Mucormycosis: Two cases of disseminated disease with cultural identification of rhizopus; review of literature

Abstract

1. 1. Two cases of mucormycosis, a usually fatal infection reported with increasing frequency, are presented. In one, a young woman with post-abortal necrosis of the spleen, kidneys and adrenals, and severe uremia, mucormycosis was thought to contribute to the fatal outcome. The second case was a young man with hepatic disease, possibly toxic in origin, and ischémic tubular necrosis. In both cases mucormycosis was disseminated, involving the respiratory and gastrointestinal tracts. 2. 2. Rhizopus arrhizus was identified in the second case. This is the sixth case of visceral mucormycosis in which the organism has been identified by culture. 3. 3. Clinical and pathologic features of fifty-five cases of mucormycosis reported in the English literature are summarized. In twenty-one of these cases diabetes was present and in thirteen, leukemia or lymphoma. The role of these conditions, as well as that of cortisone and antibiotics in the pathogenesis of mucormycosis, is discussed. 4. 4. The most frequently involved sites have been the brain and meninges, usually in diabetic patients. Pulmonary and disseminated forms have predominated in non-diabetic subjects. 5. 5. The diagnosis of mucormycosis should be suspected in the diabetic patient who presents a triad of orbital cellulitis, ophthalmoplegia and meningoencephalitis. Some of these patients may have ulceration of the nasal mucosa and here the diagnosis may be established by histologic examination and culture of biopsy material or scrapings. The diagnosis in the pulmonary and gastrointestinal forms of infection remains difficult. 6. 6. The experimental data are summarized. Alterations resulting from acute alloxan diabetes, acid osis in the form of ketosis, leukopenia, hyperglycemia and cortisone administration have been found to decrease host resistance to mucormycosis. 7. 7. Recovery has been reported in three patients with cerebral mucormycosis. The treatment recommended includes control of the underlying disease, use of vaccines, amphotericin B and iodides.