Zygomycosis Follow-up

Updated: Aug 12, 2015
  • Author: Jose A Vazquez, MD, FACP, FIDSA; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

Further Outpatient Care

Once the patient is stabilized and no further surgical procedures are planned, discharge the patient home on antifungal therapy with follow-up visits every 2-4 weeks.

Monitor patients on amphotericin B products at least biweekly for adverse effects and toxicity (eg, CBC counts, electrolytes, BUN, serum creatinine).

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Further Inpatient Care

Inpatient care of mucormycosis is frequently prolonged because of the severe nature of the illness.

Patients with mucormycosis frequently undergo multiple surgical procedures in an attempt to eradicate devitalized tissue.

Antifungals are generally provided parenterally for a period of several months to achieve cure.

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Inpatient & Outpatient Medications

Because of the severity of the infection, most patients with mucormycosis undergo inpatient care for most of their treatment. If patient is clinically stable, the infection appears controlled, and the gastrointestinal tract is functional, he or she may be switched to oral posaconazole and discharged home with close monitoring for efficacy and toxicity.

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Transfer

Transfer patients to the service that can care for serious infections (eg, neurosurgery, otorhinolaryngology, infectious diseases, ophthalmology).

Transfer patients with altered mental status to an appropriate critical care unit.

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Deterrence/Prevention

Control blood sugar in patients with diabetes mellitus.

Control metabolic acidosis.

Eliminate risk factors such as neutropenia and immune modulators.

Closely monitor patients on deferoxamine therapy.

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Complications

Invasive mucormycosis frequently spreads to adjacent organ systems (ie, osteomyelitis), including sinuses and adjacent bones.

The ocular globe is frequently affected, which may cause blindness.

Cavernous sinus thrombosis with cranial nerve palsies and extension of infection into the brain and meningitis is a possibility.

Brain abscess and CNS infarction with ischemia and necrosis may occur.

Pulmonary infiltrates, cavitary lesions, and life-threatening pulmonary hemorrhages are possible.

Gastrointestinal hemorrhages may result from gastrointestinal perforation and may lead to peritonitis and sepsis.

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Prognosis

The prognosis of mucormycosis depends on several factors, including the infection site, rapidity of diagnosis, and type and severity of immunosuppression.

The overall mortality rate among patients with mucormycosis is approximately 50%, although rhinocerebral and gastrointestinal forms of the infection carry a mortality rate of approximately 85%. Mortality rates are high because of the difficulty in establishing the diagnosis and the lack of adequate antifungal therapy. By the time a diagnosis of mucormycosis is confirmed, it has frequently spread via either local invasion with extensive tissue destruction or widely disseminated infection.

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Patient Education

Inform patients and family members that this is an extremely serious condition with a poor prognosis (high morbidity and mortality rate) unless aggressive action is taken early.

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