SEMINAR PRESENTED BY DR SANTOSH NARAYANKAR AT NSCBMCH JABALPUR

1. MUCORMYCOSIS
PRESENTED BY -DR SANTOSH M NARAYANKAR

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

3. MUCORMYCOSIS
Mucor species Rhizopus sp

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.

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

20. 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

22. 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%

24. MISCALLANEOUS FORMS
 ENDOCARDITIS,PYELONEPHRITIS-IN I V
DRUG USERS.
 BONES,MEDIASTINUM,KIDNEYS,PERITONE
UM.IN PATIENTS WITH DIALYSIS

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

26. HIGH SUSPICION
REQUIRED

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

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

29. OTHER STUDIES
 CSF EXAMINATION
 BRONCHOALVEOLAR LAVAGE

30. THANK YOU

31. 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.