Volume : V, Issue : VIII, August - 2015

Mucormycosis an emerging fungal infection

Dr Mohinisingh, Dr Swathymoorthy, Dr A. Cvaieramanigandan

Abstract :

Background Mucormycosis is an emerging infection associated with high mortality. These fungi are very common molds to which exposure is probably quite frequent, still, clinical disease is rare and affects severely immunocompromised patients or patients with diabetes mellitus. Mucormycosis is manifested by a wide variety of syndromes, devastating rhino–orbitalcereal and pulmonary infections are the major presentation. The diagnosis of mucormycosis relies upon the identification of organisms in tissue, however culture often yields no growth. The identification of risk factors, clinical features and radiological findings increase the possibility of an early diagnosis, which may prevent progressive tissue invasion, reduce the need and/or extent of surgical resection, and improve survival. Aims and Objective To describe theclinical presentation, risk factors and the mortality rate of mucormycosis in a resource limited setting. Material and Methods We studied 28 patients of mucormycosis admitted to our institution over a period of one year. Demographic features, predisposing conditions, clinical features, radiological features and in hospital mortality were obtained from the medical records.Tissue sections were reviewed with Gomori’smethenamine silver (GMS) and periodic acid Schiff (PAS) stains . Results The study material included 18 males and 10 females with age ranging from 34 – 76 years. The clinical syndrome included rhino–orbital–cereal in 20, followed by pulmonary in 6 patients and disseminated and gastrointestinal mucormycosis in 1 patient each. Diabetes mellitus being the commonest underlying risk factors identified in 24 patients out of which 4 patients also had history of steroid usage. Other underlying conditions noted were HIV and Acute myeloid leukemia in 1 patient each. Out of 20 patients with rhino–orbital–cereal mucormycosis, 15 patients presented with fever, headache, acute sinusitis and periorbital swelling. 3 patients presented with nasal necrosis in addition and 2 patients presented in addition with decreased vision. Pulmonary mucormycosis patients presented with dyspnea and cough. Gastrointestinal mucormycosis patients presented with abdominal pain, voimiting and hemetemesis.Out of 15 tissue samples submitted for histopathological examination only 8 samples showed fungal hyphae resembling mucormycosis. Cultures were positive only in 4 samples. Out of 20 patients with rhino–orbital–cereal mucormycosis, 4 patients underwent surgical deidement. All the patients were treated with amphotericin B in a dose of 1.0 – 1.5 mg/ kg. Total number of patients who died in this current study was 16, out of which 11 pts had rhino–orbital–cereal mucormycosis, 4 patients had pulmonary mucormycosis and 1 patient had disseminatedmucormycosis. Out of 11 patients with rhino–orbital–cereal mucormycosis, 2 patients had undergone surgical deidement and 4 patients had renal failure. Conclusion Mucormycosis as an infection is uncommon and is largely confined to severly immunocompromised patients such as diabetes. There are several clinical presentation of mucormycosis, the most common being the rhino–orbital–cereal and pulmonary forms. The diagnosis of mucormycosis relies upon the identification of organisms in tissue by histopathology with culture confirmation. However, culture often yields no growth. A high index of clinical suspicion, leading to early diagnosis and prompt treatment initiation may result in a more favourable outcome.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr Mohinisingh, Dr Swathymoorthy, Dr A.CVaieraManigandan Mucormycosis an Emerging Fungal Infection Indian Journal of Applied Research, Vol.5, Issue : 8 August 2015

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