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Mucormycosis

  • A. Serda Kantarcioglu
Chapter

Abstract

The Mucorales is the largest order of zygomycete fungi comprising ubiquitous, mostly saprophytic organisms. However, once invade, the fungus shows angiotropic and neurotropic predilection. These fungi infect humans through spore inhalation. Within tissue, they grow as nonseptate moulds and have right-angle branching and irregular, non-parallel cell walls. The most prevalent agent of mucormycosis is Rhizopus species.

The rhinocerebral form of mucormycosis may occur in immunocompetent hosts, but there is a distinct predilection for diabetics. Other risk factors for mucormycosis include ketoacidosis, steroid use, neutropenia, renal failure and intravenous drug use. Direct intracranial extension from the sinuses occurs with Mucorales infection, producing characteristic lesions at the inferior frontal lobes adjacent to the posterior sinuses, usually with enhancement and reduced diffusion. Perineural invasion is a common finding in rhino-orbito-cerebral mucormycosis (ROCM), as are angioinvasion and infarcts. ROCM develops when inhaled spores infect the paranasal sinuses and extend into the orbits, optic nerves, oral cavity and cranium and invades the intracranial vasculature. Central nervous system infection almost always involves the frontal lobes. Morphological features on histopathologic examination suggest the etiology. Specific identification of the etiologic agent requires isolation of the organism by culture.

Surgical debridement of devitalized tissue, antifungal chemotherapy, correction of impaired immunity and controlling blood glucose levels are the treatment strategies for mucormycosis. Mucorales appear to be susceptible to amphotericin B and are generally not susceptible to the triazoles and echinocandins. Among the extended-spectrum triazoles, posaconazole appears to be active against most of the species.

Keywords

CNS mucormycosis Neurotropism Angiotropism Perineural spread 

Abbreviations

ABLC

AmB lipid complex

AIDS

Acquired immunodeficiency syndrome

Als

Agglutinin-like sequence

AmB

Amphotericin B

BHB

β-hydroxy butyrate

BHI

Brain heart infusion

CAS

Caspofungin

CNS

Central nervous system

CotH

Coating

CSF

Cerebrospinal fluid

CT

Computed tomography

DC

Dendritic cell

ECMM

European Confederation of Medical Mycology

EUCAST

European Committee on Antimicrobial Susceptibility Testing

G-CSF

Granulocyte colony-stimulating factor

GM-CSF

Granulocyte-macrophage colony-stimulating factor

GMS

Grocott methenamine silver

GRP

Glucose-regulated protein

HBO

Hyperbaric oxygen

H&E

Haematoxylin and eosin

HIV

Human immunodeficiency virus

IFN

Interferon

IL

Interleukin

ILC

Innate lymphocyte

ISA

Isavuconazole

ISHAM

International Society for Human and Animal Mycology

ITS

Internal transcribed spacer

iv

Intravenous

KOH

Potassium hydroxide

LAmB

Liposomal AmB

MALDI-TOF

Matrix-assisted laser desorption/ionization time-of-flight

MHC

Major histocompatibility complex

MIC

Minimal inhibitory concentration

MNC

Mononuclear cell

MRI

Magnetic resonance imaging

NK

Natural killer

NO

Nitric oxide

PAS

Periodic acid-Schiff

PCR

Polymerase chain reaction

PDGF

Platelet-derived growth factor

PL

Pectin lyase

PMN

Polymorphonuclear neutrophil

PRR

Pathogen recognition receptor/Pattern recognition receptor

PSZ

Posaconazole

RANTES

Regulated on activation, normal T cell expressed and secreted

RCM

Rhinocerebral mucormycosis

ROCM

Rhino-orbito-cerebral mucormycosis

SIG

Special Interest Group

TLR

Toll-like receptor

TNF

Tumour necrosis factor

Th 1

T-helper type 1

VRZ

Voriconazole

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • A. Serda Kantarcioglu
    • 1
  1. 1.Division of Mycology, Department of Medical Microbiology, Cerrahpasa Medical FacultyIstanbul University-CerrahpasaIstanbulTurkey

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