Fungal infection - mucormycosis; Zygomycosis
Mucormycosis is a fungal infection of the sinuses, brain, or lungs. It occurs in some people with a weakened immune system.
Mucormycosis is caused by different kinds of fungi that are often found in decaying organic matter. These include spoiled bread, fruit, and vegetables, as well as soil and compost piles. Most people come in contact with the fungus at some time.
However, people with a weakened immune system are more likely to develop mucormycosis. These include people with any of the following conditions:
- Diabetes (usually poorly controlled)
- Leukemia and lymphoma
- Long-term steroid use
- Metabolic acidosis
- Poor nutrition (malnutrition)
- Use of some medicines
Mucormycosis may involve:
- A sinus and brain infection called rhinocerebral infection: It may start as a sinus infection, and then lead to the swelling of the nerves that stem from the brain. It may also cause blood clots that block vessels to the brain.
- A lung infection called pulmonary mucormycosis: Pneumonia 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 of rhinocerebral mucormycosis include:
- Eyes that swell and stick out (protrude)
- Dark scabbing in nasal cavities
- Mental status changes
- Redness of skin above sinuses
- Sinus pain or congestion
Symptoms of lung (pulmonary) mucormycosis include:
- Coughing blood (occasionally)
- Shortness of breath
Symptoms of gastrointestinal mucormycosis include:
- Abdominal pain
- Blood in the stools
- Vomiting blood
Symptoms of kidney (renal) mucormycosis include:
- Pain in the upper abdomen or back
Symptoms of skin (cutaneous) mucormycosis include a single, painful, hardened area of skin that may have a blackened center.
Exams and Tests
Your health care provider will examine you. See an ear-nose-throat (ENT) doctor if you are having sinus problems.
Testing depends on your symptoms, but may include these imaging tests:
A biopsy must be done to diagnose mucormycosis. A biopsy is the removal of a small piece of tissue for laboratory examination to identify the fungus.
Surgery should be done right away 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. But, without such aggressive surgery, chances of survival are greatly decreased.
You will also receive antifungal medicine, usually amphotericin B, through a vein. After the infection is under control, you may be switched to a different medicine such as posaconazole or isavuconazole.
Mucormycosis has a very high death rate, even when aggressive surgery is done. Risk of death depends on the area of the body involved and your overall health.
These complications may occur:
- Blindness (if the optic nerve is involved)
- Clotting or blockage of brain or lung blood vessels
- 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:
- Sinus pain
- Eye swelling
- Any of the other symptoms listed above
Because the fungi that cause mucormycosis are widespread, the best way to prevent this infection is to improve control of the illnesses associated with mucormycosis.
Kontoyiannis DP, Lewis RE. Agents of mucormycosis and entomophthoramycosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 260.
Patterson JW. Mycoses and algal infections. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:chap 25.