INTRODUCTION:
Mucormycosis is a fungal disease. Mucormycosis is also known as black fungus or zygomycosis.it generally causes due to the filamentous molds.it may be found in the dirt bread, dust. The human immune system has the ability to inhibit the large number of pathogens infection. But, sometime overuse of corticosteroids and immunosppresive drug, it lead to enhancing the fungal infection 1. After infection, they produce lesion of black color due to which Mucormycosis are also known as black fungus. From last two decennary revealed that, Mucormycosis lead to higher mortality rates 2-3. It can be defined as an insidious fungal infection caused by members of Mucorales and zygomycotic species 4. The innate immunity prevent the infection of the Mucormycosis by the phagocytic ells and neutrophils destroy the spores, prevent germination .in the diabetic patient the Mucormycosis is not controlled. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or other type of skin injury 5
History:
The American pathologist R.D. Baker coined the term mucormycosis. The Arnold paltauf coined the term mycosis mucorina in 1885; the 1st case of rhinoorbital is occurring in the diabetic patient 5. The mucormycosis in India was 0.14 cases per 1000 population, with 38.2% deaths per year during the pre-COVID-19 period
Etiology:
The fungi that cause the mucormycosis present in the Environment. Mostly found in the soil such as decaying organic matters, animal dung, manures. As compared to air, most fungi are found in soil in the summer season9 6. Mostly people are come in contact with the microscopic fungal so it’s impossible to avoided mucormycosis completely 7. Some people who have weakened Immune those people get easily affected by mucormycosis. If anyone inhale the mycormycete spores or through injured skin or burn The mycormycete spores get easily entered into the body and may lead to the infection to the mucormycosis 8-9. There is no any type of vaccine to avoid the mycormycete infection.
Symptoms: 1) Symptoms for Rhinocerebral (sinus and brain): - Headache, Fever, pigmented lenisions on the inside the mouth due to extra secretion of melanin, Facial swellings 10
2). pulmonary mucormycosis: Fever, cough, chest pain, shortness breath 11
3) Cutaneous mucormycosis:
Skin red around the lesion, skin gets blackish or brownish in color, irritation 12
4) Gastrointestinal mucormycosis:
Abdominal pain, nausea, vomiting, GI bleeding13
SPECIES:
Medicinally important species according updated taxonomy
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|
Current Species Name |
Previous Names |
1. |
Lichtheimia corymbifera |
Absidia corymbifera Mycocladus ramosus |
2. |
Mycor janssenil |
Mucor cirinelloide janssenii |
3. |
Lichteimia ramosa |
Absidia ramose Mycocladus ramosus |
4. |
Lichteimia ornata |
Absidia ornata |
Types of Mucormycosis:
1) Rhinocerebral (sinus and brain) Mucormycosis:
The Mucormycosis is an infection in the sinuses that can spread to the brain. This is rare case of infection but it is life threatening. This type of infection occur in immunosuppressive patient and the hematopoietic stem cell transplant 14-15
2) Pulmonary (lung) Mucormycosis: this type of Mucormycosis occur in patient who are suffering from cancer and in people who have had an organ transplant or a stem cell transplant.16
3) Gastrointestinal Mucormycosis: this occurs in gastrointestinal tract. Is more common in young children as compare to adults. Premature and low-birth-weight infants less than 1 month of age are at risk if they have had given an immunosuppressant drugs.17-18 The most commonly used antibiotic is amphotericin B the most common symptoms are abdominal pain. Nausea, and fever, may occur.
4) Cutaneous (skin) Mucormycosis: it is the 3rd most common type of infection after pulmonary and rhinocerebral. The infection occur in the body when the fungi enter in the body through the cut skin. The cutaneous infection may also occur to the insulin injection or catheter insertion sites. 19
5) Disseminated Mucormycosis:
when the infection is spread from blood stream to the other part of the body like spleen, brain, skin, heart etc. 20
Medication used in treatment of mucormycosis:
1) Ayurvedic drugs used:21,22
1) Pratimarsha nasaya: The oil of nasaya is used to maintain the health of the nasal passage and prevent the entry of microbes into the respiratory tract. Nasaya is a potent drug with antimicrobial activity.
