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Mucormycosis

Mucormycosis is a fungal infection of the sinuses, brain, or lungs that occurs in some people with a weakened immune system.

Causes

Mucormycosis is caused by a common fungus frequently found in the soil and in dying plants. Most people come in contact with the fungus at some time. However, people with a weakened immune system are more likely to get this infection.

Conditions most commonly associated with mucormycosis include:

  • AIDS
  • Burns
  • Diabetes (usually poorly controlled)
  • Leukemia and lymphoma
  • Long-term steroid use
  • Metabolic acidosis
  • Poor nutrition (malnutrition)
  • Use of some medicines, such as deferoxamine

Mucormycosis may involve:

  • Sinus and brain infection (rhinocerebral infection), which may start as a sinus infection, then causes swelling of the cranial nerves. It may cause blood clots that block vessels to the brain.
  • Lung infection (pulmonary mucormycosis): pneumonia that gets worse quickly and may spread to the chest cavity, heart, and brain.
  • Other parts of the body: Mucormycosis of the gastrointestinal tract, skin, and kidneys

Symptoms

Symptoms of rhinocerebral mucormycosis include:

  • Eye swelling and protrusion (proptosis)
  • Dark nasal eschar (scabbing)
  • Fever
  • Headache
  • Mental status changes
  • Redness of skin overlying sinuses
  • Sinus pain or congestion

Symptoms of lung (pulmonary) mucormycosis include:

  • Cough
  • Coughing blood (occasionally)
  • Fever
  • Shortness of breath

Symptoms of gastrointestinal mucormycosis include:

  • Abdominal pain
  • Blood in the stools
  • Diarrhea
  • Vomiting blood

Symptoms of kidney (renal) mucormycosis include:

  • Fever
  • Flank (side) pain

Symptoms of skin (cutaneous) mucormycosis include a single, painful, hardened area of skin that may have a blackened center.

Exams and Tests

The doctor or nurse will examine you. An ear-nose-throat (ENT) doctor should be seen if you are having sinus problems.

Testing depends on your symptoms but may include:

A biopsy must be done to make a definitive diagnosis of mucormycosis.

Treatment

Surgery should be done immediately to remove all dead and infected tissue. Surgery can lead to disfiguration because it may involve removal of the palate, parts of the nose, or parts of the eye. Without such aggressive surgery, however, chances of survival are greatly decreased.

You will also receive antifungal medicines through a vein, usually amphotericin B.

Outlook (Prognosis)

Mucormycosis has an extremely high death rate even when aggressive surgery is done. Death rates range from 25 - 85% depending on the body area involved and your overall health.

Possible Complications

  • Blindness (if the optic nerve is involved)
  • Clotting or blockage of brain or lung blood vessels (thrombosis)
  • Death
  • Nerve damage

When to Contact a Medical Professional

People with weakened immune systems and immune disorders (including diabetes) should seek medical attention if they develop fever, headache, sinus pain, eye swelling, or any of the other symptoms listed above.

Prevention

Because the fungi that cause mucormycosis are widespread, the most appropriate preventive measures involve improved control of the underlying illnesses associated with mucormycosis.

Alternative Names

Zygomycosis

References

Kontoyiannis DP. Mucormycosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 348.

Kontoyiannis DP, Lewis RE. Agents of mucormycosis and entomophthoramycosis.In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 259.

Update Date: 10/6/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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