Rearrange individual pages or entire files in the desired order. A case of rhinocerebral mucormycosis in a 65yearold diabetic male patient typically presenting as headache, especially in parietal and frontal lobes, with nose and left eye discharge. Page 1 invasive fungal orbitorhinocerebral mucormycosis gina m. The most common form of mucormycosis in diabetes and immunosuppressive patients is rhinocerebral mucormycosis. Successful treatment of rhinocerebral mucormycosis with wide. Feb 12, 2018 mucormycosis has a fulminantly fatal clinical pattern. It is assumed that the port of entry is colonization of the nasal mucosa, allowing the fungus to spread via the paranasal sinuses into the orbit. The histopathology specimen revealed the growth of. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. We report a case of rhinocerebral mucormycosis in a 75 yearold diabetic. Epidemiology and clinical manifestations of mucormycosis. Pathology reports were collected from patients files. Rhinocerebral zygomycosis with pansinusitis in a 14yearold. Rhino cerebral mucormycosis usually begins in the nasal mucosa or palate and extends to the paranasal sinuses.
Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that may compromise the immunologic. Mucormycosis most commonly affects the sinuses or lungs. Rhinocerebral mucormycosis with intracranial involvement has a high mortality. Involvement of the brain and cavernous sinus occurs by way of the. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Full text is available as a scanned copy of the original print version. Hence we conclude that rhinocerebral orbital mucormycosis should be considered in all the patients with orbital inflammation associated with retinal or orbital infarction,regardless of their immunologic. Mucormycosis has an extremely high death rate even when aggressive surgery is done. Mucormycosis infections merck manuals consumer version. Symptoms most frequently result from invasive necrotic lesions in the nose and palate, causing pain, fever, orbital cellulitis, proptosis, and purulent nasal discharge.
Even with this therapy, the mortality rate has been 48% in the series reported since 1980. Its rhinocerebral variant is an acute invasive fungal. Symptoms compatible with mucormycosis in a predisposed patient call for prompt initiation of treatment while appropriate steps are taken towards confirmation of diagnosis12. A 76 year old woman recently diagnosed with acute myelogenous leukemia aml and admitted for induction chemotherapy day.
On the basis of clinical presentation and anatomic sites involved. Mpro full text journal articles about rhinocerebral. Invasive fungal infections ifi are an important cause of mor bidity and mortality in immunocompromised patients with hematologic malignancies hm. Mucormycosis is an opportunistic fungal infection that is caused by normally saprobic organism of the class zygomycetes. A 38yearold female presented with diabetic ketoacidosis with right eye ptosis and a frozen globe without any. The morbidity and mortality associated with this complication are further magni. Rhinoorbitalcerebral mucormycosis johns hopkins university. Invasive fungal orbitorhinocerebral mucormycosis gina m.
At the time of publication, four references were missing from the full text file. A timely diagnosis in patients with predisposing factors leading to immunosuppression is of great importance in reducing mortality and morbidity. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinoorbital mucormycosis in a patient with diabetes satvinder singh bakshi a man aged 70 years who had diabetes for 12 years presented with an ulcer that had been on his right cheek for 5 days and had prevented him from opening his right eye for the past 3 days. Mucormycosis refers to infection caused by diverse fungal organisms in the order mucorales, including those in the genera rhizopus, rhizomucor, and mucor. Case report fatal gastrointestinal mucormycosis in an. Characteristic sinus involvement was demonstrated by ct and conventional tomography, but the latter produced a better image of bone destruction. Dateraokarodpati n, gundecha v, bafna p, bhange r, gandhi r. It is common in diabetics and other immunocompromised patients but the disease is reported even in normal individuals, especially zygomycetes fungi3,4. Rhinoorbital mucormycosis in a patient with diabetes. Based on the clinical presentation and particular site of in volvement six. The survival rates among patients with invasive sinus disease without cerebral involvement may be as high as 5080%.
Mucorales are characterized by nonseptate, thickwalled hyphae. The symptoms of mucormycosis depend on where in the body the fungus is growing. A 38yearold female presented with diabetic ketoacidosis with right eye ptosis and a frozen globe without any signs of inflammation, externally. Zygomycosis is a rare lifethreatening fungal infection affecting mostly patients with predisposing conditions such as diabetes mellitus, immunodeficiency, haemochromatosis or major. Rhinoorbital mucormycosis in an immunocompetent adult vijant singh chandail, pritpal singh, annil mahajan mucormycosis is a rare life threatening opportunistic fungal infection caused by fungi of. Mucormycosis is a devastating complication that can be a life threatening fungal. Its rhinocerebral variant is an acute invasive fungal infection which normally affects immunocompromised patients with uncontrolled diabetes, organ transplant and hematological malignancies. Rhinocerebral mucormycosis in a child with autoimmune.
