Understanding treatments for mucormycosis

MUCORMYCOSIS( previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air, or the skin after the fungus enters the skin through a cut, burn, or other type of skin injury. However, it can occur in nearly any part of the body.

Symptoms of Mucormycosis

The symptoms of mucormycosis depend on where in the body the fungus is growing. Symptoms of rhinocerebral ( sinus and brain) mucormycosis include: One- sided facial swelling, headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of mouth that quickly become more severe, fever. Symptoms of pulmonary ( lung) mucormycosis include: fever, cough, chest pain, and shortness of breath.

Cutaneous ( skin) mucormycosis can look like blisters or ulcers, and the infected area may turn black. Other symptoms include pain, warmth, excessive redness, or swelling around a wound. Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients with disseminated infection in the brain can develop mental status changes or coma.

Who gets mucormycosis?

Mucormycosis is rare, but it is more common among people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Certain groups of people are more likely to get mucormycosis, including people with: diabetes, especially with diabetic ketoacidosis, cancer, organ transplant, stem cell transplant, low number of white blood cells, long- term corticosteroid use, injection drug use, too much iron in the body ( iron overload or hemochromatosis), skin injury due to surgery, burns, or wounds, prematurity and low birthweight ( for neonatal gastrointestinal mucormycosis)

It is difficult to avoid breathing in fungal spores because the fungi that cause mucormycosis are common in the environment. There is no vaccine to prevent mucormycosis. For people who have weakened immune systems, there may be some ways to lower the chances of developing mucormycosis.

Prevention

Protect yourself from the environment. Try to avoid areas with a lot of dust like construction or excavation sites. If you can’t avoid these areas, wear an N95 respirator ( a type of face mask) while you’re there. Avoid direct contact with water- damaged buildings and floodwater after hurricanes and natural disasters. Avoid activities that involve close contact to soil or dust, such as yard work or gardening. If this isn’t possible, wear shoes, long pants, and a long- sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas. Wear gloves when handling materials such as soil, moss, or manure. To reduce the chances of developing a skin infection, clean skin injuries well with soap and water, especially if they have been exposed to soil or dust. Antifungal medication. If you are at high risk for developing mucormycosis ( for example, if you’ve had an organ transplant or a stem cell transplant), your healthcare provider may prescribe medication to prevent mucormycosis and other mold infections. Treatment for Mucormycosis

Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole. These medicines are given through a vein ( amphotericin B, posaconazole, isavuconazole) or by mouth ( posaconazole, isavuconazole). Other medicines, including fluconazole, voriconazole, and echinocandins, do not work against fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected tissue.

* Dr. Nwaoney is an epidemiologist and Chief Executive Officer ( CEO) of Richie Hospital