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Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
Mucormycosis is a relatively rare (usually not more than 10% of Aspergillosis) but fatal fungal infection with high potential of causing mortality and significant morbidity. Four genera of mucorales are associated with human disease (Rhizopus, Mucor, Absidia, and Cunninghamella). Rhino-orbito-cerebral form is one of the common manifestations of mucormycosis. Other clinical syndromes are pulmonary, gastrointestinal, cutaneous, and disseminated forms. Initial human infection is either secondary to inhalation of sporangiospores or inoculation of wound. Immunocompromised individuals are at highest risk of contracting the infection. Uncontrolled diabetes mellitus, deferoxamine therapy, anti-neoplastic administration, malignancy, burns, and trauma pose a higher risk of developing mucormycosis.
Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Mucormycosis (Phocomycosis) is caused by fungi of Zygomycetes type which are inhaled as spores from moulds found in decaying vegetable matter. Most commonly immunosuppressed patients or those with diabetes, leukaemia or lymphoma are affected. The typical chest radiographic appearance is of a round area of pneumonia with poorly defined margins, but others have nodular or lobar infiltrates, activation, mediastinal widening, nodules or a miliary pattern. The main feature is of massive tissue invasion (Illus. MUCORMYCOSIS). Frequently pulmonary infection is complicated by haemorrhagic infarction, resulting in wedge-shaped infiltrates and gangrene. It may also lead to pulmonary aneurysm formation. Another important site of infection is in the sinuses (particularly the frontals) leading to orbital oedema and frontal lobe invasion.
Mucormycosis
Published in Srijan Goswami, Chiranjeeb Dey, COVID-19 and SARS-CoV-2, 2022
Soumyajit Dutta, Srijan Goswami
Mucormycosis is an angioinvasive, non-contagious but serious life-threatening disease known to be caused by a group of fungi called mucormycetes. The word “mucormycosis” is derived from two Latin words Mucor and mycosis. The word Mucor (Latin) refers to mold and mycosis (Latin) refers to “the presence of fungi as parasites in the body”. The mucormycetes group of fungi can be found everywhere in the environment especially on surfaces with dead and decaying organic matter. Encounters with these fungi groups are completely unavoidable but they are not harmful to the majority of the human population. However, in individuals with immunosuppressive conditions, inhalation of the spores from the fungi may cause pulmonary infection and inflammation of nasal sinuses or may even spread to different locations of the body, thus causing a serious pathological state (WHO, 2021; CDC, 2021). Mucormycosis may be caused by several types of fungi belonging to the order Mucorales. According to the Centers for Disease Control and Prevention (CDC), Rhizopus and Mucor are the two most common species of fungus that are known to cause mucormycosis, the other possible names include Rhizomucor species, Cunninghamella bertholletiae, Apophysomyces, Lichtheimia, and Saksenaea (WHO, 2021; CDC, 2021).
Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus
Published in Baylor University Medical Center Proceedings, 2023
Pallak Arora, Geetpriya Kaur, Nutan Tyagi, Madhu K. Nair
Emerging complications associated with COVID-19 are being reported, with associated fungal infections causing significant morbidity in patients due to their unprecedented and sudden appearance in compromised patients.1 Mucormycosis is a life-threatening infection that occurs commonly in immunocompromised patients, characterized by vascular fungal invasion and ensuing tissue necrosis. The predisposing factors include diabetes, neutropenia, organ transplantation, and corticosteroid administration. Diabetes is the most frequent comorbidity associated with mucormycosis.2 In a debilitated patient, mucormycosis may manifest with pulmonary, gastrointestinal, disseminated, or rhinocerebral involvement. The rhinomaxillary form of the disease begins with the inhalation of fungal spores in the air by a patient with risk factors. The infection spreads initially in the nose and paranasal sinuses with subsequent invasion of vascular tissue, leading to thrombosis and necrosis of associated hard and soft tissues.1,3
A Proposed Diagnostic Algorithm for Fungal Orbital Infections after 20 Years of Experience in a Tertiary Eye Care Center– Egypt
Published in Ocular Immunology and Inflammation, 2023
Mohamed Ashraf Eldesouky, Hazem A. Elbedewy
The causes which make the patients at risk of developing orbital fungal infection include uncontrolled diabetes mellitus, diabetic ketoacidosis, neutropenia, deferoxamine therapy, intravenous drug use, prematurity, prolonged use of corticosteroids (more than 3 months), chemotherapy, bone marrow transplantation and trauma. Due to the affinity of the fungus to invade the blood vessels and to cause vascular occlusion, tissue necrosis occurs leading to the classical necrotic black eschar at the site of infection (nasal mucosa or palate). Extension of the fungal infection outside the orbit can cause central retinal artery occlusion, cerebral infarction, and cavernous sinus thrombosis.2–5 Disseminated mucormycosis is rare and occurs most commonly in severely immunocompromised patients, with a very high mortality rate up to 96% in some studies.6
The rise of mucormycosis in Covid-19 patients in India
Published in Expert Review of Anti-infective Therapy, 2022
The health-care system in India has been unable to cope with the onslaught of wave 2 Covid-19 pandemic. At its peak in early May 2021, over 400,000 cases of Covid-19 were being reported on a daily basis [1], and India found itself unprepared with acute shortage of drugs, vaccines, ventilators, and oxygen [2]. Although Covid cases are currently getting under control, India is now facing a public health emergency of mucormycosis, commonly labeled as ‘black fungus,’ a rare but potentially fatal fungal infection. Mucormycosis is caused by the mucormycetes, a group of molds, with Rhizopus and Mucor as the most common species [3]. As announced by Mr Harsh Vardhan, the former Health Minister of India, there are over 40,000 cases of mucormycosis reported as of 28 June 2021 [4]. Mucormycosis has been declared an epidemic in several Indian states and has been classified as a notifiable disease. Early diagnosis and prompt initiation of treatment is crucial as the condition can progress rapidly with fatal outcome. The treatment for this condition is based on a combination of antifungal medication and aggressive surgical debridement of necrotic tissue if necessary. The recommended anti-fungal drug is Liposomal Amphotericin B on a dose of 5 mg/kg/day. However, acute shortage of Amphotericin B on the one hand and its prohibitive cost to patients and their families on the other is a major challenge.