Citation, DOI, disclosures and article data
Citation:
Bell D, Mucormycosis vs aspergillosis. Reference article, Radiopaedia.org (Accessed on 28 Mar 2024) https://doi.org/10.53347/rID-90999
It is important to be able to distinguish between mucormycosis and aspergillosis because:
- antifungal sensitivity: mucormycosis is resistant to voriconazole, whilst aspergillosis is sensitive to it
- mucormycosis may have an improved prognosis if treated earlier
It is to be noted that there has been a rise of mucormycosis in the second wave of the COVID-19 pandemic in India attributed to uncontrolled diabetes mellitus and overzealous use of steroids.
Clinical presentation
Unfortunately, there is a marked overlap in the clinical presentations of the two conditions, such that they cannot be confidently distinguished. The following symptoms are variably seen in both fungal infections 5,6:
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fever refractory to broad-spectrum antibiotics
- dry cough
- progressive dyspnea
- less commonly
Complications
- massive, potentially fatal, hemoptysis
- invasion of the major pulmonary blood vessels by hyphae
- organ invasion by hyphae infiltrating through tissue planes
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Practical points
Imaging features that favor mucormycosis over aspergillus lung infection in a neutropenic patient are 1-4:
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1. Christopher M. Walker, Gerald F. Abbott, Reginald E. Greene, Jo-Anne O. Shepard, Dharshan Vummidi, Subba R. Digumarthy. Imaging Pulmonary Infection: Classic Signs and Patterns. (2014) American Journal of Roentgenology. doi:10.2214/AJR.13.11463
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2. Jonathan H. Chung, J. David Godwin, Jason W. Chien, Sudhakar J. Pipavath. Case 160: Pulmonary Mucormycosis1. (2010) Radiology. doi:10.1148/radiol.10081907
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3. Chamilos, Georgios, Marom, Edith M., Lewis, Russell E., Lionakis, Michail S., Kontoyiannis, Dimitrios P.. Predictors of Pulmonary Zygomycosis versus Invasive Pulmonary Aspergillosis in Patients with Cancer. (2005) Clinical Infectious Diseases. 41 (1): 60. doi:10.1086/430710
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4. Legouge, C., Caillot, D., Chrétien, M.-L., Lafon, I., Ferrant, E., Audia, S., Pagès, P.-B., Roques, M., Estivalet, L., Martin, L., Maitre, T., Bastie, J.-N., Dalle, F.. The Reversed Halo Sign: Pathognomonic Pattern of Pulmonary Mucormycosis in Leukemic Patients With Neutropenia?. (2014) Clinical Infectious Diseases. 58 (5): 672. doi:10.1093/cid/cit929
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5. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases: Expert Consult Premium Edition - Enhanced Online Features and Print, 8e. Saunders. ISBN:1455748013. Read it at Google Books - Find it at Amazon
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6. Goldman L, Schafer AI. Goldman's Cecil Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print, Single Volume. Saunders. ISBN:1437716040. (pages 1994-1997) Read it at Google Books - Find it at Amazon
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