Mucormicosis

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Artículo de revisión
Rev Asoc Colomb Dermatol. 2017; 25 : 4 (octubre - diciembre), 284-293

Mucormicosis

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Autor(es): 
Nathalie Quiroz
nathaliequiroz@hotmail.com
Médica dermatóloga, Universidad del Valle, Cali, Colombia
Janeth del Pilar Villanueva
Médica dermatóloga y micóloga; profesora asistente, Sección de Dermatología y Cirugía Dermatológica, Departamento de Medicina Interna, Facultad de Salud, Universidad del Valle. Cali, Colombia
Edgar Andrés Lozano
Médico dermatólogo, Universidad del Valle, Cali, Colombia
Resumen: 

La mucormicosis es una micosis oportunista y poco frecuente, producida por hongos Zygomicetos del orden Mucorales, asociada con inmunosupresión y de curso agresivo y mortal. Puede dividirse en varios tipos, según el lugar de infección, en rinocerebral (por extensión desde la rinofaringe o por diseminación hematógena), cutánea (más habitualmente en pacientes con diabetes mellitus descompensada, leucemia o cáncer) y pulmonar, entre otras. 
Generalmente, se adquiere por vía respiratoria ya que las esporas de los hongos se encuentran en el ambiente, aunque en las formas cutáneas primarias, la infección se adquiere por solución de continuidad. 
El diagnóstico se confirma con un estudio completo de hongos (examen directo y cultivo para hongos en agar Sabouraud). El estudio anatomo-patológico, aunque permite visualizar perfectamente a los agentes fúngicos, por su demora, no es el método diagnóstico de elección. Una vez hecho el diagnóstico, se debe iniciar un tratamiento temprano, oportuno y adecuado, identificar los factores predisponentes y corregirlos de manera oportuna, ya que esta entidad tiene una alta tasa de mortalidad. 
Se utiliza la anfotericina B como tratamiento de elección que se mantiene hasta estabilizar al paciente y, en las variedades rinocerebrales o pulmonares, se requiere la eliminación quirúrgica del material necrótico. Algunos autores recomiendan el uso de azoles para estas infecciones, sin embargo, el consenso general es que el mejor tratamiento sigue siendo la anfotericina B y los otros antifúngicos están reservados para casos especiales.
 

Palabras clave: 
mucormicosis, mucorales, inmunosupresión

Summary: 

Mucormycosis is an opportunistic mycosis, uncommonly produced by Zygomycetes fungi of the orderMucorales, associated with immunosuppression, of an aggressive and fatal course. It can be divided into several types, depending on the site of infection, such as rhinocerebral (by extension from the rhinopharynx or by hematogenous dissemination), cutaneous (more commonly in patients with decompensated diabetes mellitus, leukemia or cancer) and pulmonary, among others. 
It is generally acquired by the respiratory route since the spores of fungi are found in the environment, although in the primary cutaneous forms, infection is acquired by solution of continuity. 
The diagnosis is confirmed by a complete mycological study (direct examination and culture for fungi in Sabouraud agar). The anatomo-pathological study, although it allows visualizing perfectly the mycotic agents, due to its delay is not the method of choice. Once the diagnosis has been made, an early, adequate and appropriate management should be initiated, the predisposing factors identified and corrected promptly, since this entity has a high mortality rate. 
Amphotericin B is used as the treatment of choice, which is maintained until the patient is stabilized, and surgical removal of the necrotic material is required in the rhinocerebral or pulmonary varieties. Some authors recommend the use of azoles for these infections, however, in general consensus is that the best treatment is still amphotericin B and the other antifungal drugs are reserved for special cases.
 
 

Key words: 
Mucormycosis, mucorales, immunosuppression
PDF del articulo
Tabla 1. Historia de la mucormicosis
Tabla 1. Historia de la mucormicosis
Figura 1. Taxonomía de los mucorales
Figura 1. Taxonomía de los mucorales
Figura 2. Examen directo con hidróxido de potasio (KOH) en el que se visualizan filamentos hialinos de bordes irregulares, largos y anchos, y con escasos tabiques.
Figura 2. Examen directo con hidróxido de potasi...
Figura 3. Examen directo del cultivo con azul de lactofenol en el que se observan filamentos muy gruesos, sin tabiques (cenocíticos), con estructuras asexuadas de reproducción (esporangióforo, esporangio y esporangiosporas).
Figura 3. Examen directo del cultivo con azul de...
Tabla 2. Diagnóstico diferencial
Tabla 2. Diagnóstico diferencial
Figura 4. Tratamiento de la mucormicosis
Figura 4. Tratamiento de la mucormicosis

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