Get a printable copy pdf file of the complete article 1. Combined aspergillosis and mucormycosis of a single region has been reported by few authors. The main form of mucormycosis are pulmonary and rhinocerebral. Early diagnosis of rhinocerebral mucormycosis and prompt and effective treatment are very important for good outcome of the patient1,4. Symptoms of sinus infections include fever, headache, and sinus pain. Rhinocerebral mucormycosis is a devastating and lifethreatening condition of the nasal mucosa that can have a very rapid contiguous.
A case report of rhinoorbitalcerebral mucormycosis authors vijayalaxmi kanthe1 mahesh suresh jadhav2 1assistant professor, dept. The patient, a 37 yearold male, was hospitalized because. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and wellbeing around the world. It is common in diabetics and other immunocompromised patients but the disease is reported even in normal. As the traditional term of rhinocerebral mucormycosis omits the critical involvement of the. Rhinocerebral mucormycosis is a frequent complication of diabetes mellitus. Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. Death rates range from 2585% depending on the body area involved. Feb 12, 2018 rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi. However, one american oncology center revealed that mucormycosis was found in 0. Mucormycosis has a fulminantly fatal clinical pattern.
Full text pdf 674k abstracts references22 reported is a rare case of a brain abscess that occurred as a result of rhinocerebral mucormycosis. Rhinocerebral mucormycosis is a life threatening fungal infection occurring in humans, which is caused by the ubiquitous saprophytic fungi of order mucorales. Vmg medical college, maharashtra university of health sciences, solapur, maharastra, india 2junior resident, dept of internal medicine, dr vmgm college, solapur corresponding author. Mucormycosis creeping along the nerves in an immunocompetent individual. Mucormycosis is an angioinvasive fungal infection, associated with high. Mucormycosis or zygomycosis is the term for infection caused by fungi of the order mucorales. Mucormycosis is a rare, lifethreatening fungal infection that almost invariably occurs in immunocompromised patients. Economopoulou p, laskaris g, ferekidis e, kanelis n. Rhinocerebral mucormycosis with isolated sixth nerve palsy.
During the last 30 years, advances in intensive and critical care units, organ transplantation, concomitant use of immunosuppressive drugs, and increasing prevalence of chronic diseases, malnutrition, and other debilitating conditions, as well as the human immunodeficiency virus pandemic, have increased the incidence of. Nov 23, 2001 mucormycosis or zygomycosis is the term for infection caused by fungi of the order mucorales. Ct scanning in rhinocerebral mucormycosis and aspergillosis. He was from an impoverished family and came from a very remote area of puducherry.
Mucormycosis, also known as zygomycosis and phycomycosis, is a rare opportunistic fungal infection with a fulminant course and high mortality rate. A 14yearold girl with type 1 diabetes mellitus occurred with. Rhinocerebral mucormycosis treated with 32 gram liposomal. Mucormycosis is any fungal infection caused by fungi in the order mucorales. Mucormycosis is a progressively invasive disease, with a fatal outcome, on late presentation. The fungus destroys the tissue of the nasal passages, sinuses, or hard palate, producing a black or pusfilled discharge and visible. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. Distribution of lebanese an external file that holds a picture. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis sheri k. Rhinocerebral mucormycosis commonly affects individuals with diabetes and those in immunocompromised states. Michael lemole, jr, md university of arizona, banner university medical center sheri k. Rhinocerebral mucormycosis an emerging threat sciencedirect.
An aggressive multidisciplinary approach reduces mortality in. The standard therapy consists of aggressive surgical debridement accompanied by high doses of amphotericin b deoxycholate. As the traditional term of rhinocerebral mucormycosis omits the critical involvement of the eye, the more comprehensive term as rhinoorbitalcerebral mucormycosis rocm is used. Slowly progressive cutaneous, rhinofacial, and pulmonary. An abdominal ct scan documents intraperitoneal free gas. Lung infections with the fungus can cause fever and cough symptoms. Successful treatment of rhinocerebral mucormycosis with. Although most literature related to sinonasal mucormycosis pertains to adults, there are a growing number of case reports and small series reporting on the disease in. If infection spreads to the brain, the case fatality rate can exceed 80%. Mucormycosis is one of the rapidly progressing and lethal form of fungal infection.
Rhinocerebral mucormycosis definition of rhinocerebral. Salvage therapy for mucormycosis by maydelin pecchio, yariela. Mucormycosis is an uncommon fungal infection in immunocompromised patients during the past decades. A successful treatment of rhinocerebral mucormycosis due. Mucormycosis is an increasingly frequent lifethreatening infection caused by opportunistic fungal organisms of the class zygomycetes. Mucormycosis is a very rare infection, and as such, it is hard to note histories of patients and incidence of the infection. Patients with rhinocerebral mucormycosis and rhinocerebral aspergillosis had computed tomography ct as well as other studies. Dematiaceous infection 1 sinus higher mortality rate in mucormycosis patient 71% over aspergillosis 29% p0. Rhinocerebral mucormycosis is an aggressive opportunistic infection which appears in cerebral, pulmonary, ocular, superficial and disseminated forms rhinocerebral disease is the commonest form.
Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis. Mucormycosis is an opportunistic and frequently fulminating fungal infection caused by members of the family mucoraceae, order mucorales and class zygomycetes1. Links to pubmed are also available for selected references. Rhinocerebral mucormycosis is an invasive, opportunistic fungal infection usually seen in immunocompromised patients, and particularly in the setting of diabetes or immune deficiency. Rhinocerebral mucormycosis may cause pain, fever, sinus pain, and, if the eye socket is infected called orbital cellulitis, bulging of the affected eye. Rhinocerebral zygomycosis with pansinusitis in a 14year. Rhinocerebral mucormycosis is an infection of the nose, eyes, and brain. Rhinocerebral mucormycosis is the commonest form of systemic mucormycosis1,2. Survival of a rhinocerebral mucormycosis in a ketoacidosis. An aggressive multidisciplinary approach reduces mortality. Sequence base identification of respiratory mucormycosis. Mr findings in rhinocerebral mucormycosis johns hopkins. The fungus destroys the tissue of the nasal passages, sinuses, or hard palate, producing a black or pusfilled discharge and visible patches of dying tissue. Death may occur within 2 weeks if mucormycosis is not treated or is unsuccessfully treated.
When the fungi are introduced into nares of patients with serious underlying pathologic disorder, they induce a fulminant infection. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin b. Mucormycosis is an acute often fatal infection caused by fungi of family mucoracea kauffman and malani curr infect dis rep 96. Mucormycosis is an opportunistic, lifethreatening infection caused by. On the basis of clinical presentation and anatomic sites involved, mucormycosis can be classified into at least 6 categories. Pdf endoscopic sinus surgery for rhinocerebral mucormycosis. Mucormycosis is classified according to anatomical site into rhinocerebral which is the most common, central nervous system, pulmonary, cutaneous, disseminated and miscellaneous. Palejwala, md university of arizona, neurosurgery banner university medical center. She underwent transnasal endoscopic debridement of paranasal sinuses and exenteration of the right eye. Rhinocerebral mucormycosis rhinocerebral mucormycosis rocm is the most common form of mucormycosis in patients with diabetes mellitus 27, 28. A successful treatment of rhinocerebral mucormycosis due to.
Rhinocerebral mucormycosis is rapidly fatal with a mortality rate of 85%, even when maximally treated with surgical debridement, antifungal therapy, and. A 31yearold diabetic man presented to the outpatient. In rhinocerbral mucormycosis, the infected nasal mucosa may appear normal in earliest stage, then progresses. Rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi. Mucormycosis in humans is usually initiated by inhalation of spores. The pathognomonic feature is the presence of invasive aseptate. Rhino cerebral mucormycosis usually begins in the nasal mucosa or palate and extends to the paranasal sinuses, spreading via the angular, lacrimal, and ethmoid vessels as well as by direct extension from the sinuses into the retroorbital region. For other fungal topics, visit the fungal diseases homepage. Mucoraceae may produce severe disease in susceptible individuals, notably patients with. May, 2005 rhinocerebral mucormycosis is an invasive, opportunistic fungal infection usually seen in immunocompromised patients, and particularly in the setting of diabetes or immune deficiency. Mucormycosis is a rare opportunistic fungal infection, often lifethreatening.
It can invade blood vessels and cause thrombosis and necrosis. It may also occur in patients with underlying malignancies, recipients of hematopoietic stem cell or solid organ transplants, and individuals with other risk factors 39. Characteristic sinus involvement was demonstrated by ct and. Rhinocerebral mucormycosis is a fungal disease that has a 50% mortality. Higher mortality rate in mucormycosis patient 71% over aspergillosis 29% p0. Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients.
Jan 25, 2012 mucormycosis workup biopsyof involved tissue. What links here related changes upload file special pages permanent link page information wikidata item cite this page. We present our experience in 14 patients with this condition. Mucormycosis is a fairly rare fungal infection caused by ubiquitous. Mucoracea are found in soil, decaying vegetation and other organic matter. Download fulltext pdf download fulltext pdf endoscopic sinus surgery for rhinocerebral mucormycosis article pdf available in american journal of rhinology 2. Advanced age predisposes to mucormycosis,however severe. Rightsided periocular swelling history of present illness. Rhinocerebral mucormycosis with isolated sixth nerve palsy in. The earliest signs, ulceration and pain, may appear in the mouth. Mucormycosis is a polymorphic disease with diverse clinical manifestation. Dec 10, 20 zygomycosis is a rare lifethreatening fungal infection affecting mostly patients with predisposing conditions such as diabetes mellitus, immunodeficiency, haemochromatosis or major trauma. Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that may compromise the immunologic defenses of the host or alter the normal flora. Hence we conclude that rhinocerebralorbital mucormycosis should be considered in all the patients with orbital.