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Mucormycosis is a rare and serious fungal infection that is caused by a group of molds called mucormycetes. There are approximately 40 species of molds that are found in the environment. The fungi live in soil and decaying organic matter such as leaves, compost piles, or rotten wood (CDC, 2015). Patientâ€™s that typically contract mucormycosis are usually immunocompromised and have weakened immune systems. It most commonly affects sinuses or lungs but can also be found in the skin or other areas in the body. The infection starts with signs of a fever, cough sometimes with dark or bloody sputum, and shortness of breath, it then progresses and rapidly multiplies in blood vessel walls. Most common group of people that are at higher risk are diabetics, cancer patients and anyone with an immunologic condition (CDC, 2015).
The infection can progress quickly, and survival can be poor. It is believed that pathogenesis progression of the disease relates to iron metabolism which plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron (CDC, 2015).
1) Educate the patient on the importance of taking their medication as prescribed and to finish the entire dose.
2) Monitor vital signs and apply Oxygen as needed to help ease the symptoms of dyspnea
3) Control any underlying immune compromised condition if possible
The attending physician will prescribe an antifungal treatment for mucormycosis. Prescription antifungals will be used such as amphotericin B, posaconazole or isavulcaonazole (CDC, 2015)
Which lab values are abnormal:
Fasting Glucose 138mg/dL. A fasting glucose above 126mg/dL on two separate occasion indicates diabetes.
WBC= 15,200/mm. A white count >10,000 indicates infection. Infection with pneumonia from mucormyosis.
Lymphocytes =10%. Are produced in the bone marrow and differentiate into B cells (responsible for production of antibodies) and T cells (play a role in immunity). Patient that is immunocompromised is at risk of mucormyosis infection.
pH =7.50 (7.35-7.45). A high level indicates alkalosis.
PaCO2= 25mm Hg (35-45). Is controlled by the lungs. A low value indicates alkalosis.
HCO3= 29meq/L (22-26). Primarily controlled by the kidneys. High levels indicate alkalosis.
PaO2 =59mm Hg on RA (80-100) a low level indicates hypoxemia. The infection causes fluid and secretions to accumulate in the alveoli where gas exchange happens.
A decreased PaCo2 and an increased pH level give you respiratory alkalosis. The HCO3 should be normal or low if he is compensating, but they are slightly elevated at 29. In the acute phase compensatory mechanisms would bring HCO3 to normal or even low therefore, the patient is now also developing metabolic alkalosis because it is passed the acute phase.
What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.
Mucormycosis is usually treated with prescription antifungal medication, usually amphotericin B, posaconazole or isavuconazole. These medications are given through a vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole). Often, mucormycosis requires surgery to cut away the infected tissue. It can quickly penetrate through blood vessels and allow the fungus to be carried to other organs. Biopsy can be done to diagnosis the tissue and sputum cultures can be collected from an infected person to determine treatment protocol (CDC, 2015).
CDC.gov (2015). Fungal diseases. Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/risk-prevention.html March 18, 2019
CDC.gov, (2015). Fungal diseases. Treatment of mucormycosis. Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html March 18, 2019