Mucormycosis (cont.)

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What are symptoms and signs of mucormycosis?

Most of the symptoms of mucormycosis do not differ to any major extent between the various fungal causes; most authorities describe the signs and symptoms of the disease according to the predominant or initial body area that is infected. Some patients have more than one body area infected. The following is a list of signs and symptoms (note that many authors prefer the term mucormycosis instead of zygomycosis since the majority of fungi, when identified, are from the Mucoraceae family of fungi):

  • Rhinocerebral mucormycosis: fever, headache, reddish and swollen skin over nose and sinuses, dark scabbing in the nose by the eye(s), visual problems, eye(s) swelling, facial pain
  • Pulmonary (lung) mucormycosis: fever, coughing sometimes with bloody or dark fluid production, shortness of breath
  • GI mucormycosis: diffuse abdominal pain, bloody and sometimes dark vomitus, abdominal distension
  • Renal mucormycosis: fever, flank pain
  • Cutaneous mucormycosis: initially, reddish and swollen skin often adjacent to an area of skin trauma, that becomes an ulcer with a dark center and sharply defined edges
  • Disseminated mucormycosis: initially may have any of the above symptoms; as the disease spreads to other organs, headaches, fever, and mental-status changes occur

Although these symptoms suggest that a patient may have mucormycosis, they are not definitive. In addition, they may not develop very quickly because it may take a few days to over a week in many people before they develop, and when they do initially, it is not unusual to ascribe the symptoms to causes other than fungi (often to secondary bacterial infections). Consequently, the fungal diagnosis may be delayed (see diagnosis section below).

How is mucormycosis diagnosed?

Presumptive diagnosis is based on the patient's history, physical exam, and the patient's risk factors for getting a fungal infection. A definitive diagnosis is difficult. Although tests such as CT or MRI may help define the extent of infections or tissue destruction, their findings are not specific for mucormycosis. There are no serological or blood tests that are helpful. Growth of the fungi from a biopsy (tissue obtained by surgical removal or endoscopes with biopsy tool) of infected tissue and special tissue stains that may identify fungus from tissue debris can help make the definitive diagnosis (for example, Grocott methenamine-silver stain or periodic acid-Schiff [PAS] staining; some by immunofluorescence techniques). However, sometimes it is still difficult to determine the specific fungal genus and species infecting the patient; in some instances, this is done by cultivation of these organisms and then microscopic identification is made from the unique structural components of the fungi. This helps distinguish mucormycosis from other fungal diseases such as candidiasis and histoplasmosis. Consequently, mucormycosis is often a "working" diagnosis that clinicians use because the supportive care and treatments for the causative fungal agents are essentially the same. Figure 2 shows a periorbital eye infection eventually diagnosed as mucormycosis.

Picture of periorbital fungal infection known as zygomycosis, mucormycosis, or 
Fig. 2: Picture of periorbital fungal infection known as zygomycosis, mucormycosis, or phycomycosis; SOURCE: CDC/Dr. Thomas F. Sellers/Emory University
Medically Reviewed by a Doctor on 4/30/2014

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Mucormycosis - Risk Factors Question: If known, what were the risk factors for mucormycosis in you or someone you know?
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