Mucormycosis is a fungal infection caused by molds in the order Mucorales. It most commonly affects the sinuses or lungs after inhaling fungal spores. Risk factors include uncontrolled diabetes, neutropenia, and immunosuppression. Pulmonary mucormycosis presents with fever, cough, dyspnea, and chest pain. Diagnosis involves imaging showing nodules or masses and microscopic examination of sputum or tissue samples. Treatment involves liposomal amphotericin B, with an overall mortality rate of approximately 50%.
Mucormycosis - etiology , pathogenesis & clinical manifestations.pdfJim Jacob Roy
Mucormycosis is a serious fungal infection. It got attention during the COVID 19 pandemic as many cases of mucormycosis were reported.
In this document , the etiologic agents of mucormycosis ; its pathogenesis and the various clinical syndromes are described.
Medically Important Histoplasma species .pptxNawangSherpa6
The Presentation here is about Medically important Histoplasma species. How does it infect the Human host? What are it's clinical manifestations and How can we diagnose for their infection and potential application for other studies.
Mucormycosis - etiology , pathogenesis & clinical manifestations.pdfJim Jacob Roy
Mucormycosis is a serious fungal infection. It got attention during the COVID 19 pandemic as many cases of mucormycosis were reported.
In this document , the etiologic agents of mucormycosis ; its pathogenesis and the various clinical syndromes are described.
Medically Important Histoplasma species .pptxNawangSherpa6
The Presentation here is about Medically important Histoplasma species. How does it infect the Human host? What are it's clinical manifestations and How can we diagnose for their infection and potential application for other studies.
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizoo...Md Fayezur Rahaman
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizootic lymphangitis in horses(Histoplasma farciminosum),Zygomycosis, Pythiosis and Rhinosporidiosis in man and animals.
All of the information are collected , it's not a research work but i think it will help the students to know about the basic information.
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizoo...Md Fayezur Rahaman
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizootic lymphangitis in horses(Histoplasma farciminosum),Zygomycosis, Pythiosis and Rhinosporidiosis in man and animals.
All of the information are collected , it's not a research work but i think it will help the students to know about the basic information.
Pulmonology Histoplasmosis is a fungal infection which is caused by endemic fungas histoplasma capsulatum. May present with acute or chronic pulmonary histoplasmosis and disseminated histoplasmosis.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. Mucormycosis
Mucormycosis (previously called zygomycosis)
is opportunistic fungal infection caused by molds
in the order Mucorales.
Rhizopus and Mucor are the most common
fungus in this order causes mucormycosis.
It most commonly affects the sinuses or the lungs
after inhaling fungal spores from the air.
It can also occur on the skin after a cut, burn, or
other type of skin injury.
3. Transmission
Transmission occurs through inhalation,
inoculation or ingestion of spores from the
environment.
There is no human to human transmission.
4. Pathogenesis
Mucormycosis is angioinvasive, resulting in
thrombosis, infarction, and tissue necrosis, with
risk for dissemination to other sites.
After fungal spores access to the host,
mononuclear and polymorphonuclear phagocytes
normally serve as a primary host defense against
invasion.
Hyperglycemia and acidosis in people with
poorly controlled diabetes impair phagocyte
function.
5. Pathogenesis
Systemic acidosis increases free iron by
decreasing iron binding to transferrin.
Growth of pathogenic Mucorales is enhanced by
free iron.
7. Rhinocerebral mucormycosis
The most common form in patients with diabetes and
with renal transplants.
It also occurs in neutropenic cancer patients and
hematopoietic stem cell transplant or solid organ
transplant recipients.
Symptoms may include unilateral facial swelling,
headaches, nasal or sinus congestion or pain,
serosanguinous nasal discharge, and fever.
As the infection spreads, ptosis, proptosis, loss of
extraocular muscle function, and vision
disturbance may occur.
Necrotic black lesions on the hard palate or nasal
turbinate and drainage of black pus from eyes are
useful diagnostic signs.
8. Cutaneous mucormycosis
May be primary or secondary.
Primary infection is usually caused by direct inoculation
of the fungus into disrupted skin and is most often seen in
patients with burns or other forms of local skin trauma,
and can occur in patients who are not immunosuppressed.
Primary infection produces an acute inflammatory response
with pus, abscess formation, tissue swelling, and necrosis.
The lesions may appear red and indurated and often
progress to black eschars.
Secondary cutaneous infection is generally seen when the
pathogen spreads hematogenously; lesions typically begin
as an erythematous, indurated, and painful cellulitis and
then progress to an ulcer covered with a black eschar.
9. Gastrointestinal mucormycosis
Less common than the other clinical forms and is believed
to result from ingestion of the organism.
It typically occurs in malnourished patients or premature
infants.
The stomach, colon, and ileum are most commonly
affected.
Non-specific abdominal pain and distension, nausea, and
vomiting are the most common symptoms, and
gastrointestinal bleeding can occur.
It is the most common form of mucormycosis among
neonates and is challenging to diagnose partly because of
its clinical resemblance to necrotizing enterocolitis, a far
more common disease.
10. Disseminated mucormycosis
may follow any of the forms of mucormycosis
but is usually seen in neutropenic patients with a
pulmonary infection.
The most common site of spread is the brain, but
the spleen, heart, skin, and other organs can also
be affected.
11. Pulmonary Mucormycosis
Pulmonary mucormycosis generally occurs in
patients with hematologic malignancy or
profound neutropenia.
The symptoms are non-specific and include
fever, cough, chest pain, and dyspnea.
Angioinvasion results in tissue necrosis, which
may ultimately lead to cavitation and/or
hemoptysis.
12. Risk factor for pulmonary
mucormycosis
Neutropenia
Uncontrolled Diabetes
Solid organ or allogeneic stem cell
transplantation
Prolonged high-dose glucocorticoid therapy
Leukaemia and other haematological
malignancies
Cytotoxic chemotherapy
Chronic Lung disease
14. Investigation
Imaging:
Chest X-ray PA view
CT scan of chest
Finding: Nodule, mass lesion, consolidation,
cavitary lesion and ground-glass opacities.
Both the halo sign and the reversed halo sign
may be seen but the reversed halo appears to
be more common in Mucormycosis.
15. Investigation
Microscopic examination: sputum and
BAL specimens
may show the characteristic broad 10-to 20-μm,
ribbon-like, irregularly branching hyphae.
Culture: Sputum or tissue
Bronchoscopy
findings include luminal narrowing or obstruction
with pseudomembranes and necrosis
16. Complication
Life-threatening haemoptysis due to vascular
invasion by the fungus.
Disseminate or expand locally to involve
contiguous structures, including the mediastinum
and chest wall.
Uncommon: bronchopleural, bronchocutaneous
and bronchoarterial fistulas.
17. Treatment
Specific treatment
Liposomal amphotericin B (LAmB) treatment of
choice
LAmB is typically initiated at a dosage of 5
mg/kg/day but has been increased to 10 to 15
mg/kg/day in severe infections that fail to respond.
Azoles: posaconazole and isavuconazole.
As step-down therapy or
As a component of salvage regimens in patients
refractory to or intolerant of AmB.
18. Prognosis
The overall prognosis depends on several factors,
including the rapidity of diagnosis and treatment,
the site of infection, and the patient’s underlying
conditions and degree of immunosuppression.
The overall mortality rate is approximately
50%, although early identification and treatment
can lead to better outcomes.
Editor's Notes
duration of therapy for invasive Mucormycosis is not well defined and is determined on a case-by-case basis and is dependent on multiple factors including extent of infection, clinical response, and immune reconstitution.