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A. Properties navigator

  1. Highly resistant, destructive organisms
  2. Usually occurs in immunocompromised patients, especially diabetics
  3. Increased risk in patients on long term voriconazole prophylaxis
  4. Genera: Rhizopus, Absidia, Cunninghamella, Mucor (uncommon) and other species

B. Infections navigator

  1. Sinus colonization with invasion
  2. Deep bone / soft tissue penetration, often in face [2]
    1. About 50% of infections occur in diabetics
    2. Ketoacidosis is most important risk factor
    3. Early symptoms include facial, ocular pain, nasal stuffiness
    4. Proptosis, chemosis, and necrotic lesions on palate or nasal mucosa occur later
    5. Black necrotic eschar on nasal turbinates may be seen
  3. Meningitis
    1. Usually progression from deep infections
    2. Generalized headache, fever, lethargy
    3. Ophthalmoplegia or visual loss (blindness) from cranial nerve involvement [4]
    4. Cavernous sinus thrombosis
    5. Thrombosis of carotid artery or jugular vein

C. Diagnosisnavigator

  1. Diagnosis is difficult
  2. Biopsy and culture of necrotic tissue
  3. Cultures often remain negative
  4. Invasive tissue biopsy with stains is required
  5. Specific radiographic appearances in susceptible hosts are also used

D. Treatment navigator

  1. Surgical debridement is mainstay of therapy
  2. Drainage of infected areas including sinuses is key
  3. Amphotericin B
    1. High dose amphotericin B 1.5mg/kg/day indefinitely
    2. Amphotericin B lipid complex may be effective (high doses can be used fairly safely) [3]
  4. Itraconazole has some activity, but is not depenable
  5. Newer triazole antifungals are being developed
  6. Posaconazole has activity against many strains, may be active as salvage therapy

References navigator

  1. Patterson TF. 2005. Lancet. 366(9490):1013 abstract
  2. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. 1999. NEJM. 341(25):1906 abstract
  3. Strasser MD, Kennedy RJ, Adam RD. 1996. Arch Intern Med. 156(3):337 abstract
  4. Bienfang DC and Karluk D. 2002. NEJM. 346(12):924 (Case Record) abstract