2) Dhoopana karma: The dhoopana karma is used in the treatment of fungal infection and it also inhibits the growth of microbes. The dhoopana karma is in powder form; it is stored in an airtight container for up to 2 years, and it retains its original color and fragrance.
3) Rasayana drugs: The Rasayana drugs boost the immune system and prevent the microbial infection. The Rasayana is used as an immunomodulator, and the chyavanprasha avleha, agastya haritaki Rasayana, is used as a respiratory immunomodulator.
4) Antifungal herbal drugs: The herbal drugs used in the treatment of mucormycosis are rakta shodhaka, raktaprasadaka drugs and pranvaha srotus/ urdhajatrajata roga. Other medicinal plants like allium sativum, Glycyrrhiza glabra, curcuma longa, Mentha piperita, aloe Vera also used as antifungal agents
2) ALLOPATHEIC DRUGS USED:
1] POLYENE:
The polyenes are structurally related to cyclic lactone with rings of 25 to 38 carbon atom present.
EX. 1) Amphotericine -B: In the amphotericin the Polyenes ring is present .in the mucormycosis treatment most preferable drug is Amphotericin B. The Potency of Amphotericin B has been shown in the both laboratory as well as clinical studies23. As compare to the conventional Amphotericin B, a lipid formulation of amphotericin B is effective and has better therapeutic index. 23
2] AZOLESL 24
Azoles are the class of 5 membered heterocyclic compound containing nitrogen atom and heteroatom like (o, s)
Ex Triazoles: The triazoles inhibit the ergosterol synthesis in the fungal cell membrane by inhibiting the 14 alpha-demethylase.
Example: # posaconazole: Posaconazole is a species dependent and has invitro activity against mucorales .the posaconazole administered by oral route in the form of oral suspension. The posaconazole with salvage therapy successes rate was 70 %25
# Isavuconazole isavuconazole is broad spectrum triazoles.25Isavuconazonium sulfate is a prodrug of isavuconazole which is a biologically active agent. Isavuconazole is administered in intravenous or oral route (26, 27, and 28)
Diagnosis of mucormycosis:
1] Imaging: By the CT scan of lungs and sinuses, it show the sign of nodules, cavities halo signs, lungs get constrict etc. it suggest signs of fungal infection but do not confirms it is a mucormycosis, currently for investigation of rhinoorbital cerebral mucormycosis, MRI with gadolinium contrast are used.29
2] Biopsy: To confirm the diagnosis of mucormycosis biopsy will be done. Sample is collected from the infected person and get cultured. When organism get fragile cultured sample does not show any result. The cultured can be observed under the microscopy. The microscopy can determine the genus and species but for their identification expert mycologist is required.30
CONCLUSION:
The mucormycosis is a rare fungal infection. The ayurvedic drugs are used a primary treatment for the fungal infection with yoga, diet, exercise. the existing drugs are not helpful for managing this infection, hence the novel drug delivery system is important to developed to improve the therapeutic effect and to improve the effectiveness of drug. If we give the Ayurvedic treatment then patient alive more than 1year to date by this information, Ayurveda have much scope for mucormycosis Also maintain hygiene is the primary prevention in mucormycosis to maintain the oral hygiene personal hygiene It is rare infection which leads to increase in the mortality rate.
-So this Ayurveda and Amp B have much more scope for the control on mucormycosis. This infection mostly occurs in those patients who suffering from Diabetes patient, leukemia, stem cell transplant and cancer type of disease If the patient immune system weakness or administered immunosuppressive drug such patient mostly suffering from mucormycosis. Hence we conclude that Amphotericin Isavuconazole, posaconazole those type of allopathic drug is used in mucormycosis
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Received on 27.08.2024 Revised on 10.10.2024 Accepted on 17.11.2024 Published on 14.12.2024 Available online on December 05, 2024 Research J. Science and Tech. 2024; 16(4):317-320. DOI: 10.52711/2349-2988.2024.00046 ©A and V Publications All right reserved
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