Explain what is Mucor
There is a general class of fungi that is called Zygomycetes or better known as Mucormycosis.
This type of fungi is rare and grows in dirt , and decomposing leaves or compost. This type of fungi is easily identified due to their unique “morphological” appearance (Medicine Net, 2015a). According to the Centers of Disease Control and Prevention, Mucormycosis is a very serious condition that affects those individuals that have a very weak immune system (Centers of Disease and Control and Prevention, 2014c).
How is a patient likely to become infected with Mucor?
According to the Centers of Disease Control and Prevention there are two specific types of
infection that can be caused by Mucor. The route of exposure can be through the Lungs or
sinus when spores are inhaled from the environment. The spores can cause infection to
the lungs, sinuses, eyes, and face and there are also rare times where the infection can attack
the central nervous system. Infection can also occur through the skin. The organism enters a person’s body if the integrity of the skin was compromised by a cut, scrape, wound puncture, or other skin trauma (Centers of Disease Control and Prevention, 2014b).
Describe the pathophysiologic progression of the infection into pneumonia.
The progression of mucormycosis infection into pneumonia is associated with a high mortality
and morbidity rate. The CDC claims that pulmonary mucormycosis happens to people that
suffer from cancers of the blood, steroid use, or abnormally low or few neutrophils in the
blood, which leads to a high susceptibility to infection (Centers of Disease Control and
Prevention, 2014a). These patients suffer from fever, cough, shortness of breath, and chest
pain. As the disease progresses there will be Angioinvasion that will lead to death of the tissue
that will end up in empty spaces and coughing of blood (Centers of Disease Control and
Prevention, 2014a).
Use two medical/nursing interventions that would be helpful in treating the patient.
Intervention: Keep patient isolated (Doenges, 2016).
Rationale: Provides safety to patient by not introducing other pathogens to a very vulnerable
immune system (Doenges, 2016).
Intervention: Rotate patients position every 2 hrs (Doenges, 2016).
Rationale: Helps facilitate secretion movement and drainage and decreases atelectasis (Doenges, 2016).
What laboratory values are considered abnormal?
The following information is based on the patient’s labs:
Na – normal,
K – Normal
Cl – normal, HCO3 – > 25 which is alkalosis
BUN – normal
Cr – normal
Ca – normal but on the low side
Mg – normal but on the low side
PO4 – Normal but on the low side
Glucose fasting – is above (if glucose fasting is > 125 in two separate tests the patient, then the diagnosis
of diabetes is made)
Hb – depends if it’s male, female, newborn, or infant, but if the subject is male or female adult the range
is normal on the low side
Hct – normal but on the low side
WBC – is elevated indicating infection
Lymphocytes – are low and it can indicate steroid use, infections, blood cancers, infectious diseases.
Having a low count of lymphocytes compromises the body from fighting infection (MD Health, 2014).
pH – is high and indicates alkalosis
PaO2 – is extremely low
PaCO2 – is also extremely low. Based on the acid-base imbalances the patient is having respiratory
alkalosis (hyperventilation, may be related to: initial stage of pulmonary embolus).
Discuss the probable causes from a pathophysiologic perspective.
Based on the labs, ABG’s, x-ray, and the source of infection, the patient is suffering from
pulmonary mucormysis. According to Hindawi Publishing Corporation, this type of infection has
the tendency to invade the nearby organs, such as the pericardium, chest wall, and
mediastinum. The invasion of the large mediastinal vessels will lead to hemoptysis and lead to
mortality (Hindawi Publishing Corporation, 2012). This disease is very hard to diagnose due to
the rarity of the disease. Chest x-rays sometimes show “pulmonary mucormycosis may present
with focal consolidation, lung masses, pleural effusions, or multiple nodules. A tissue biopsy is recommended for diagnosis. The histopathological findings reveal irregular broad no septate hyphae and spores” (Hindawi Publishing Corporation, 2012).
What medications are used to treat mucormycosis
Based on the Centers of Disease Control and Prevention the following antifungal medications
should be used to treat pulmonary mucormycosis (Centers for Disease Control and Prevention,
2015b).
Amphotericin B – this medication is used to treat serious fungal infections. The medication
works by destroying the fungus and not allowing the reproduction of the fungus (drugs.com,
2016). Posaconazole and isavuconazole are also medications that the CDC recommends to
attack this problem.
According to Hindawai Publishing Corporation, “Effective management requires a 3-pronged
combination of medical and surgical modalities along with correction of the predisposing
underlying condition(s). Amphotericin B or its newer lipid formulation—liposomal
Amphotericin—B (L-AmB) along with extensive surgical debridement to remove the necrotic
Tissue. Thus it is important that clinicians maintain a high degree of suspicion for pulmonary mucormycosis in case of immunocompromised patients with no resolving pneumonia. Early diagnosis and aggressive treatment might reduce the mortality associated with this devastating fungal infection” (Hindawi Publishing Corporation, 2012). Patients with diabetes must have their glucose supervised closely. Patients might also undergo surgical procedures to remove
the fungi from the body, extended antifungal medications, and consultation with the physicians
that specialize in infectious diseases (Medicine Net, 2015b)
References
Centers of Disease Control and Prevention. (2014a). Clinical features of mucormycosis.
Retrieved fromhttp://www.cdc.gov/fungal/diseases/mucormycosis/symptoms/clinicalfeatures.
html
Centers of Disease Control and Prevention. (2015a). Mucormycosis. Retrieved from
http://www.cdc.gov/fungal/diseases/mucormycosis/index.html
Centers of Disease Control and Prevention. (2014b). Sources of mycormycosis. Retrieved from
http://www.cdc.gov/fungal/diseases/mucormycosis/causes.html
Centers of Disease Control and Prevention. (2014c). Symptoms of mucormycosis. Retrieved
from http://www.cdc.gov/fungal/diseases/mucormycosis/symptoms/
Centers of Disease Control and Prevention. (2015b). Treatment for mucormycosis. Retrieved
from http://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html
Doenges, Marilynn E., et al. Nurses pocket guide: diagnoses, prioritized interventions, and rationales. Philadelphia, F.A. Davis Company, 2016.
Drugs.com. (2016). Amphotericin b. Retrieved from
