Flesh-Eating Fungus

Bacteria and viruses aren’t the only risks with hospital infections. Contracting a flesh-eating fungus is also a possibility.

About Mucormycosis

Mucormycosis is a fungal infection caused by Mucorales fungi. These infections involve the brain, lungs, mouth, sinuses, gastrointestinal tract, skin, and other organs. The most common types are cerebral and oral. One sign of mucormycosis invasion is when the vascular network is involved. This can cause “thrombosis and death” of tissue due to blood supply loss. When the infection attacks the brain, there may be symptoms of a “one-sided headache behind the eyes”, fever, acute sinusitis, facial pain, or “nasal stuffiness that progresses to black discharge”. Skin infections develop with reddening and edema, leading to it turning black from necrosis. Some patients, affected in the other organ systems, may have a difficulty breathing, vomiting, nausea, abdominal pain, and coughing up blood. Swabbing the discharge and tissues are not reliable diagnostic techniques for mucormycosis. In general, diagnosis involves performing a tissue biopsy. The prognosis for mucormycosis is poor. Complications from this infection include clotting in lung and brain vessels, blindness, and “partial loss of neurological function”. The mortality rate is extremely high.¹

Hospitals and Mucormycosis

In New Orleans, there was a recent mucormycosis outbreak at Children’s Hospital. The flesh-eating fungal infection was spread by towels, gowns, and bed linens. It took doctors over 10 months from the first fatality to connect the cases. “Deadly fungal infections (are) on the rise” due to more people having suppressed immune systems, patients with serious illnesses who live longer, and changes in the environment. If hospitals handle contaminated linens improperly, such as having contaminated medical waste near the linens, moving dirty and clean linens on the same cart, or storing linens in unclean areas, infections can spread. Children’s Hospital was also accused of failing to alert the public of the outbreak in a timely manner. Although these outbreaks are still rare, deaths cannot be prevented if they are not dealt with quickly. Moist environments help fungi to thrive, and laundry and linen facilities need to be free of mold and properly ventilated, as well.² Five children died at the New Orleans hospital during that 2008-2009 outbreak. Patients with compromised immune systems are most at risk.³

Prevention and Treatment

Amphotericin B is the first line of treatment for mucormycosis. It needs to be administered quickly, because the disease spreads rapidly and has a high mortality rate. Amphotericin B damages the fungi’s cell walls, and treatment takes about 4-6 weeks. Another treatment method, posaconazole has also proven to be effective. After the medications, surgeons need to remove the “fungus ball”. Even after treatment, there may be resurgence, so patients need to be monitored. Surgery can be invasive and “drastic”, and it may require removing disfiguring amounts of body structures. Patients can lose some brain tissue, eye structures, nasal cavity, or their palate. Multiple operations may be involved.⁴ Aside from rapid intervention when mucormycosis is suspected, prevention of fungal infections is crucial. Hospitals need to make sure that cross-contamination, even from linens, does not occur. Special care also must be taken with immune-suppressed patients.