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|Year : 2004 | Volume
| Issue : 2 | Page : 133-
Mucormycosis: A clinicomycological spectrum
LR Patel, TH Modi, PD Shah, JS Deokule
Department of Microbiology, Smt. NHL Municipal Medical College and Sheth VS General Hospital, Ahmedabad - 380 006, Gujarat, India
J S Deokule
Department of Microbiology, Smt. NHL Municipal Medical College and Sheth VS General Hospital, Ahmedabad - 380 006, Gujarat
|How to cite this article:|
Patel L R, Modi T H, Shah P D, Deokule J S. Mucormycosis: A clinicomycological spectrum.Indian J Med Microbiol 2004;22:133-133
|How to cite this URL:|
Patel L R, Modi T H, Shah P D, Deokule J S. Mucormycosis: A clinicomycological spectrum. Indian J Med Microbiol [serial online] 2004 [cited 2020 Apr 9 ];22:133-133
Available from: http://www.ijmm.org/text.asp?2004/22/2/133/8091
A definite diagnosis of mucormycosis is established by potassium hydroxide examination and culture on Sabouraud dextrose agar (SDA) of the clinical sample. Rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement and control of the underlying disease have been credited with its successful management. Five cases of mucormycosis are presented here. Out of five cases, majority were females with ages ranging between 36 and 70 years and duration of symptoms ranged from eight days to three years and all were diabetic. The initial clinical findings in four cases were fever, headache, lethargy, blackening of nostril with nasal discharge. The orbital findings were pain, blackening of eye, proptosis, ptosis and periorbital cellulitis. Vision and fourth cranial nerve were compromised in one case. Findings in one case of cutaneous mucormycosis were fever, pain, redness, blackening and gaping at operated site over lower abdomen.
Specimens received included of nasal secretion (2 cases), scraping of nasal mucosal tissue (2 cases) and debridement tissue (1 case). Direct microscopic examination with 10% aqueous potassium hydroxide (KOH) revealed wide aseptate hyphae, irregular in diameter and frequent 'tangles' in necrotic background. Colony morphology in all cases after 2-4 days on SDA at 25°C was white at first of 'salt-and-pepper' appearance with a colourless reverse surface. Microscopic morphology of the colonies showed hyphae that were predominantly aseptate, broad with long, straight and usually unbranched sporangiophores having prominent rhizoids. Sporangia were large and round. Mature sporangia had collapsed columella in an “umbrella” shape. The organisms were identified as Rhizopus species.
All five patients in present study had severe metabolic imbalance due to diabetes which impaired normal body defenses and predisposed to Rhizopus infection. Fungal spores probably spread from nasal mucosa to turbinate bones paranasal sinuses, orbit (in 3 cases) and palate with extension in to brain (in one case) where massive invasion of blood vessels caused major infarct. The patient with cutaneous form might have had an infection secondary to trauma which probably lead to collapse of weight bearing area of head of femur and avascular necrosis which were confirmed by plain radiograph. Recovery was achieved in three patients with rhinoorbital mucormycosis. Two cases gradually lapsed into coma and died. Early diagnosis and treatment is therefore, of utmost importance, and a high index of suspicion should be kept in diabetics or other immunocompromised patients who present with sinusitis and proptotic eye especially when not responding to appropriate antibiotic therapy or when draining black necrotic pus from the eye or the nose.
|1||Anaissie EJ, Shikhani AH. Rhinocerebral mucormycosis with internal carotid occlusion: Report of two cases and review of the literature. Laryngoscope 1985;95:1107-1113.|