Mucor and Rhizopus

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Key Points

  • Mucor and Rhizopus
    • Characteristics
      • Fungus in mold form only
        • Broad (ribbon-like) non-septate hyphae
        • with right-angle (wide-angle) branching
        • Contrast vs. Aspergillus (narrow septate hyphae branching at acute angles)
    • Transmission
      • Spores are inhaled
        • fungi proliferate in nasal sinuses, penetrate cribriform plate, and enter brain → rhinocerebral, frontal lobe abscess, cavernous sinus thrombosis
      • Opportunistic infection
        • Affects immunocompromised patients
        • Especially in uncontrolled diabetes
          • Highly associated with diabetic ketoacidosis
          • Fungi have ketone reductase which allows them to thrive at high glucose levels
        • Also associated with states of iron overload
    • Presentation: Mucormycosis
      • Invasive necrotic paranasal sinus infection
        • Fever, nasal congestion, purulent nasal discharge, sinus pain
        • Classically forms black eschar in nasal cavity
      • Spreads to orbits and brain (rhino-cerebral)
        • Presents with facial pain, headache, blindness, altered mentation, neurological deficits, death
      • Pulmonary, gastrointestinal, and cutaneous forms are also seen but are less classic
    • Diagnosis
      • Diagnosis is mostly clinical as early treatment is critical
      • Histopathology of mucosal biopsy and culture confirmation
    • Treatment
      • Surgical debridement and Amphotericin B
        • Should be initiated as quickly as possible to reduce disfigurement and death