Mucormycosis , writing homework help

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Mucormycosis is a fungal infection that is rare and invasive. It is primarily seen in immunocompromised patients, critically ill patients and in patients who have had a major surgery or have pneumonia (Zilberberg, Shorr, Huan, Chaudhari, Menzin, 2014). Diabetic patients are also at high risk of being infected with Mucor, as this type of fungus has a “ketone reductase enzyme” that permits them to flourish in a high-glucose setting (Panigrahi, Manju, Kumar & Toi, 2014). Mucor is part of the Mucorales family and are found in nature and enter the body via respiratory or an open sore on the skin (Panigrahi et al, 2014). This fungal infection noted to have a high mortality rate, as it can cause thrombosis, tissue death and can affect the blood vessels (Panigrhi et al, 2014). It is important to have a prompt and proper diagnosis of pulmonary mucormycosis; as it is imperative that the patient receives the proper medications, as it is often diagnosed as an Aspergillus fungus and treatment for Aspergillus can actually cause mucormycosis (Panigrhi et al, 2014).

Once the fungi have entered the body and with optimal conditions, such as in immunocompromised & diabetic patients (Diabetics have increased iron levels and the fungi have an affinity to iron ) – this causes growth that leads to the fungal infection. Pneumonia is seen when the mucormycosis obstructs the bronchioles, leading to lung collapse or growth in the pulmonary blood vessels. This can cause fatal hemoptysis (Panigrhi et al, 2014).

Medical/nursing interventions for mucormycosis would be:

• To correct any glycemic control issues that the patient may have.
• Have the patient comfortable in semi or high fowlers position and to change positions every 2 hours – this assists with lung expansion.
• Deep breathing and coughing – this assists in clearing secretions, encourages air movement into the lungs and extents the expiratory phase

(Nanda Nursing, 2011).

In reviewing lab results, it is noted that the Fasting glucose high (Diabetics are at risk of mucormycosis), The WBCs are increased (indication of infection), The Lymphocytes are low (patient possibly immunocompromised – perfect for opportunistic fungi to invade). The ABG results showed respiratory alkalosis.

• PH – increased
• PO2 – decreased
• PaCO2 – decreased

Alveolar hyperventilation causes a decrease in PaCO2, which increases the PH. The body is trying to remove more carbon dioxide that than what the body produces in the tissues (Byrd, 2016).

Since mucormycosis has such high mortality rates in patients with mucor pneumonia, therapy should not be delayed, once a diagnosis has been made.

There could be the need for surgical intervention, such as debridement of any necrotic tissue, along with antifungal therapy. The recommended medications are:

• Lipid amphotericin B – primary line of therapy – IV (1mg/kg)
• Posaconazole – salvage therapy, – PO 400 mg BID
• Echinocandin (Caspofungin) – used for salvage therapy
• Isavuconazole

(Mandanas, 2016)

In addition to treating the patient with antifungals, you would want to correct any underlying issues such as:

• Obtaining strict glycemic control
• Consider neutropenia recovery – use of growth factors in patients who are undergoing chemotherapy and bone morrow transplants
• Gradually reducing immunosuppressive drugs and steroids