Mucorales/Mucormicosis

Características Generales

Características básicas de Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis

Taxonomía:

• Orden: Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis
• Géneros más comúnmente asociados con infección humana:
  • Rhizopus Rhizopus A genus of zygomycetes fungi of the family mucoraceae, order mucorales, a common saprophyte and facultative parasite of mature fruits and vegetables. It may cause cerebral mycoses in diabetes and cutaneous infection in severely burned patients. Mucorales/Mucormycosis
  • Rhizomucor Rhizomucor A genus of zygomycetes fungi of the family mucoraceae, order mucorales. Mucorales/Mucormycosis
  • Mucor Mucor A genus of zygomycetes fungi of the family mucoraceae, order mucorales. It is primarily saprophytic, but may cause mucormycosis in man from spores germinating in the lungs. Mucorales/Mucormycosis
  • Cunninghamella Cunninghamella A genus of zygomycetous fungi of the family cunninghamellaceae, order mucorales. Some species cause systemic infections in humans. Mucorales/Mucormycosis
  • Lichtheimia Lichtheimia Mucorales/Mucormycosis (antes Absidia Absidia Mucorales/Mucormycosis)
  • Apophysomyces
  • Saksenaea

Morfología:

• Colonias:
  • Crecimiento rápido
  • Algodonosas
  • Color blanco-amarillo → se vuelven gris
• Características microscópicas:
  • Hifas anchas
  • Septos ausentes o poco frecuentes
  • Ramificación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ángulo recto
  • Esporangióforos:
    • Hifas erguidas
    • Soportan esporangios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de saco llenos de esporangiosporas asexuales

Enfermedades asociadas

La mucormicosis es causada por muchas especies del orden Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis, que pueden clasificarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función del lugar de la infección:

• Mucormicosis rinoorbitario-cerebral (rinocerebral) (más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos)
• Mucormicosis pulmonar
• Mucormicosis cutánea
• Mucormicosis gastrointestinal

Epidemiología

• Infección muy rara; la incidencia real es desconocida.
• Aproximadamente 500 casos anuales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos
• La incidencia está aumentando debido al AL Amyloidosis creciente número de pacientes inmunocomprometidos.
• No hay predilección por el sexo
• No hay predilección racial
• No hay predilección por la edad
• Tasa de mortalidad: 50%–85%

Patogénesis

Reservorios

El orden Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis es común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el medio ambiente y se puede encontrar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:

• Vegetación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum descomposición
• Suelo

Transmisión

• Inhalación de esporas (método principal)
• Ingestión de alimentos contaminados
• Inoculación cutánea

Factores de riesgo del huésped

Casi todas las infecciones se producen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de una enfermedad subyacente:

• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus (especialmente cetoacidosis diabética)
• Tumores malignos hematológicos
• Cáncer de órganos sólidos
• Trasplante de órganos
• Trasplante de células madre
• Terapia inmunosupresora
• Uso crónico de corticosteroides
• VIH/SIDA
• Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia ( los LOS Neisseria neutrófilos son la defensa clave del huésped contra los LOS Neisseria hongos)
• Condiciones de sobrecarga de hierro (e.g., hemocromatosis y terapia con deferoxamina)
• Lesión cutánea debida a cirugía, quemaduras o traumatismos
• Uso de medicamentos inyectables
• Malnutrición

Fisiopatología

• La mayoría de las esporas ingresan por la vía respiratoria → se adhieren al AL Amyloidosis moco
• Individuos sanos:
  • Suele desaparecer al AL Amyloidosis toser, estornudar o tragar
  • Los LOS Neisseria neutrófilos fagocitan → destruyen el hongo
• Pacientes susceptibles:
  • Las esporas se transforman en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la forma de hifa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria cornetes nasales o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria alvéolos.
  • Las hifas invaden los LOS Neisseria vasos sanguíneos → infarto tisular y trombosis
  • Conduce a una enfermedad rinocerebral o pulmonar
• Otras vías de infección → enfermedad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria sitios respectivos:
  • Inoculación o contaminación traumática → enfermedad cutánea
  • Ingestión → enfermedad gastrointestinal

Presentación Clínica

Enfermedad rinocerebral

Los LOS Neisseria pacientes comienzan con síntomas de sinusitis Sinusitis Sinusitis refers to inflammation of the mucosal lining of the paranasal sinuses. The condition usually occurs concurrently with inflammation of the nasal mucosa (rhinitis), a condition known as rhinosinusitis. Acute sinusitis is due to an upper respiratory infection caused by a viral, bacterial, or fungal agent. Sinusitis aguda. Los LOS Neisseria síntomas progresan debido a la propagación de la infección a las estructuras contiguas.

