mucor

Mucor Mycosis:

It is a fungal infection. Usual causative agents are: Rhizopus, Rhizomucor, and Cunninghamella

EPIDEMIOLOGY AND PATHOLOGY:

Rhizopus and Rhizomucor species appearing on foods of high sugar content. The disease is largely confined to patients with serious preexisting diseases. Mucormycosis originating in the paranasal sinuses and nose predominantly affects patients with poorly controlled diabetes mellitus.

The infection is acquired from nature, with no person-to-person spread.

the foremost histologic findings are: 1.Vascular invasion by hyphae 2.Ischemic or hemorrhagic necrosis

CLINICAL MANIFESTATIONS:

of the nose and paranasal sinuses: Low-grade fever, dull sinus pain, nasal congestion a thin, bloody nasal discharge double vision, increasing fever, obtundation.

Unilateral opthalmoplegia, chemosis, and proptosis (so should be differentiated from orbital cellulites). Dusky red or necrotic nasal turbinates on involved side. Sharply delineated necrosis, respecting the midline in the hard palate. Inflamed cheek Blindness (globe or ophthalmic art. involvement) Coma (frontal lobe invasion) Clouding of the sensorium (D.K.A) Cavernous sinus thrombosis (IN ORBITAL INVASION)

DIAGNOSIS:

C.T scan & M.R.I: Opacification of one or more sinuses Carotid arteriography: Show invasion or obstruction of the carotid siphon. Biopsy for histological exam & culture: Diagnose lesions of craniofacial structures.

TREATMENT:

1) Regulation of diabetes mellitus and 2) A decrease in the dose of immunosuppressive drugs facilitate the treatment of mucormycosis. 3) Extensive debridement of craniofacial lesions appears to be very important. Orbital inoculation may be required. 4) Intravenous amphotericin B: Optimal dose of 0.5 - 1.5 mg/kg/day for a total of 12 weeks.

Prognosis:

Appropriate management results in cure of about half of craniofacial infections i.e.: mortality rate with optimal management is 50%. Without treatment patient die after a few days to a few weeks.