Mucormycosis

What is mucormycosis?

Mucormycosis is a serious fungal infection caused by many types of fungi called mucormycetes.

Mucormycetes can infect your eyes, sinuses (hollow spaces in your forehead and cheeks), brain, lungs, gastrointestinal tract (stomach and intestines) or skin. It causes different symptoms depending on what part of your body is infected. Mucormycosis is also sometimes called zygomycosis.

Mucormycetes live in the outside environment around us, but most of us never get sick from them. People with diabetes, certain types of cancers or other conditions that weaken your immune system are at a higher risk for mucormycosis.

Mucormycosis is often fatal. Go to an emergency room or seek medical attention immediately if you have symptoms of mucormycosis.

What are the types of mucormycosis?

Types of mucormycosis include:

• Rhino-orbital-cerebral or rhinocerebral mucormycosis.
• Pulmonary (lung) mucormycosis.
• Cutaneous (skin) mucormycosis.
• Gastrointestinal mucormycosis.
• Disseminated mucormycosis.

What are the symptoms of mucormycosis?

Symptoms of mucormycosis depend on where in your body the infection is. You might have symptoms in your nose, lungs, digestive tract, around your eyes or on your skin.

Rhino-orbital-cerebral or rhinocerebral mucormycosis

Rhino-orbital-cerebral mucormycosis is the most common type. The fungi infect your sinuses and can spread to the area around your eye (orbit) and your brain. It’s most common in people who have poorly managed diabetes (an A1C greater than 8% for over a year despite standard care) and organ transplant recipients.

Symptoms of rhino-orbital-cerebral mucormycosis include:

• Fever.
• Headache.
• Sinus pain.
• Nasal congestion.
• Ulcers or sores on the roof of your mouth.
• Vision loss or double vision.
• Difficulty controlling eye movements or smiling (cranial nerve palsy).
• Bulging eyes (proptosis).
• Swelling around your eyes.
• Black tears or pus draining from your eyes.
• Confusion or other mental changes.

Pulmonary (lung) mucormycosis

Pulmonary mucormycosis, a fungal infection in your lungs, is the second most common type. It’s most common in people who have:

• A hematologic cancer (like leukemia, lymphoma or myeloma), especially if you have low levels of certain white blood cells (neutropenia).
• Received a stem cell (bone marrow) transplant.
• Received a solid organ transplant.

Symptoms of pulmonary mucormycosis include:

• Fever.
• Chest pain.
• Shortness of breath (dyspnea).
• Coughing up blood (hemoptysis).

Cutaneous (skin) mucormycosis

You get cutaneous mucormycosis by getting the fungus in a break in your skin. It usually happens if you get a scrape or cut that forces fungi into the wound when you got it. This is the most common type of mucormycosis in people with healthy immune systems.

Symptoms of cutaneous mucormycosis include:

• Painful blisters, ulcers or hard patches on your skin.
• Skin redness, discoloration or swelling.

These skin changes get worse over time. They might turn black or discolored and spread to large areas or deep into your muscle or bones.

Gastrointestinal mucormycosis

Gastrointestinal mucormycosis is an infection in your stomach or intestines. It’s most common in premature infants. But recently cases have been increasing adults with neutropenia, long-term corticosteroid use and other conditions that weaken your immune system.

Symptoms of gastrointestinal mucormycosis include:

• Abdominal (belly) pain.
• Nausea and vomiting.
• Gastrointestinal bleeding.

Disseminated mucormycosis

Disseminated mucormycosis is when the infection spreads through your blood to different parts of your body. It most often spreads to your brain, but it can also move to your heart, spleen or skin. It’s the most serious form of mucormycosis and most likely to be fatal. Disseminated mucormycosis is most common in people who have:

• Hematologic cancer, especially if you have neutropenia.
• Received a stem cell (bone marrow) transplant.
• Received a solid organ transplant.

Disseminated mucormycosis can affect many parts of your body. It can cause the same symptoms as the other types of mucormycosis listed above, or symptoms similar to those of underlying illnesses.

What causes mucormycosis?

Many types of fungi cause mucormycosis. The most common are Rhizopus oryzae and Rhizopus delemar. These fungi live in the environment — especially in dirt, compost and rotting leaves or wood. They can also contaminate food that hasn’t been washed well enough. Most of us can breathe in or come in contact with the fungi without getting sick. But if you have certain health conditions, your immune system may not be able to fight off an infection.

How do you get mucormycosis?

You get mucormycosis after breathing in the fungal spores (reproductive parts of the fungus), eating something contaminated with them or getting them in a break in your skin. They’re very small, so you can’t see them or avoid them.

Though rare, people have gotten mucormycosis in the hospital, through contaminated medical equipment. There have also been outbreaks after natural disasters. For instance, severe tornadoes can disrupt a large amount of soil and cause fungi to become airborne.

Is mucormycosis contagious?

Mucormycosis isn’t contagious. You can only get the fungus from the environment, not from other people.

What are the risk factors for mucormycosis?

People with diabetes and those with certain conditions that can weaken their immune systems are most at risk for mucormycosis. Having too much iron in your body can also contribute. Risk factors include:

• Diabetes (diabetes mellitus), especially with hyperglycemia and ketoacidosis.
• Solid organ transplant.
• Hematopoietic stem cell transplant (bone marrow transplant).
• Low neutrophil count (neutropenia).
• Cancer, especially leukemia, lymphoma or myeloma.
• Long-term corticosteroid use.
• Nonmedical injection drug use.
• Hemochromatosis, which can lead to iron overload.
• Burns or traumatic skin injury that forces dirt and germs into the wound.
• Being born prematurely or low birth weight.

