS
Left PeriOrbital & facial swellingnia
juvenile Diabetic CT Scan not so bad

18. MUCORMYCOSIS

19. MUCORMYCOSIS
• Right sided orbital
cellulitis in a case of
Leukemia .
• Such patients have fatal
out come & disease
progresses very rapidly

20. MRI-The invaded tissue is non-
enhancing on contrast-enhanced MRI
and may show diffusion restriction.

21. Diseased tissue is
prone to necrosis
and devitalization,
which in turn leads
to a lack of
enhancement seen
on MR imaging,
“the black turbinate
sign,

22. Treatment modality Mucormycosis
• (1) Amphotericin B
• (2) A early radical surgical debridement of the involved
paranasal sinuses i.e FESS
• (3)continue with amphotericin b ;repeat debridement
if required
• (4) most importantly control of the underlying
condition is to be undertaken
• (5)new antifungal-posaconazole is now available

23. Amphotericin B
• dose of 50 mg given in a 5% Dextrose infusion,
monitoring the vital signs.
• A total dose of up to 1.5-3 g is given
• common adverse effects =chills, fever, headache,
nausea, and vomiting.
• potassium depleting effect
• The most serious side effect =nephrotoxicity
• hence weekly monitoring of blood urea and
serum creatinine levels is mandatory
• If blood urea >50 mg per cent and serum
creatinine >1.5 mg per cent, the dosage is to be
reduced or the drug stopped

24. Amphotericin liposomal
• form is available
• no nephrotoxicity
• less adverse effects
• dose of up to 2-3 mg/kg daily
• costly.

25. Take home massage
• Prevention is better than cure-
• Early detection is must
• Alarming signs need to be
assessed
• Diagnostic nasal endoscopy helps
in detecting mucor at the earliest

26. • Surgery reduces load of disease so the
amphotericin works more efficiently
• Sometimes signs and symptoms are
disproportionate to pts comorbidities
and radiological findings
• Despite surgery there maybe worsening
of symptoms as surgery reduces load of
disease not the vascular invasion

27. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT& anesthesia pediatric
post graduates & intensivists.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

28. MUCORMYCOSIS
•THANKYOU