We report a case of rhinocerebral mucormycosis in a 75 yearold diabetic. This is seen most often associated with diabetic ketoacidosis. A 31yearold diabetic man presented to the outpatient. Aug 10, 2010 in recent years, substantial advances have been achieved in the treatment of mucormycosis. The histological and mycological details will be described more fully elsewhere. Diagnosis and management of orbital mucormycosis american.
At present, the incidence of fungal infections is increasing. A retrospective analysis of eleven cases of invasive rhino. Rhinocerebral mucormycosis treated with 32 gram liposomal. In all cases, the diagnosiswas made using fiberoptic bronchoscopy. In most cases, the prognosis of mucormycosis is poor and has varied mortality rates depending on its form and severity. Pulmonary mucormycosis commonly presents as a cough in patients with underlying malignancy or transplant bone marrow or solid organ. Introduction mucormycosis is manifested by a variety of different syndromes in humans, particularly in immunocompromised patients and those with diabetes mellitus. This paper reports a case of rhinocerebral mucormycosis which is a rare fungal infection linked to diabetes. Usually occurs during an episode of dka, with disruption of host defense mechanisms,thereby permitting growth of rhizopus oryzae. The fungi are broad, 1020m in diameter, with nonseptate hyphae that branch at right angles. Nov 23, 2001 mucormycosis or zygomycosis is the term for infection caused by fungi of the order mucorales. Every diabetic patient with sinusitis symptoms, headache, and visual. Michael lemole, jr, md university of arizona, banner university medical center sheri k. It may also occur in patients with underlying malignancies, recipients of hematopoietic stem cell or solid organ transplants, and individuals with other risk factors.
A 23yearold male presented with headache, speech disturbance and hearing difficulty. Mucormycosis clinical presentation is also related to underlying conditions. 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. A timely diagnosis in patients with predisposing factors leading to immunosuppression is of great importance in reducing mortality and morbidity. However, one american oncology center revealed that mucormycosis was found in 0. Mucormycosis is one of the rapidly progressing and lethal form of fungal infection.
Discussion this is the first record of rhinocerebral mucormycosis in great britain. This form of mucormycosis is most common in people with uncontrolled diabetes and in people who have had a kidney transplant. Clinicians should be alert of the clinical presentation of this fulminant fungal infection and notice that prompt diagnosis can be. Rhinocerebral mucormycosis rocm is the most common form of mucormycosis in patients with diabetes mellitus 27, 28. Symptoms most frequently result from invasive necrotic lesions in the nose and palate, causing pain, fever, orbital cellulitis, proptosis, and purulent nasal discharge. The ct scans revealed an isodense mass in the right side of the ethomoid, maxillar, and sphenoid sinuses and in the orbital apex. Its difficult to avoid breathing in fungal spores because the fungi that cause mucormycosis are common in the environment. Rhinocerebral mucormycosis is a life threatening fungal infection occurring in humans, which is caused by the ubiquitous saprophytic fungi of order mucorales. Nasopharyngeal and palatal destruction seen in mucormycosis aggressive inflammatory nasal conditions e. In two of these patients, the diagnosis was made byidentifying the typical hyphae of mucormycosis. Mucormycosis is one of the most rapidly fatal fungal infections.
Sarcoidwegeners granulomatosis anca positive vasculitis tcell lymphoma previously known as lethal midline granuloma bacterial. 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. In the rhinocerebral form, the mortality rate is between 30% and 70%, whereas disseminated mucormycosis presents with the highest mortality rate in an otherwise healthy patient, with a mortality rate of up to 90%. Rhinocerebral mucormycosis is a rare disease, affecting almost exclusively patients with known predisposing conditions such as diabetes mellitus, immunocompromised status, haemochromatosis or major trauma. The symptoms of mucormycosis depend on where in the body the fungus is growing. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Patients and methods the infection developed a few weeks after tooth. The rhinocerebral form of the disease, which comprises nearly one half of recently reported cases, is most often found in uncontrolled diabetics or profoundly dehydrated. Rhinocerebral mucormycosis rocm is the most common form of mucormycosis in patients with diabetes mellitus. Mucormycosis has the highest mortality among fungal infections. The roof of the mouth palate, the facial bones surrounding the eye socket or sinuses, or the divider between the nostrils septum may be destroyed by the infection. Typically an airborne infection, primary disease is initiated in the upper or lower airways and is associated with the clinical development of sinusitis, rhinocerebral mucormycosis, or. They are ubiquitous saprophytes and cause disease in debilitated, diabetic with keto acidosis or immunocompromised patients. Five patients with pulmonary mucormycosis diagnosed during life aredescribed.
Archives of clinical infectious diseases combination. Reports of combined mucormycosis and aspergillosis infections limited to the oro rhinocerebral region are very rare 3. Mucormycosis also called zygomycosis is a rare infection caused by organisms that belong to a group of fungi called mucoromycotina. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. Rhinocerebral mucormycosis jama otolaryngologyhead. Rhinocerebral mucormycosis commonly affects individuals with diabetes and those in immunocompromised states. Rhinocerebral mucormycosis with isolated sixth nerve palsy. In rhinocerbral mucormycosis, the infected nasal mucosa may appear normal in earliest stage, then progresses. Palejwala, md university of arizona, neurosurgery banner university medical center. Symptoms of rhinocerebral sinus and brain mucormycosis include onesided facial swelling.