• Fiebre
• Congestión nasal (puede tener una secreción negra)
• Cefalea retro-orbital unilateral
• Dolor Dolor Inflammation facial
• Entumecimiento
• Hiposmia
• Inflamación orbital con proptosis Proptosis Retinoblastoma y quemosis
• Celulitis facial
• La formación de escaras puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Mucosa nasal
  • Paladar
  • Piel superpuesta

Enfermedad pulmonar

Los LOS Neisseria pacientes con enfermedad pulmonar desarrollan una neumonía rápidamente progresiva (a menudo bilateral).

• Fiebre
• Disnea
• Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome
• Hemoptisis

Enfermedad cutánea

• Celulitis
• Necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage cutánea
• Formación de escaras negras

Enfermedad gastrointestinal

La enfermedad provoca úlceras necróticas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tracto gastrointestinal (con más frecuencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estómago), que pueden conducir a perforación. Los LOS Neisseria signos y síntomas incluyen:

• Dolor Dolor Inflammation abdominal
• Distensión
• Náuseas
• Vómitos
• Hematemesis Hematemesis Vomiting of blood that is either fresh bright red, or older ‘coffee-ground’ in character. It generally indicates bleeding of the upper gastrointestinal tract. Mallory-Weiss Syndrome (Mallory-Weiss Tear)
• Hematoquecia
• Obstrucción
• Signos peritoneales

Manifestaciones poco comunes

• Enfermedad diseminada:
  • Puede presentarse con signos y síntomas inespecíficos
• Mucormicosis del SNC:
  • Suele ocurrir por la diseminación directa de una infección sinusal
  • Signos y síntomas:
    • Letargo
    • Cefalea
    • Déficits neurológicos focales

Diagnóstico y Tratamiento

Diagnóstico

Se requiere un alto índice de sospecha para hacer el diagnóstico.

• Muestra por biopsia:
  • La identificación histopatológica del organismo causante establece el diagnóstico.
  • Se puede observar necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage tisular
• Cultivos fúngicos (a menudo negativos)
• Imagenología (e.g., TC de cabeza o de tórax) para evaluar el alcance de la infección y el daño tisular
• El 1,3-β-D-glucano no es útil (no es un componente de la pared celular de los LOS Neisseria Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis).

Tratamiento

• Se debe tratar la enfermedad subyacente cuando sea posible (e.g., cetoacidosis diabética).
• Si es posible, el tratamiento debe realizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un centro de atención terciaria.
• La terapia antifúngica debe iniciarse inmediatamente:
  • Anfotericina B liposomal (1ra línea)
  • Isavuconazol
  • Posaconazol
• La resección quirúrgica del tejido necrótico está indicada para limitar la diseminación:
  • Se asocia a una mayor supervivencia
  • Puede provocar una desfiguración importante

Comparación de Especies

Diagnóstico Diferencial

• Celulitis orbitaria bacteriana: infección de los LOS Neisseria tejidos orbitarios, que puede producirse por diseminación hematógena, extensión desde los LOS Neisseria senos adyacentes o inoculación traumática. Los LOS Neisseria pacientes presentan edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema y enrojecimiento, eritema conjuntival, dolor Dolor Inflammation al AL Amyloidosis mover el ojo y proptosis Proptosis Retinoblastoma. El diagnóstico es clínico. La base del tratamiento es la terapia con antibióticos y la cirugía se reserva para los LOS Neisseria casos graves.
• Trombosis del seno cavernoso: una condición rara y potencialmente mortal que se produce por una infección facial. La trombosis del seno cavernoso suele ser de etiología bacteriana. Los LOS Neisseria pacientes se presentan con fiebre, cefalea, proptosis Proptosis Retinoblastoma y oftalmoplejia. El diagnóstico se confirma mediante TC o RM. El tratamiento incluye antibióticos y, ocasionalmente, esteroides. El uso de anticoagulación es controversial.
• Neumonía adquirida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad: infección del parénquima pulmonar causada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria casos por una bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology o un virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology. Los LOS Neisseria pacientes se presentan con fiebre, disnea y tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome productiva. La radiografía de tórax suele mostrar una consolidación lobar. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la administración de antibióticos empíricos, que pueden adaptarse si se identifica el organismo causante. Los LOS Neisseria antivirales se utilizan cuando se sospecha una causa viral.