So mucor is on the rise, time for a quick revision. A short thread for those interested.
It's a bad infection with an unreasonably high mortality(40-80%) which depends on the organ involved.
Risk factors: DM/ neutropenia/ HSCT
DM=rhino-orbital mucor
Neutropenia=pulmonary mucor
It's a bad infection with an unreasonably high mortality(40-80%) which depends on the organ involved.
Risk factors: DM/ neutropenia/ HSCT
DM=rhino-orbital mucor
Neutropenia=pulmonary mucor
Mucormycosis is caused by fungi of order "MUCORALES" which includes rhizopus/mucor/licthemia/cunninghemela species. But DON'T WORRY species identification doesn't change treatment so we don't need to get to that.
Coming to the PRACTICAL POINTS that need to be remembered.
➡️IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.
➡️CT PNS/Orbits/ MRI Brain
➡️HRCT chest as per presentation
➡️IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.
➡️CT PNS/Orbits/ MRI Brain
➡️HRCT chest as per presentation
Rx= ANTI-FUNGALS + SURGERY
Urgent SURGICAL DEBRIDEMENT improves outcomes dramatically.
1st choice Antifungal is Liposomal AmpB (not AmpB deoxy) at 5mg/kg
⬆️Dose of 10mg/kg for CNS mucor.
Urgent SURGICAL DEBRIDEMENT improves outcomes dramatically.
1st choice Antifungal is Liposomal AmpB (not AmpB deoxy) at 5mg/kg
⬆️Dose of 10mg/kg for CNS mucor.
2nd choice is iv Isavuconazole/posa.
Isavu @ 200mg Tds for 2d➡️200 OD
Posa @ 300mg Bd on D1 ➡️300mg OD
Repeat imaging WEEKLY to look for disease status.
The duration of therapy➡️major problem, it's not defined & is to be continued till there is resolution of the risk factor.
Isavu @ 200mg Tds for 2d➡️200 OD
Posa @ 300mg Bd on D1 ➡️300mg OD
Repeat imaging WEEKLY to look for disease status.
The duration of therapy➡️major problem, it's not defined & is to be continued till there is resolution of the risk factor.
Thus it seems prudent to PREVENT this horrible infection.
How can that be done??
1 Keep your sugars in check.
2 Take ur diabetes meds/insulin.
3 Avoid drugs that ⬆️ sugars(steroids) {w/o a doctor's advise}
4 Watch out for sinus pain/eye pain/double vision and report urgently
How can that be done??
1 Keep your sugars in check.
2 Take ur diabetes meds/insulin.
3 Avoid drugs that ⬆️ sugars(steroids) {w/o a doctor's advise}
4 Watch out for sinus pain/eye pain/double vision and report urgently
Issues with Amphotericin B
Nephrotox, ⬇️K ⬇️Mg
Issues with Posa
Hepatotox, need for TDM, drug interactions
Issues with Isavuconazole are fewer than posa
Significant issue➡️➡️COST 😭
50mg Liposomal AmpB = 6k
5 mg/kg x 60kg = 300mg = 36k/day!!
Iv posa/ isavu= equally expensive
Nephrotox, ⬇️K ⬇️Mg
Issues with Posa
Hepatotox, need for TDM, drug interactions
Issues with Isavuconazole are fewer than posa
Significant issue➡️➡️COST 😭
50mg Liposomal AmpB = 6k
5 mg/kg x 60kg = 300mg = 36k/day!!
Iv posa/ isavu= equally expensive
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