Mucormycosis other diagnostic studies

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Mucormycosis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mucormycosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

When a clinician suspects invasive mucormycosis infection, an early diagnostic procedure performed within 16 days from the onset of symptom and early initiation of antifungal therapy will lead to successful management of this highly fatal disease.[1] Biopsy with H&E staining of the specimen and PCR may confirm the diagnosis in suspected cases.

==Key Findings on Hemotoxylin and Eosin (H&E) sections in Mucormycosis==[2]

  • Subcutaneous lesions showed aseptate hyphae immersed in an intense acute inflammatory exudate of neutrophils, eosinophils and fibrosis
  • Focal collections of epithelioid and Langhans multinucleated giant cells were also observed
  • Mucor spp. typically are rapid growing, producing globose sporangia on sporangiophores that are either solitary or branched
  • The sporangia contain the entire columella and spores that are mucus bound.
  • The sporangial wall collapses irregularly, if at all.
  • Rhizoids and stolons are absent. These features distinguish the Mucor spp. from the other producers of globose sporangia


Key Findings on PCR analysis in Mucormycosis

  • Detection of fungal DNA from biopsy specimens allows rapid identification of the causative organism of mucormycosis[3]
  • Mucorales quantitative PCR could not only confirm the mucormycosis diagnosis when other mycological arguments were present but could also anticipate this diagnosis[4]
  • Quantification of DNA loads may also be a useful adjunct to treatment monitoring

References

  1. Jeong SJ, Lee JU, Song YG, Lee KH, Lee MJ (2015). "Delaying diagnostic procedure significantly increases mortality in patients with invasive mucormycosis". Mycoses. 58 (12): 746–52. doi:10.1111/myc.12428. PMID 26565066.
  2. Ribes JA, Vanover-Sams CL, Baker DJ (2000). "Zygomycetes in human disease". Clin. Microbiol. Rev. 13 (2): 236–301. PMC 100153. PMID 10756000.
  3. Rickerts V, Just-Nübling G, Konrad F, Kern J, Lambrecht E, Böhme A, Jacobi V, Bialek R (2006). "Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples". Eur. J. Clin. Microbiol. Infect. Dis. 25 (1): 8–13. doi:10.1007/s10096-005-0078-7. PMID 16416267.
  4. Millon L, Herbrecht R, Grenouillet F, Morio F, Alanio A, Letscher-Bru V, Cassaing S, Chouaki T, Kauffmann-Lacroix C, Poirier P, Toubas D, Augereau O, Rocchi S, Garcia-Hermoso D, Bretagne S (2016). "Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF)". Clin. Microbiol. Infect. 22 (9): 810.e1–810.e8. doi:10.1016/j.cmi.2015.12.006. PMID 26706615.

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