risk factor for mucormycosis

 Q; Pick one of the following as risk factor(s) for mucormycosis? 

 A) Iron overload 

 B) Deferoxamine 

 C) Iron and deferoxamine 

 D) Aluminum overload 

 E) Deferasirox 

 Answer: C 

 It is interesting that iron alone as well as in combination with its chelating agent Deferoxamine increases the risk for mucormycosis. Diabetic patients are extremely prone to develop mucormycosis. Clinically, it becomes significant to know as in diabetic ketoacidosis, free serum iron level goes up. One of the species for mucormycosis is Rhizopus. Increase iron uptake leads to its increased uptake by the fungus, it's growth, and tissue invasion. 

Traditionally deferoxamine is used as iron's chelating agent. The deferoxamine-iron chelate, known as feroxamine, is a siderophore for the species Rhizopus. This also enhances the iron uptake by the Rhizopus. 

Other iron-chelating agents, deferasirox and deferiprone, have not shown any such risks so far.   

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References:

1. Boelaert JR, de Locht M, Van Cutsem J, et al. Mucormycosis during deferoxamine therapy is a siderophore-mediated infection. In vitro and in vivo animal studies. J Clin Invest 1993; 91:1979. 

2. Maertens J, Demuynck H, Verbeken EK, et al. Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis. Bone Marrow Transplant 1999; 24:307. 

3. Artis WM, Fountain JA, Delcher HK, Jones HE. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: transferrin and iron availability. Diabetes 1982; 31:1109.