Awareness about the threat posed by indoor mold and how it can impact our health continues to grow by leaps and bounds. It is well-known that mold spores and airborne mycotoxins can certainly cause respiratory distress, allergic reactions, headaches and promote inflammation conditions. Though these aren’t the only ways that mold and other members of the fungi family can affect your health. One of the more insidious health concerns posed by indoor mold is a disease known as Mucormycosis.
Mucormycosis is a relatively rare infection caused by members of the fungi family in the order of Mucorales. Most of the time, a healthy human immune system is completely capable of defeating the strains of mold that attempt to infiltrate the body.
Unfortunately, for some immunocompromised individuals, mold spores from the Mucorales order, that infiltrate the body, can lead to a severe case of mucormycosis. In these rare instances, the disease can be extremely dangerous, with disturbingly high mortality rates. It’s also worth noting that some countries have recently reported a rise in these mycoses. Many of these statistics include neutropenic patients with hematological diseases that also lend toward high mortality rates.
What Causes Mucormycosis?
Taxonomically the Mucorales order itself is known to hold 261 distinct species, and comprises 55 genera. Of these the Rhizopus, Lichtheimia, and Mucor species account for roughly two-thirds of medically important Mucorales genera. Of these 38 Mucorales species are known to be associated in some way with human infections.
When these fungal strains enter the body of immunocompromised individuals, they can replicate. This can cause Mucormycosis, as well as making it hard for the individual’s weakened immune system to deal with other present conditions.
What Are The Symptoms Of Mucormycosis?
The Centers for Disease Control note that the active symptoms of mucormycosis can vary depending on where in the body the fungus is growing. Some of the more common symptoms include, but are not limited to:
- One-sided facial swelling
- Nasal or sinus congestion
- Black lesions on nasal bridge or upper inside of mouth that quickly become more severe
- If the fungal presence manifests in the lungs it typically causes:
- Chest pain
- Shortness of breath
In a case where the fungal presence affects the skin “Cutaneous Mucormycosis” can cause:
- Infected skin lesions that turn black pain
- Localized swelling
- Warmth on the skin
- Gastrointestinal mucormycosis symptoms often include:
- Abdominal pain
- Nausea and vomiting
- Gastrointestinal bleeding
Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions. Some of these individuals can develop an infection in the brain and can develop mental status changes or coma.
Increased Risk Factors For Mucormycosis
There are several factors and underlying conditions that can predispose an individual for a Mucormycosis infection. This includes:
- Hematological malignancies
- A recent organ transplant
- Low white blood cell count
- Corticosteroid therapy which suppresses the immune system
- Iron overload
- Illicit intravenous drug use
- Neonatal prematurity
A growing body of research found evidence suggesting that the underlying disease might also be connected to the site of infection. This could mean that a pulmonary mucormycosis might also be associated with hematological malignancies and neutropenia, or diabetes. Though specific risk factors for the infection can vary considerably based on the geographical area where certain strains of fungus are more prevalent.
How Is Mucormycosis Diagnosed?
Diagnosing an active mucormycosis infection starts with identifying the visual characteristics in tissue, sputum, exudates or scrapings. This often includes techniques like sampling, and cultivating the fungus in the laboratory. Sporangia are seldom found, and the diagnosis is usually based on visual detection of hyphae.
In many of these cases the Mucorales order fungi can be seen in the infected tissues as erratically shaped, non-septate, right-angle branching hyphae. Most of the time this includes a noticeable branching trait which prevents the misidentification of infectious Mucorales fungi.
Since mucormycosis is a rare disease, it can make premortal diagnosis difficult. Though it is sometimes found in special conditions such as leukemia cases with pulmonary filamentous fungal infections.
Should a physician suspect that an individual has a Mucormycosis infection in conjunction with another condition or risk factor, there are special diagnostics that might be performed. This includes an Internal transcribed spacer (ITS), which is used to identify one of the most widely sequenced DNA regions for fungi in general.
How A Mucormycosis Infection Progresses
With most cases of Mucormycosis the infection usually begins with the accidental inhalation of a fungal spores. Though in some cases, such as Cutaneous Mucormycosis the infection can start with a flesh wound or perhaps via intravenous drug use. Though respiratory ingestion tends to be the most common.
In these cases, the inhaled fungal spores become deposited in the upper respiratory tract or pass through to the lung’s alveoli. In a healthy individual special alveolar macrophage can prevent spores from germinating. Though in an immunocompromised individual, the spore germination occurs, and hyphae start to grow. At this point, the formation of the mycelia (hyphal aggregate) marks the beginning of invasive mycosis. In cases of seriously reduced immunocompetence, the mycelium can invade deeper tissue layers.
A lot of individuals with pulmonary mucormycosis, the notable symptoms often present just like clinical manifestations described for aspergillosis. This includes:
- Thoracic pain
- Difficulty breathing
In severe cases this can lead to coughing up blood.
Since Mucorales strains tend to have an increased tendency to invade blood vessels, this can often lead to the insufficient blood supply and thrombosis in the involved organ. Once these infections affect the bloodstream, they can lead to other dangerous conditions such as septic thromboembolism.
How Is Mucormycosis Treated
The first step in most treatment strategies for Mucormycosis is to arrest the fungal reproduction via spreads with antifungal medications such as aAmphotericin B.
In a severe case where the fungal presence has already spread, an aggressive amputation of the infected body region might need to be performed to stop its progress. Unfortunately, this sometimes means the removal of certain skin and bone segments, which has the potential to complicate other present medical conditions. Especially in an immunocompromised individual.