What happens in tissues
Fungal spores enter the nasal mucosa when breathing, and less often - into the lungs, damaged skin or the gastrointestinal tract. In a healthy person, they are destroyed by immune cells. With ketoacidosis, excess iron in the blood and neutropenia, this protection does not work: the mycelium grows quickly and grows into the walls of the arteries. The vessel thromboses, the tissue area remains without blood and dies. This is why a characteristic black scab appears, and antifungal drugs do not penetrate well into the dead area - it is difficult to stop the infection without surgical treatment with medications alone.
- Rhinoorbitocerebral form - nose, sinuses, orbit, brain
- Pulmonary form - in patients with blood diseases
- Skin form - after burns, wounds, injections
- Gastrointestinal form - in malnourished and premature infants
- Disseminated form affecting several organs
Who's at risk
The main group is people with diabetes, especially those with high glucose levels and diabetic ketoacidosis. The second large group consists of patients from hematology and oncology departments with a long-term decrease in the number of neutrophils, as well as those who have undergone bone marrow or organ transplantation. Uncontrolled or prolonged use of glucocorticoids is dangerous, including in severe viral infections. Additionally, iron overload, chronic renal failure, extensive burns and contaminated wounds increase the risk. Mucormycosis is practically not a threat to a healthy person, and it is not transmitted from person to person.
- Decompensated diabetes mellitus and ketoacidosis
- Leukemia, lymphoma, prolonged neutropenia
- Organ and bone marrow transplantation
- Long-term use of glucocorticoids and immunosuppressants
- Iron overload, hemodialysis
- Severe burns and contaminated wounds
- Prematurity and severe wasting
Symptoms
In the most common form, the disease begins as prolonged unilateral sinusitis: nasal congestion, pain in the cheek and orbital area, facial swelling, fever. The difference from ordinary sinusitis is that it quickly worsens over one to two days and the appearance of dark crusts or areas of dead mucous on the turbinate or on the roof of the mouth. Then comes swelling of the eyelids, protrusion of the eye, double vision, decreased vision, and numbness of the cheek. The pulmonary form causes fever, cough, chest pain, and hemoptysis that does not respond to antibiotics.
- Unilateral nasal congestion and brown discharge
- Pain in the face, teeth, orbital area
- Black crusts on the mucous membrane of the nose or palate
- Swelling and redness of the eyelid, protrusion of the eye
- Double vision, decreased vision, drooping eyelid
- Numb cheek skin
- Fever, cough, hemoptysis with lung damage
Diagnostics
The main thing is not to waste time. The ENT doctor examines the nasal cavity with an endoscope and takes a piece of changed tissue. The diagnosis is confirmed by histological examination: under a microscope, wide ribbons of mycelium are visible with almost no partitions, branching at right angles, and germination into blood vessels. At the same time, the material is sown on nutrient media. Computed tomography of the sinuses, orbits and brain shows the spread of the process and destruction of the bone walls, CT scan of the chest shows lesions and cavities in the lungs. Be sure to evaluate blood glucose, acid-base status and general blood test.
- Endoscopy of the nasal cavity with biopsy
- Histological examination of tissue
- Sowing for mushrooms with species identification
- CT scan of the paranasal sinuses, orbits and brain
- MRI for suspected brain damage
- CT scan of the chest for cough and fever
- Blood glucose, glycated hemoglobin, complete blood count
Treatment and prevention
Treatment is always inpatient and begins immediately upon reasonable suspicion, without waiting for culture. The basis is systemic antifungal drugs from the groups of polyene antimycotics and triazoles, active against mucormycetes; Conventional anti-candida medications do not work here. At the same time, surgeons remove dead tissue, sometimes repeatedly. The third mandatory direction is eliminating the background: normalizing blood sugar and eliminating ketoacidosis, reducing the dose of glucocorticoids, restoring the number of leukocytes. Prevention comes down to diabetes control and respiratory protection when working with dust and soil in people at risk.
- Immediate hospitalization
- Intravenous antifungal drugs as prescribed by a doctor
- Surgical removal of dead tissue
- Correction of blood sugar and ketoacidosis
- Reconsidering immunosuppressive therapy
- Diabetes control as the main preventive measure
- Respirator for excavation and construction work for patients at risk