Healthcare Nursing Mucormycetes And Mucor Fungus Treatments

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Mucor is one of 80 types of fungus found worldwide and part of a group of molds called mucormycetes. This species is found in our environment, specifically in soil, decaying leaves, compost piles and where rotting wood is found (CDC, 2019). Mucormycosis is an infection resulting from inhalation of the fungal spores into the bronchioles and alveoli of the lungs. It is an aggressive and often fatal infection usually diagnosed in immunocompromised individuals. Pneumonia, a result of these microbial agents, occurs when the fungus is introduced or inhaled into the lungs overwhelming the normal defense mechanisms. The infectious spores populate and initiate pulmonary inflammation. The infection may proliferate into the mediastinum and heart and the mortality rate is high in pulmonary mucormycosis. Symptoms include fever, cough, chest pain and shortness of breath. Treatment usually involves intravenous antifungal therapy, lung surgery and neutrophil recovery. Nursing interventions for these patients include monitoring vital signs, oxygen saturation, maintaining oxygen therapy through mask or nasal cannula, establishing intravenous access for IV drug treatment, specimen collection (blood and sputum), and reverse isolation precautions for immunocompromised patients. Strict glycemic control is a priority as well.

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The ABG results reveal respiratory alkalosis from hyperventilation, decreasing the oxygen level in the blood due to the restrictive or obstructive source in the lungs. The glucose is elevated and is a medium for more fungal growth. The elevated white blood cell count and lymphocyte counts are indicative of infection and an immune response to fighting off disease. The chest x-ray shows increased density in the left lower lung and a loss of the outline of the diaphragm indicative of left lower lobe pneumonia (Medscape, 2019).

There are three medications commonly used in the treatment of Mucormycosis. Amphotericin B, a lipid-based antifungal agent, increases the permeability of the fungal cell causing an alteration in the cell membrane ultimately causing its demise. Amphotericin B remains the gold standard therapy for treatment of mucormycosis (Badior, Trigo, Eloy & Guimaraes, 2013). Posaconazol is another systemic antifungal agent that alters the cell membrane and interferes with several fungal enzymes. It is considered a good step-down drug or prophylactic therapy for patients with hematologic cancers and or undergoing chemotherapy. Isavuconazol, a newer medication, significantly alters the structure and function of the fungal membrane leading to cell death. It is advertised with a good safety profile and is used as a step-down treatment presently (Mir, Basnet, Ellsworth, & Mohanty, 2018).

Treatments used to combat mucormycosis include surgical debridement of the involved tissues if possible and lobectomy. Combination antifungal drug therapy is an option but not recommended. Correcting underlying medical conditions such as neutropenia, anemia, and hyperglycemia, to name a few, is a priority and beneficial before antifungal treatment is started. Hyperbaric oxygen therapy has been attempted with these patients but further research is necessary to prove its benefit in therapy (Cox, Kauffman , & Thorner, 2019).

Badior, M., Trigo, F., Eloy, C., & Guimarães, J. (2013). Mucor Infection: Difficult Diagnosis. Clinical Drug Investigation, 33, 19–21. Retrieved from https://lopes.idm.oclc.org/login?url=https://searc…

 
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