Pulmonary Mucormycosis Over 130 Years: A Case Report and Literature Review

Abstract

Mucor is a ubiquitous fungus that belongs to the family of Zygomycetes, though a noninvasive saprophyte in the normal host, it can cause life threatening infections in immunocompromised patients, including angioinvasive pulmonary mucormycosis; a disease notorious for its high mortality. This article tracks the ever-changing management of pulmonary mucormycosis over the last 130 years, and how this affected mortality. KEYWORDS: Pulmonary mucormycosis, posaconazole, fungal infection INTRODUCTIONPulmonary mucormycosis is a rare but serious fungal infection that usually occurs in the presence of a defective immune system. Pulmonary mucormycosis was first described in 1876 by Furbringer [1]. Since then only a few hundred cases have been reported.In a classic review in 1955, Baker [2] thoroughly described all mucormycosis cases previously reported; it included six cases in the old German literature and 10 cases in the American literature. He considered mucormycosis to be a new disease in the USA and attributed its increasing incidence to the amplified use of antibiotics, cortisone, and Adrenocorticotropic hormone ACTH. The respiratory tract was recognized to be the portal of entry for mucorales, and these fungi can easily invade arteries, veins, and lymphatics and produce thrombosis and infarction. In the first half of the twentieth century, no antifungal therapy was available except for potassium iodide. In 1971, Baker [3] further expanded his review to include 49 cases of mucormycosis (including 39 pulmonary cases), which were reported in the literature till that time.The review by Tedder et al.[4] in 1994 included 30 patients who were treated at their institution and 225 cases reported in the literature; some of their patients had disseminated mucormycosis. Of the 92 patients diagnosed antemortem, 61% underwent medical treatment with antifungal agents, 21% were surgically treated, and 18% underwent combined medical and surgical therapy.Francis et al. [5] described 87 cases of pulmonary mucormycosis reported in the literature from 1970 to 2000 after introducing flexible bronchoscopy. In his review, 55 patients underwent antifungal therapy, in which most received amphotericin B and only seven received an Azole. The overall survival rate was 44% and was higher in patients who underwent combined medical and surgical therapy.In this study, we describe a patient with diabetic ketosis who presented subacutely with semi-invasive pulmonary mucormycosis infection and review 22 other cases of pulmonary mucormycosis treated with posaconazole reported in the literature since 2001 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. CASE PRESENTATIONA 21-year-old male patient was referred to our hospital for elective bronchoscopy because of 4-month history of recurrent respiratory symptoms and persistent pulmonary infiltrates that failed to improve even after different antibiotic courses. His symptoms included purulent yellowish sputum on coughing, occasional streaks of blood, feverish sensation, non-specific chest...

Pulmonary Mucormycosis: A Case Report of a Rare Infection with Potential Diagnostic Problems

“…Pulmonary mucormycosis may develop as a result of inhalation of spores or by hematogenous or lymphatic spread. Portal of entry for Mucorales is the respiratory tract where the fungi can easily invade arteries, veins, and lymphatics and produce thrombosis and infarction which can be fatal [11][12][13].…”

A case report of fatal disseminated fungal sepsis in a patient with ARDS and extracorporeal membrane oxygenation

“…Although the reported single cases about mucormycosis increased lately, they are rare. Most cases were described in patients with malignancies, organ transplantation, HIV or DM (recently reviewed in [12]). Our patient was affected by none of these diseases but had received corticoid therapy and was therefore immunocrompromised.…”

“…The reported single cases about mucormycosis increased lately. Most cases were described in patients with malignancies, organ transplantation, HIV or DM (recently reviewed in [12]). Recently Jiang and coworkers suggested the liquid-based cytopathology to identify mucorales promptly in samples obtained by bronchial brushes [13].…”

Pediatric pulmonary mucormycosis in a diabetic patient treated with extended pleurectomy and Clagett procedure

“…Pulmonary mucormycosis has been described in patients in diabetic ketoacidosis [4], and it is speculated that a combination of hyperglycemia and ketoacidosis suppresses innate immune function and promotes fungal spread [4]. However, there is no analogous mechanism in type two diabetes [5,6].…”

“…Diagnosis is made by transbronchial biopsy, bronchoalveolar lavage, or thoracic fluid sampling with visualization of fungal hyphae [2,3]. Treatment includes antifungal therapy, aggressive surgical debridement or excision of necrotic tissue and stabilization of underlying comorbidities [6]. Mortality is estimated to be 50–80%, with the severity of comorbidities positively correlating with death rate [1].…”