Invasive disease due to Mucorales: a case report and review of the literature

CK Yeung, VCC Cheng, AKW Lie, KY Yuen
Division of Haematology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong

OBJECTIVE. To review the mycology, pathogenesis, clinical characteristics, investigations, and treatment modalities of mucormycosis.

DATA SOURCES. A local case of mucormycosis; MEDLINE and non-MEDLINE search of the literature.

STUDY SELECTION. Key words for the literature search were 'mucormycosis' and 'Mucorales'; all available years of study were reviewed.

DATA EXTRACTION. Original articles, review papers, meta-analyses, and relevant book chapters were reviewed.

DATA SYNTHESIS. Mucormycosis is a fungal infection that is rare but increasingly recognised in the growing population of immunocompromised patients. It is caused by saprophytic non-septate hyphae of the order Mucorales. The pulmonary and disseminated forms commonly occur in patients with haematological malignancy, especially acute leukaemia and lymphoma, and those receiving treatment with immunosuppressive effects. The rhinocerebral form is more prevalent in patients with diabetes mellitus, particularly those with the complication of diabetic ketoacidosis. The use of amphotericin B combined with surgery remains the mainstay of treatment. The prognosis largely depends on prompt correction of the underlying risk factors. New strategies to combat this life-threatening infection will result from better understanding of its pathogenesis.

CONCLUSION. A high index of suspicion is needed, in appropriate clinical settings, to diagnose and aggressively treat this infection in view of the high mortality rate for susceptible patients.

Hong Kong Med J 2001;7:180-8

Key words: Amphotericin B; Diabetes mellitus; Immunosuppression; Leukemia; Mucormycosis