Under the Microscope Dr. Shepard is an ENT specialist who is examining a patient
ID: 3506733 • Letter: U
Question
Under the Microscope Dr. Shepard is an ENT specialist who is examining a patient in the hospital emergency department. She notes that the patient's facial and sinus bones are severely necrotic and the orbit of one eye has collapsed. She suspects a type of fungal infection and schedules biopsies for that day 2. What will biopsies show? 3. How will this patient be surgically treated? 4. What fungal medications will be required if the diagnosis is confirmed? 5. Is this an emergency situation? 1. What type of fungal infection does Dr. Shepard think the patient has?Explanation / Answer
1. Dr. Shepard is suspecting that the patient has mucormycosis infection. Mucormycosis is a fungal infection caused by fungi belonging to Mucorales and include Mucor, Rhizopus, Absidia, and Cunninghamella. The hyphae of these fungi grow around the blood vessels. The mucormycosis commonly affects the sinuses, brain and lungs. When the infection enters the blood vessels it may cause formation of blood clots and necrosis or tissue death of surrounding tissues due to lack of blood supply. Infection spread to brain may cause one side headache and pain around eyes. The sinuses are filled with mucus resulting nasal congestion. Eye swelling may occur and the infection may spread to orbit of eye. Further the infection may spread to multiple organs. The infection is potential threat in diabetic and immunocompromised individuals.
2) The biopsis show cells containing fubgal conidia and sporangiospores or zygospores (asexual or sexual) along with fungal hyphae.
3) The patient is treatedby surgery during which the necrotic tissue is removed through surgical debridement.
4) Antifungal agent like Amphotericin B is mainly given and other antibiotics like posaconazole or isavuconazole may be given in treatment. In diabetic patients, the blood glucose levels should be under control.
5) The fungal infection, mucormycosis is an emergency situation because of necrosis of facial and sinus bones and infection spread to eye and may lead to blindness. The tissue in untreated cases may also cause death by spread of infection.
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