eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Mucormycosis: Follow-up

Author: Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center
Coauthor(s): Debra Whaley, MD, Staff Physician, Department of Pediatrics, University of Nebraska Medical Center, Creighton University Joint Pediatric Residency Program; Mary Carmen Y Mancao, MD, Associate Professor, Department of Pediatrics, University of South Alabama College of Medicine; Christine A Reyes, MD, Medical Director, Medical Technology School, Methodist Hospital; Consulting Staff, Department of Pathology, Methodist Hospital, Children's Hospital
Contributor Information and Disclosures

Updated: Nov 20, 2008

Follow-up

Deterrence/Prevention

  • No method to prevent mucormycosis is recognized.
  • Studies in adults have demonstrated some benefit with the use of high-efficiency particulate air (HEPA) filters and different chelating agents instead of deferoxamine to decrease the risk of mucormycosis.

Complications

  • In patients with rhinocerebral mucormycosis, cerebral abscess formation, cavernous sinus thrombosis, and thromboembolism internal carotid artery should be suspected as complications.
  • If the disease progresses and if the underlying condition remains uncontrolled, death usually ensues.
  • Close observation of patients who were treated and who survived the acute infection is important because of chronic manifestation of mucormycosis or late sequelae are possible.

Prognosis

  • Early diagnosis and treatment of mucormycosis improve the patient's outcome, as evidenced by high survival rates in some adults.
  • In neonates, these invasive fungal infections can be rapidly fatal; the time from clinical symptoms to death is in the range of 6-42 days.
  • Because the disease is rare and because therapy is not standardized, no studies aid in predicting patient outcomes.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to promptly and correctly make the diagnosis (Mucormycosis can be life threatening.)
  • Failure to promptly begin vital antifungal therapy
  • Failure to address appropriate management of the underlying disease process
  • Failure to closely observe patients who were treated and who survived the acute infection to look for chronic manifestation or late sequelae

Special Concerns

  • Because fungi of the order Mucorales contaminate laboratory specimens, use caution when these organisms are isolated from bronchial washings, sinus samples, and sputum obtained from immunosuppressed hosts.
 


More on Mucormycosis

Overview: Mucormycosis
Differential Diagnoses & Workup: Mucormycosis
Treatment & Medication: Mucormycosis
Follow-up: Mucormycosis
Multimedia: Mucormycosis
References
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References

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  2. Simbli M, Hakim F, Koudieh M, Tleyjeh IM. Nosocomial post-traumatic cutaneous mucormycosis: a systematic review. Scand J Infect Dis. 2008;40(6-7):577-82. [Medline].

  3. Dave SP, Vivero RJ, Roy S. Facial cutaneous mucormycosis in a full-term infant. Arch Otolaryngol Head Neck Surg. Feb 2008;134(2):206-9. [Medline].

  4. Scheinfeld N. A review of the new antifungals: posaconazole, micafungin, and anidulafungin. J Drug Dermatol. 2007;12:1249-51. [Medline].

  5. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med clin north Am. 2008;26:571-95. [Medline]. [Full Text].

  6. Boelaert JR, Van Cutsem J, de Locht M, et al. Deferoxamine augments growth and pathogenicity of Rhizopus, while hydroxypyridinone chelators have no effect. Kidney Int. Mar 1994;45(3):667-71. [Medline].

  7. Bogard BN. Pulmonary mucormycosis. N Engl J Med. Mar 16 1972;286(11):606. [Medline].

  8. Bradley JS, Nelson JD. Nelson's Pocket Book of Pediatric Antimicrobial Therapy 2002-2003. 15th ed. 2002:62-5.

  9. De Decker K, Van Poucke S, Wojciechowski M, et al. Successful use of posaconazole in a pediatric case of fungal necrotizing fasciitis. Pediatr Crit Care Med. Sep 2006;7(5):482-5. [Medline].

  10. Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med. Mar 2001;125(3):375-8. [Medline].

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  12. Greenberg RN, Scott LJ, Vaughn HH, Ribes JA. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis. Dec 2004;17(6):517-25. [Medline].

  13. Kontoyiannis DP, Lionakis MS, Lewis RE, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. Apr 15 2005;191(8):1350-60. [Medline].

  14. Parfrey NA. Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases. Medicine (Baltimore). Mar 1986;65(2):113-23. [Medline].

  15. Rex JH, Ginsberg AM, Fries LF, et al. Cunninghamella bertholletiae infection associated with deferoxamine therapy. Rev Infect Dis. Nov-Dec 1988;10(6):1187-94. [Medline].

  16. Richardson M, Koukila-Kahkola P, Shankland G. Rhizopus, Rhizomucor, Absidia, and other agents of systemic and subcutaneous zygomycoses. In: Manual of Clinical Microbiology. 8th ed. Washington, DC: American Society of Microbiology; 2003:1761-80.

  17. Robertson AF, Joshi VV, Ellison DA, Cedars JC. Zygomycosis in neonates. Pediatr Infect Dis J. Aug 1997;16(8):812-5. [Medline].

  18. Sugar A. Agents of mucormycosis and related species. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005:2973-83.

  19. Wiedermann BL. Zygomycosis. In: Feigen RD, ed. Textbook of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Saunders; 2004.

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Further Reading

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Keywords

mucormycosis, Mucorales infection, fungal infection, Rhizopus species infection, Rhizomucor species infection, Absidia corymbifera infection, A corymbifera infection, Apophysomyces elegans infection, A elegans infection, Cunninghamella bertholletiae infection, C bertholletiae infection, Mucor species infection, Saksenaea vasiformis infection, S vasiformis infection, burns, trauma, diabetes mellitus, leukemia, diabetic ketoacidosis, malnutrition

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Contributor Information and Disclosures

Author

Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center
Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: phamaceutical companies Honoraria Speaking and teaching; phamaceutical companies Grant/research funds clinical trials

Coauthor(s)

Debra Whaley, MD, Staff Physician, Department of Pediatrics, University of Nebraska Medical Center, Creighton University Joint Pediatric Residency Program
Debra Whaley, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Mary Carmen Y Mancao, MD, Associate Professor, Department of Pediatrics, University of South Alabama College of Medicine
Mary Carmen Y Mancao, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

Christine A Reyes, MD, Medical Director, Medical Technology School, Methodist Hospital; Consulting Staff, Department of Pathology, Methodist Hospital, Children's Hospital
Christine A Reyes, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Pathologists, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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