Critical thinking
Explain what Mucor is and how a patient is likely to become infected with Mucor.
Mucormycosis is a condition that is usually caused by mucor mycetes which are typically a group of molds. The condition is rate but in its prevalence it has been associated with high mortality and morbidity rates due to little knowledge of the condition and the fact that patients rarely present with this condition. Once identified rightly, the condition is very manageable and curable. Mucor mostly affects people with a compromised immune system and it may occur in any part of the body where the spores of the fungi may penetrate into the body. The fungi of mucorales order are the primary causes of mucor. Within the body, there are the mononuclear and the polymorphonuclear phagocytes that typically lead to the destruction of the mucorales by acting as the body’s defense system against the mucormycosis (Ibrahim, Spellberg, Walsh & Kontoyiannis, 2012).
The phagocytes accomplish this by producing or generating cationic peptides defensins as well as oxidative metabolites that normally kill the mucorales. However, in the event of a compromised defense systems, such as in neutropenic patients, use of steroids, diabetic patients as well as the presence of ketacidiosis, all which impair the action of phagocytes, the spores of the mucorales tend to multiply (Mohammadi et al., 2012). This could be due to the favorable environment where they find the appropriate conditions such as the lungs, wounds, the gastrointestinal system, the brain or within any of the vital organs. The presence of spores and the appropriate conditions which include the absence of phagocytes implies that the mucorales will regenerate and these high populations tend to impair the normal working or functioning of the organs or system that has been infected (Ibrahim, Spellberg, Walsh & Kontoyiannis, 2012).
In the event that the mucorales find their way into the lungs and the phagocytes are in a dysfunctional state where they cannot actually prevent the regeneration of the spores, then these mucorales tend to continually multiply. As the numbers significantly increase in the bronchioles, then there is gradual accumulation of fluid in the sacs. Apparently, this implies that there is blockage of the air sacs and the lower respiratory system in general therefore limiting the supply of the air and oxygen into the blood system. It is this state that is referred to as pneumonia (Mohammadi et al., 2012).
Hemoglobin = 8 g/dl: The normal hemoglobin level in a healthy individual is between below normal 13.5 to 17.5 g/dL which implies that in this case the hemoglobin levels are lower than normal. Low hemoglobin levels could be an indication of an anemic condition (Mohammadi et al., 2012).
Hematocrit = 32%: The normal hematocrit levels in a healthy individual are between 36% and 45% which implies that for this patient, the levels are below normal values. This is an indication of an anemic condition as it implies low volume of red blood cells compared to the total blood volume (Muqeetadnan et al., 2012).
Erythrocyte count = 3.1 x 10/mm: This indicates the normal levels of immature red blood cells which in normal cases should be between 4.7-6.1 x 10/mm. The patient therefore has low erythrocyte count which can be translated as low production of red blood cells in the bone marrow (Muqeetadnan et al., 2012).
RBC smear showed microcytic and hypochromic cells: The presence of microcytic and hypochromic cells is an indication of iron deficiency anemia. Characteristically such cells are smaller than usual and can only carry less hemoglobin (Mohammadi et al., 2012).
Reticulocyte count = 1.5%: The normal reticulocyte count is 0.5%. a higher value than this in adults could indicate a case of anemia such as in this case where it extends to 1.5%.
Medication and treatment
In the case of this patient, the iron deficiency is the primary cause of the fungal infection. In the absence of sufficient iron in the body, the phagocytes cannot provide accomplish their defense mechanism roles appropriately either by oxidative or non-oxidative means. This implies that once the mucorales found their way into the lungs probably through inhalation, the body could not stop their multiplication thus leading to the ultimate infection of the lungs (Mohammadi et al., 2012). For patients with this type of pulmonary mucormycosis or pneumonia, the following medications can be useful;
Antibiotics: The use broad-spectrum antibiotic such as ciprofloxacin can help prevent the progression to a severe pneumonic condition. In the event of an infection of the lungs by the fun, and the accumulations of fluid in the air scabs, the bacterial find a perfect environment for their growth this progressing so fast into pneumonias (Muqeetadnan et al., 2012).
Anti-mycotic: The use of an antimycotic such as ampiclox can help compensate for the action of the dysfunctional phagocytes by inhibiting their growth of the mucorales as well as killing such foreign materials (Muqeetadnan et al., 2012).
Anti haematinics: These medications are important in facilitating the blood to recover the normal hemoglobin and red blood cells levels. It is best suited for a patient with a developing anemic condition especially that which is associated with iron deficiency (Sun & Singh, 2011).
Further, the following treatments can be utilized;
Iron supplements: The lab results indicate both a low production of the red blood cells as well as increased wearing out of the red blood cells. This implies that there is a chronic deficiency of iron that can support appropriate replacement of red blood cells or any other mechanisms such as the normal functioning of the phagocytes. Iron supplements can facilitate the recovery of the anemic condition and enable natural phagocyte functioning against such invading agents such as fungi (Muqeetadnan et al., 2012).
Surgery: It would be important to eliminate or cut off the infected tissue or the necrotic tissue which in this case is a part of the lungs. This would help assure the patient of minimal infections in future from any remaining traces especially considering that the patient is already riot deficient and the body cannot facilitate the action of phagocytes as the natural defense mechanism against the mucorales/fungi. This is actually the main stay of the entire therapy (Sun & Singh, 2011).
Hyperbaric oxygen: This includes the administration of high pressure oxygen into the lungs which has been associated with an increased stimulation of the neutrophils to kill the organisms such as fungi that are invading the lungs (Sun & Singh, 2011).
References
Ibrahim, A. S., Spellberg, B., Walsh, T. J., & Kontoyiannis, D. P. (2012). Pathogenesis of mucormycosis. Clinical Infectious Diseases, 54(suppl 1), S16-S22.
Mohammadi, A., Mehdizadeh, A., Ghasemi-Rad, M., Habibpour, H., & Esmaeli, A. (2012). Pulmonary mucormycosis in patients with diabetic ketoacidosis: a case report and review of literature. Tuberk Toraks, 60(1), 66-9.
Muqeetadnan, M., Rahman, A., Amer, S., Nusrat, S., Hassan, S., & Hashmi, S. (2012). Pulmonary mucormycosis: an emerging infection. Case reports in pulmonology, 2012.
Sun, H. Y., & Singh, N. (2011). Mucormycosis: its contemporary face and management strategies. The Lancet infectious diseases, 11(4), 301-311.