What are the complications of mucormycosis?

Mucormycosis can cause destructive and life-threatening complications. These include:

• Cavernous sinus thrombosis. This is a blood clot that forms in your sinuses. It can be fatal.
• Necrotizing fasciitis. This is a severe, rapidly spreading bacterial infection (“flesh-eating bacteria”). It can be fatal.
• Osteomyelitis. This is an infection in your bones that can destroy them.

How is mucormycosis diagnosed?

A provider might suspect you have mucormycosis based on your symptoms and whether you have underlying conditions. To diagnose it, they get imaging of your affected body parts and test your body tissues for signs of fungi.

What tests will be done to diagnose mucormycosis?

Depending on where your infection is, testing might include:

• Imaging. Your provider might perform chest X-rays, CT scans (computed tomography scans) or an MRI (magnetic resonance imaging).
• Endobronchial ultrasound. This is a type of bronchoscopy where a provider gets pictures of the inside of your lungs with an ultrasound attached to a thin, lighted tube.
• Tissue biopsy. A provider can look at your tissue under a microscope or analyze it with lab tests to see if there are signs of mucormycetes.

How is mucormycosis treated?

Providers treat mucormycosis with antifungal medications. You also might need surgery to remove infected or dead tissue. Antifungal medications that treat mucormycosis include:

• Amphotericin B.
• Posaconazole.
• Isavuconazole.

You’ll need antifungal treatment for several weeks or months.

Can you prevent mucormycosis?

It’s hard to avoid the fungi that cause mucormycosis since they live all around us. Here are some steps you can take that might reduce your risk of fungal infections:

• Work with your healthcare provider to manage any conditions that might put you at risk for severe fungal infections.
• If you’re at a higher risk for fungal infections, your provider might prescribe antifungals to help prevent you from getting sick.
• If your job might expose you to fungi, ask your provider if you’re at a higher risk for infection.
• Avoid areas where you’ll be exposed to dirt or dust, like construction sites. If you must be in these areas, use an N95 respirator mask (or other protective equipment) to help filter fungal spores out of the air you breathe.
• Avoid activities like gardening, digging or other yard work that can expose you to fungal spores. Wear gloves and clothing that covers as much of your skin as possible when working outdoors.
• Clean cuts and scrapes well with soap and water.

Can mucormycosis be cured?

Yes, mucormycosis can be cured with early treatment. A delay in treatment of even a few days can greatly reduce the survival rate. Even with early treatment, it can be hard to cure.

What’s the mortality rate for mucormycosis?

Because it’s hard to treat and because most people with mucormycosis have compromised immune systems, the mortality (death) rate is high. For all types of mucormycosis, the mortality rate is around 54%. Mucormycosis that’s only infected your sinuses has a slightly lower mortality rate (46%). Mucormycosis that spreads to other parts of your body (disseminated mucormycosis) is almost always fatal.

When should I see my healthcare provider?

Ask a healthcare provider how to prevent and detect fungal infections early if you:

• Have diabetes or cancer.
• Have had an organ or stem cell transplant.
• Have a condition or take medications that weaken your immune system.

When should I go to the ER?

Mucormycosis is fatal without quick treatment. Go to an ER immediately if you have signs of mucormycosis, especially if you have a weakened immune system or diabetes. Always seek emergency care if you have symptoms of serious illness, including:

• High fever (over 103 degrees Fahrenheit/40 degrees Celsius).
• Difficulty breathing.
• Coughing up blood.
• Bulging eyes or swelling around your eyes.
• Vision changes, like double vision.
• Confusion or other mental changes.
• Seizures.
• Black mucus or tears.
• A wound that won’t heal, keeps spreading or turns black.

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• Am I at a higher risk for fungal infections?
• How can I reduce my risk?
• What symptoms should I look for and when should I seek care?
• What are my treatment options?
• What can I expect with this diagnosis?

Does COVID increase your risk of mucormycosis?

In 2021, there was an outbreak of cases of mucormycosis in people with COVID-19. But experts aren’t sure what the link is between the two. They’re not sure if having COVID is enough to increase your risk because:

• Most cases were in regions of the world where mucormycosis infections are more common. During the COVID-19 pandemic, about 1 in 3 people with mucormycosis in these areas didn’t have COVID.
• There were a few cases of people with COVID and mucormycosis in other parts of the world (that typically don’t have many mucormycosis cases) during the pandemic. But areas that typically have lower rates of mucormycosis didn’t experience outbreaks (large numbers of people) of fungal infections.
• Many people with mucormycosis and COVID-19 also had poorly managed diabetes or were using corticosteroids. These are risk factors for mucormycosis.
• Most people who had COVID and mucormycosis had rhino-orbital-cerebral mucormycosis — not an infection in their lungs like you might expect. This also points to other underlying conditions contributing to the infection, not just COVID.

A note from Cleveland Clinic

Mucormycosis is rare. Only 1 to 2 people in a million get it each year. But if you have one of the many health conditions that can weaken your immune system, you’re at a higher risk. People with diabetes and a high A1C need to be especially careful. Managing any underlying conditions is usually the best way to stay healthy, but talk to your healthcare provider about other ways to reduce your risk of infection. They can talk you through any concerns and tell you what symptoms to look out for. If you currently have symptoms of mucormycosis, go to the nearest emergency room immediately.