Describe the pathophysiologic progression of the infection into pneumonia

Pathophysiologic progression of the infection into pneumonia

Explain what is Mucor

There is a general class of fungi that is called Zygomycetes or better known as Mucormycosis.

This type of fungi is rare and grows in dirt , and decomposing leaves or compost.  This type of fungi is easily identified due to their unique “morphological” appearance (Medicine Net, 2015a). According to the Centers of Disease Control and Prevention, Mucormycosis is a very serious condition that affects those individuals that have a very weak immune system (Centers of Disease and Control and Prevention, 2014c).

How is a patient likely to become infected with Mucor?

According to the Centers of Disease Control and Prevention there are two specific types of

infection that can be caused by Mucor. The route of exposure can be through the Lungs or

sinus when spores are inhaled from the environment. The spores can cause infection to

the lungs, sinuses, eyes, and face and there are also rare times where the infection can attack

the central nervous system. Infection can also occur through the skin. The organism enters a person’s body if the integrity of the skin was compromised by a cut, scrape, wound puncture, or other skin trauma (Centers of Disease Control and Prevention, 2014b).

Describe the pathophysiologic progression of the infection into pneumonia.

The progression of mucormycosis infection into pneumonia is associated with a high mortality

and morbidity rate. The CDC claims that pulmonary mucormycosis happens to people that

suffer from cancers of the blood, steroid use, or abnormally low or few neutrophils in the

blood, which leads to a high susceptibility to infection (Centers of Disease Control and

Prevention, 2014a). These patients suffer from fever, cough, shortness of breath, and chest

pain. As the disease progresses there will be Angioinvasion that will lead to death of the tissue

that will end up in empty spaces and coughing of blood (Centers of Disease Control and

Prevention, 2014a).

Use two medical/nursing interventions that would be helpful in treating the patient.

Intervention: Keep patient isolated (Doenges, 2016).

Rationale: Provides safety to patient by not introducing other pathogens to a very vulnerable

immune system (Doenges, 2016).

Intervention: Rotate patients position every 2 hrs (Doenges, 2016).

Rationale: Helps facilitate secretion movement and drainage and decreases atelectasis (Doenges, 2016).

 What laboratory values are considered abnormal?

The following information is based on the patient’s labs:

 

Na – normal,

K – Normal

Cl – normal, HCO3 – > 25 which is alkalosis

BUN – normal

Cr – normal

Ca – normal but on the low side

Mg – normal but on the low side

PO4 – Normal but on the low side

Glucose fasting – is above (if glucose fasting is > 125 in two separate tests the patient, then the diagnosis

of diabetes is made)

Hb – depends if it’s male, female, newborn, or infant, but if the subject is male or female adult the range

is normal on the low side

Hct – normal but on the low side

WBC – is elevated indicating infection

Lymphocytes – are low and it can indicate steroid use, infections, blood cancers, infectious diseases.

Having a low count of lymphocytes compromises the body from fighting infection (MD Health, 2014).

pH – is high and indicates alkalosis

PaO2 – is extremely low

PaCO2 – is also extremely low. Based on the acid-base imbalances the patient is having respiratory

alkalosis (hyperventilation, may be related to: initial stage of pulmonary embolus).

Discuss the probable causes from a pathophysiologic perspective.

Based on the labs, ABG’s, x-ray, and the source of infection, the patient is suffering from

pulmonary mucormysis. According to Hindawi Publishing Corporation, this type of infection has

the tendency to invade the nearby organs, such as the pericardium, chest wall, and

mediastinum. The invasion of the large mediastinal vessels will lead to hemoptysis and lead to

mortality (Hindawi Publishing Corporation, 2012). This disease is very hard to diagnose due to

the rarity of the disease. Chest x-rays sometimes show “pulmonary mucormycosis may present

with focal consolidation, lung masses, pleural effusions, or multiple nodules. A tissue biopsy is recommended for diagnosis. The histopathological findings reveal irregular broad no septate hyphae and spores” (Hindawi Publishing Corporation, 2012).

What medications are used to treat mucormycosis

Based on the Centers of Disease Control and Prevention the following antifungal medications

should be used to treat pulmonary mucormycosis (Centers for Disease Control and Prevention,

2015b).

Amphotericin B – this medication is used to treat serious fungal infections. The medication

works by destroying the fungus and not allowing the reproduction of the fungus (drugs.com,

2016). Posaconazole and isavuconazole are also medications that the CDC recommends to

attack this problem.

According to Hindawai Publishing Corporation, “Effective management requires a 3-pronged

combination of medical and surgical modalities along with correction of the predisposing

underlying condition(s). Amphotericin B or its newer lipid formulation—liposomal

Amphotericin—B (L-AmB) along with extensive surgical debridement to remove the necrotic

Tissue.  Thus it is important that clinicians maintain a high degree of suspicion for pulmonary mucormycosis in case of immunocompromised patients with no resolving pneumonia. Early diagnosis and aggressive treatment might reduce the mortality associated with this devastating fungal infection” (Hindawi Publishing Corporation, 2012). Patients with diabetes must have their glucose supervised closely.  Patients might also undergo surgical procedures to remove

the fungi from the body, extended antifungal medications, and consultation with the physicians

that specialize in infectious diseases (Medicine Net, 2015b)

References

Centers of Disease Control and Prevention. (2014a). Clinical features of mucormycosis.

Retrieved fromhttp://www.cdc.gov/fungal/diseases/mucormycosis/symptoms/clinicalfeatures.

html

Centers of Disease Control and Prevention. (2015a). Mucormycosis. Retrieved from

http://www.cdc.gov/fungal/diseases/mucormycosis/index.html

Centers of Disease Control and Prevention. (2014b). Sources of mycormycosis. Retrieved from

http://www.cdc.gov/fungal/diseases/mucormycosis/causes.html

Centers of Disease Control and Prevention. (2014c). Symptoms of mucormycosis. Retrieved

from http://www.cdc.gov/fungal/diseases/mucormycosis/symptoms/

Centers of Disease Control and Prevention. (2015b). Treatment for mucormycosis. Retrieved

from http://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html

Doenges, Marilynn E., et al. Nurses pocket guide: diagnoses, prioritized interventions, and rationales. Philadelphia, F.A. Davis Company, 2016.

Drugs.com. (2016). Amphotericin b. Retrieved from

http://www.drugs.com/cdi/amphotericin