Reviewed and revised 29 July 2015
- Mucormycosis is the unifying term used to describe infections caused by fungi belonging to the order Mucorales (e.g. Rhizopus, Rhizomucor, Mucor, and Absidia).
- Rhinocerebral mucormycosis is severe sinusitis with caused by a non-Aspergillus mold, most commonly Rhizopus arrhizus
- facial pain
- purulent nasal discharge (black)
- pneumonia (associated with prolonged neutropenia): dyspnea, cough, hemoptysis
- cutaneous (black lesions)
- intraorbital extension
- intracranial extension (e.g. leptomeningeal enhancement, intracranial granulomas, epidural abscess)
- vascular invasion (e.g. cavernous or venous sinus thrombosis, mycotic aneurysm formation, cerebral infarction or haemorrhage, systemic dissemination)
- diabetes mellitus (especially wit ketoacidosis)
- chronic renal failure
- iron overload and desferrioxime treatment (iron chelator)
- blood cultures
- tissue biopsies
- CXR and CT Chest – lobar consolidation, isolated masses, nodular disease, cavitation, or wedge-shaped infarcts (angioinvasive disease); reversed halo sign on CT (a focus of ground glass surrounded by a solid ring of consolidation)
- mucosal thickening (hypoattenuating; e.g. black turbinate sign)
- opacification of the sinus (in acute fungal sinusitis, unlike in chronic infection, hyperdense material may not be seen in the sinus cavity)
- bone destruction
- stranding of fat on the outside of the sinus
- MRI is the modality of choice for demonstrating soft tissue involvement
- supportive care and monitoring
- treat underlying cause and complications (e.g. DKA, immunosuppression, nutrition, GCSF)
- surgical debridement
- amphotericin B
- consider hyperbaric oxygen
- depending on comorbidities and underlying immunosuppression, mortality may range from ~ 20-80%
References and Links
- Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011 Aug 4;118(5):1216-24. doi: 10.1182/blood-2011-03-316430. Epub 2011 May 26. Review. PubMed PMID: 21622653; PubMed Central PMCID: PMC3292433.
- Pak J, Tucci VT, Vincent AL, Sandin RL, Greene JN. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock. 2008 Jul;1(2):106-13. doi: 10.4103/0974-2700.42203. PubMed PMID: 19561989; PubMed Central PMCID: PMC2700608.
- Quan C, Spellberg B. Mucormycosis, pseudallescheriasis, and other uncommon mold infections. Proc Am Thorac Soc. 2010 May;7(3):210-5. doi: 10.1513/pats.200906-033AL. Review. PubMed PMID: 20463250; PubMed Central PMCID: PMC3266012.
FOAM and web resources