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. Mucormycosis is rare, with an estimated 500 cases occuring in immunocompromised patients in the United States annually (McDonald, 2017). “Mucormycosis, previously called zygomycosis, refers to several different diseases caused by infection with fungi in the order Mucorales. Rhizopus species are the most common causative organisms. In descending order, the other genera with mucormycosis-causing species include Mucor, Cunninghamella, Apophysomyces, Lichtheimia (formerly Absidia), Saksenaea, Rhizomucor, and other species,” (McDonald, 2017). Pulmonary infection is the second most common presentation of mucor, and the most common presentation is rhino-orbital-cerebral involvement (Muqeetadnan, Rahman, Amer, Nusrat, Hassan, & Hashmi, 2012). Causes of infection include ketoacidosis and uncontrolled diabetes mellitus, renal failure , acquired or congenital neutropenia, immunosuppressive therapy (steroids, for example), and healthcare-associated mucormycosis (related to ostomy
bags, adhesive bandages, and wooden tongue depressors), (Muqeetadnan, Rahman, Amer, Nusrat, Hassan, & Hashmi, 2012). Nursing interventions include promptly starting ordered antifungal therapy, managing the patient’s elevated blood glucose, and addressing the patient’s respiratory alkalosis by giving O2 (thus slowing respirations); also, assess and monitor mental status and perform a neurological assessment as this infection can spread to the brain.
2. The following abnormal laboratory blood test results are minor elevation of HCO3 (alkalosis), elevated fasting blood glucose, increased WBC count, decreased lymphocytes, alkalotic pH, decreased PaO2 on room air, and decrease in PaCO2 (alkalosis). All other reported lab values are within normal range. The decrease in PaO2, PaCO2, and increase in HCO3 and pH can be attributed to the disease state of this patient’s lungs as indicated in the X-ray as this patient most likely is struggling to breathe (elevated respirations
blowing off CO2 creating alkalotic state). Elevated blood glucose indicates possible use of a steroid such as prednisone, as “steroids can cause blood sugar levels to rise by making the liver resistant to the insulin produced by the pancreas,” (Cowley, 2017); and a possible reason this patient may have been on steroid therapy includes inflammation or immunological reactions. Elevated WBC count in indicative of infection, similar to the case study used in Muqeetadnan et al and their article “Pulmonary Mucormycosis: An emerging infection.” The decrease in lymphocytes may be related to possible steroid therapy. Numerous acquired diseases, conditions, and factors can cause lymphocytopenia with examples including infectious diseases such as AIDS, autoimmune disorders such as lupus, steroid therapy, and radiation and chemotherapy for cancer treatment (National Heart, Lung, and Blood Institute, 2013).
3. Medications and medical treatments for mucor are aggressive as
prognosis is poor. “The overall mortality in those with pulmonary mucormycosis is high (76%),” and the subject in the case study died (Muqeetadnan et al, 2012). Three medical treatments include surgical debridement, pneumonectomy, and hyperbaric oxygen therapy. Muqeetadnan et al suggest surgical debridement and Spellberg, Edwards, and Ibrahim state tissue necrosis results in poor penetration of the anti-infective medications and thus surgical debridement should be performed on an urgent basis. The case study patient mentioned in Muqeetadnan et al required a pneumonectomy due to the extensive damage caused by the fungal infection. Additionally, a novel approach to treatment is the use of hyperbaric oxygen. “It is hypothesized that hyperbaric oxygen might be useful for treating mucormycosis in conjunction with standard therapy because higher oxygen pressure improves the ability of neutrophils to kill the organism. Additionally, high oxygen pressure inhibits the germination of
fungal spores and growth of mycelia in vitro,” (Spellberg, Edwards, and Ibrahim, 2005). Medications to treat mucormycosis include amphotericin, posaconazole, and caspofungin. “Amphotericin remains the only approved drug for treatment of mucormycosis. Early initiation of amphotericin therapy even empirically has a profound impact on survival. Posaconazole, an orally active newer triazole, has recently shown promising results when used as salvage therapy in mucormycosis. The usual reasons for switching from amphotericin to posaconazole are drug toxicity or failure and discharge purposes,” (Panigrahi, Manju, Kumar, & Toi, 2014). A third medication available is caspofungin. Caspofungin has low toxicity compared to amphotericin (Spellberg, Edwards, and Ibrahim, 2005). Caspofungin and amphotericin were used in combination with pneumonectomy in the case study listed by Muqeetadnan et al.
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