My brother is 43 and fighting for his life! He has been treated for blastomycosis for approximately four months. Now he has mucormycosis. He is already blind in one eye. He has been in the hospital a few days. He is not a diabetic, yet when he arrived at the hospital his blood sugar was 1,000 and all his chemistry was wild. The doctors are amazed he is still alive. We would like to know all we can about this disease. Is it contagious? Is it hereditary? The doctors have never dealt with this before.

Linda

From what you have told me, your brother is quite ill. I am surprised that he would have both blastomycosis and mucormycosis. Blastomycosis is caused by the fungus Blastomyces dermatitidis. It is an uncommon infection that occurs mostly in certain areas of North America, mainly the southeastern and south central United States, a small area in the Midwest, a small area in the Northeast and parts of Canada that border the Great Lakes. There have also been cases outside the United States in Africa, India and the Middle East. Blastomycosis is usually a slow-growing infection involving the lungs and the skin. When it involves the lung, it causes chronic cough, bloody sputum (phlegm), fever and weight loss. The skin manifestations include large nodules (bumps) and ulcers. Sometimes, blastomycosis causes an acute illness resembling flu or pneumonia. In patients with weakened immune systems due to AIDS and other diseases, blastomycosis can spread to all areas of the body, causing a rapidly fatal illness. Blastomycosis does not spread from person to person. Treatment is with the prolonged use of antifungal drugs.

Mucormycosis is a dreaded fungal infection caused by a variety of molds that live in the environment, some of which are similar to bread molds. Mucormycosis is not seen in healthy people. Patients at highest risk are those with diseases that cause severe immune compromise, such as leukemia, and in patients with complicated diabetes mellitus. Mucormycosis is also being reported increasingly in bone-marrow and solid-organ transplant patients. Your brother certainly falls into the group with complicated diabetes. Sometimes the first indication of diabetes is a serious condition called diabetic ketoacidosis (DKA), in which the body is severely deficient in insulin, setting up a complex chain of events that can result in death. Mucormycosis can develop in a person's first episode of DKA.

Mucormycosis takes hold in several ways, but the most common form is called "rhino-cerebral," which means "nose-brain." The mold invades the facial sinuses, spreading quickly into the sinus bones and then the brain. It can progress quite rapidly. The mold (and the body's reaction to it) kills all the tissues it invades. The treatment involves surgery to remove all of the dead tissue and as much of the fungus as possible. In addition, doctors give the patient high doses of antifungal medication. Unfortunately, the death rate is still close to 50 percent, and patients are left with deformity from the surgery. The key to survival is early, adequate surgery.

Since the molds that cause mucormycosis are everywhere in the environment already, there is no threat of person-to-person spread. Only the smallest minority of people are at risk of this infection.