Mucormycosis

Mucormycosis
Other namesZygomycosis,[1][2] black fungus[3][4]
Periorbital mucormycosis
SpecialtyOral and maxillofacial surgery, Infectious disease, Emergency medicine
SymptomsDepends on location: runny nose, black area of skin, facial swelling, headache, fever, cough, blurred vision[5][6]
ComplicationsBlindness, thrombosis[7]
Usual onsetRapid[1]
TypesSinuses and brain, lung, stomach and intestine, skin, disseminated, miscellaneous[8]
CausesFungi of the Mucorales type[8]
Risk factorsDiabetes, iron overload, low white cells, cancer, organ transplant, kidney problems, immunosuppressants, long-term steroids[7]
Diagnostic methodBiopsy, culture, medical imaging[5]
Differential diagnosisOrbital cellulitis, cavernous sinus thrombosis, aspergillosis[9]
PreventionFace masks, avoiding contact with soil or water-damaged buildings, good diabetic control[7][10]
TreatmentAntifungals, surgical debridement, treat underlying medical conditions[7]
MedicationAmphotericin B, isavuconazole, posaconazole[8]
PrognosisPoor[9]
FrequencyRare[8]

Mucormycosis, also known as black fungus,[3][4] is a severe fungal infection[11] that comes under fulminant fungal sinusitis,[12] usually in people who are immunocompromised.[9][13] It is curable only when diagnosed early.[12] Symptoms depend on where in the body the infection occurs.[14][15] It most commonly infects the nose, sinuses, eyes and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death.[1][6] Other forms of disease may infect the lungs, stomach and intestines, and skin.[6] The fatality rate is about 54%.

It is spread by spores of molds of the order Mucorales, most often through inhalation, contaminated food, or contamination of open wounds.[16] These fungi are common in soils, decomposing organic matter (such as rotting fruit and vegetables), and animal manure, but usually do not affect people.[17] It is not transmitted between people.[15] Risk factors include diabetes with persistently high blood sugar levels or diabetic ketoacidosis, low white blood cells, cancer, organ transplant, iron overload, kidney problems, long-term steroids or use of immunosuppressants, and to a lesser extent in HIV/AIDS.[7][9]

Diagnosis is by biopsy and culture, with medical imaging to help determine the extent of disease.[5] It may appear similar to aspergillosis.[18] Treatment is generally with amphotericin B and surgical debridement.[8] Preventive measures include wearing a face mask in dusty areas, avoiding contact with water-damaged buildings, and protecting the skin from exposure to soil such as when gardening or certain outdoor work.[10] It tends to progress rapidly and is fatal in about half of sinus cases and almost all cases of the widespread type.[2][19]

Mucormycosis is usually rare,[8] but is now ~80 times more common in India.[20] People of any age may be affected, including premature infants.[8] The first known case of mucormycosis was possibly the one described by Friedrich Küchenmeister in 1855.[1] The disease has been reported in natural disasters, including the 2004 Indian Ocean tsunami and the 2011 Joplin tornado.[21] During the COVID-19 pandemic, an association between mucormycosis and COVID-19 has been reported. This association is thought to relate to reduced immune function during the course of the illness and may also be related to glucocorticoid therapy for COVID-19.[4][22] A rise in cases was particularly noted in India.[23]

  1. ^ a b c d Cite error: The named reference Chand2018 was invoked but never defined (see the help page).
  2. ^ a b "Orphanet: Zygomycosis". www.orpha.net. Archived from the original on May 13, 2021. Retrieved May 13, 2021.
  3. ^ a b Dyer O (May 2021). "Covid-19: India sees record deaths as "black fungus" spreads fear". BMJ. 373: n1238. doi:10.1136/bmj.n1238. PMID 33985993.
  4. ^ a b c Quarterly Current Affairs Vol. 4 – October to December 2020 for Competitive Exams. Vol. 4. Disha Publications. 2020. p. 173. ISBN 978-93-90486-29-8.
  5. ^ a b c Grossman ME, Fox LP, Kovarik C, Rosenbach M (2012). "1. Subcutaneous and deep mycoses: Zygomucosis/Mucormycosis". Cutaneous Manifestations of Infection in the Immunocompromised Host (2nd ed.). Springer. pp. 51–58. ISBN 978-1-4419-1577-1.
  6. ^ a b c "Symptoms of Mucormycosis". www.cdc.gov. January 14, 2021. Retrieved May 25, 2021.
  7. ^ a b c d e Spellberg B, Edwards J, Ibrahim A (July 2005). "Novel perspectives on mucormycosis: pathophysiology, presentation, and management". Clinical Microbiology Reviews. 18 (3): 556–569. doi:10.1128/CMR.18.3.556-569.2005. PMC 1195964. PMID 16020690.
  8. ^ a b c d e f g "Mucormycosis". NORD (National Organization for Rare Disorders). Archived from the original on May 26, 2021. Retrieved May 25, 2021.
  9. ^ a b c d Hernández, J. L.; Buckley, C. J. (January 2021). Mucormycosis. PMID 31335084.
  10. ^ a b "People at Risk For Mucormycosis and prevention". www.cdc.gov. February 2, 2021. Retrieved May 25, 2021.
  11. ^ Li N, Bowling J, de Hoog S, Aneke CI, Youn J, Shahegh S, Cuellar-Rodriguez J, Kanakry CG, Rodriguez Pena M, Ahmed SA, Al-Hatmi AMS, Tolooe A, Walther G, Kwon-Chung KJ, Kang Y, Lee HB, Seyedmousavi A.2024.Mucor germinans, a novel dimorphic species resembling Paracoccidioides in a clinical sample: questions on ecological strategy. mBio15:e00144-24.https://doi.org/10.1128/mbio.00144-24
  12. ^ a b Cite error: The named reference :0 was invoked but never defined (see the help page).
  13. ^ Cite error: The named reference John2017 was invoked but never defined (see the help page).
  14. ^ "ICD-11 – ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved May 25, 2021.
  15. ^ a b Cite error: The named reference CDC2021About was invoked but never defined (see the help page).
  16. ^ Reid G, Lynch JP, Fishbein MC, Clark NM (February 2020). "Mucormycosis". Seminars in Respiratory and Critical Care Medicine. 41 (1): 99–114. doi:10.1055/s-0039-3401992. PMID 32000287. S2CID 210984392.
  17. ^ "Where Mucormycosis Comes From". www.cdc.gov. February 1, 2021. Retrieved May 25, 2021.
  18. ^ Cite error: The named reference Thornton2020 was invoked but never defined (see the help page).
  19. ^ "Mucormycosis Statistics | Mucormycosis | Fungal Diseases | CDC". www.cdc.gov. May 5, 2020. Retrieved May 25, 2021.
  20. ^ Skiada A, Pavleas I, Drogari-Apiranthitou M (November 2020). "Epidemiology and Diagnosis of Mucormycosis: An Update". Journal of Fungi. 6 (4): 265. doi:10.3390/jof6040265. PMC 7711598. PMID 33147877.
  21. ^ Dannaoui E, Lackner M (December 2019). "Special Issue: Mucorales and Mucormycosis". Journal of Fungi. 6 (1): 6. doi:10.3390/jof6010006. PMC 7151165. PMID 31877973.
  22. ^ Cite error: The named reference Garg2021 was invoked but never defined (see the help page).
  23. ^ Singh AK, Singh R, Joshi SR, Misra A (May 2021). "Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India". Diabetes & Metabolic Syndrome. 15 (4): 102146. doi:10.1016/j.dsx.2021.05.019. PMC 8137376. PMID 34192610.