The patient had initially been submitted to extraction of an upper third molar by a general dental practitioner but was referred to our department three days postoperatively because of double. Mucormycosis is an aggressive opportunistic fungal infection, also known as phycomycosis and zygomycosis. Rhinocerebral mucormycosis with intracranial involvement has a high mortality. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis sheri k. Initial symptoms tend to be silent, and a pattern of different colors may be seen depending on the different clinical phases. Sequence base identification of respiratory mucormycosis. Rhinoorbital mucormycosis in a patient with diabetes. Rhinocerebral phycomycosis is a shortterm and often rapidly lethal fungal disease in the nose and paranasal sinuses.
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. Frontiers diagnosis of rhinocerebral mucormycosis by. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged. Mucormycosis is a rare fungal infection that affects immunocompromised patients, and the rhinoorbitocerebral presentation is the most common clinical form of the disease, often associated with diabetes mellitusthe treatment is complex and involves amphotericin b and surgery.
Mucormycosis is a fulminant fungal infection occurring in debilitated patients with an underlying pathologic condition. The role of bal in the diagnosis of pulmonary mucormycosis. Mucorales are characterized by nonseptate, thickwalled hyphae. Rhinocerebral mucormycosis is a devastating and lifethreatening condition of the nasal mucosa that can have a very rapid contiguous. An aggressive multidisciplinary approach reduces mortality in. He was from an impoverished family and came from a very remote area of puducherry. Mucormycosis has an extremely high death rate even when aggressive surgery is done.
Rhinocerebral mucormycosis is an aggressive opportunistic infection which appears in cerebral, pulmonary, ocular, superficial and disseminated forms rhinocerebral. Even with this therapy, the mortality rate has been 48% in the series reported since 1980. Rhinocerebral mucormycosis in an hivaids patient without. Mucormycosis infections merck manuals consumer version. We report a case of sinoorbitocerebral mucormycosis in a diabetic patient successfully treated with combination of liposomal amphotericin b lamb and posaconazole. Epidemiology and clinical manifestations of mucormycosis. Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. The rhinocerebral form of the disease, which comprises nearly one half of recently reported cases, is most often found in uncontrolled diabetics or profoundly dehydrated children. Rhinocerebral mucormycosis clinically present with rhinosinusitis, pansinusitis, and rhinoorbital or rhinocerebral manifestations 3. Rhinocerebral mucormycosis may cause pain, fever, sinus pain, and, if the eye socket is infected called orbital cellulitis, bulging of the affected eye. The infection develops after inhalation of fungal sporangio spores into the paranasal sinuses. Rhinocerebral mucormycosis with dissemination to pontine. 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.
Eight patients had diabetes and 7 had symptoms related to the orbit. The treatment of mucormycosis includes aggressive surgical debridement and systemic antifungal therapy. Rhinocerebral mucormycosis is the most common form of mucormycosis. Pdf endoscopic sinus surgery for rhinocerebral mucormycosis. Jan 12, 2016 mucormycosis is a rare and severe opportunistic fungal infection resulted from a fungus of the order mucorales. Mucormycosis is a fulminant invasive infection that affects preferably immunocompromised individuals, particularly uncontrolled diabetics and recipients of solid organ transplant. Rhinocerebral mucormycosisa case report springerlink. Our experience in the management of a case of combined mucormycosis and aspergillosis of the rhinocerebral region is presented. 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. The infection is commonly acquired by inhalation of fungal spores or by inoculation by direct trauma. A case of successfully treated rhinocerebral mucormycosis. The patient had initially been submitted to extraction of an upper third molar by a general dental practitioner but was referred to our department three days postoperatively. Feb 12, 2018 rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi.
You can manage this and all other alerts in my account. Mucormycosis creeping along the nerves in an immunocompetent individual. Mucormycosis is manifested by a variety of different syndromes in humans. Rhinocerebral sinus and brain mucormycosis is an infection in the sinuses that can spread to the brain. Cerebrorhino orbital mucormycosis is the most common type of mucormycosis. The standard therapy consists of aggressive surgical debridement accompanied by high doses of amphotericin b deoxycholate. Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. Background opportunistic fungal infections are rare, lifethreatening conditions and are a major cause of morbidity and mortality in immunocompromised hosts. Rhinocerebral mucormycosis 50% of cases occur in patients with dm. Reported is a rare case of a brain abscess that occurred as a result of rhinocerebral mucormycosis. 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 a rare opportunistic fungal infection, often lifethreatening. Register your specific details and specific drugs of interest and we will match the information you provide to articles from our extensive database and email pdf copies to you promptly.
Mucormycosis refers to infection caused by diverse fungal organisms in the order mucorales, including those in the genera rhizopus, rhizomucor, and mucor. The phycomycetes, which are ordinarily saprophytic organisms, only under appropriate conditions become pathogenic. Rhinocerebral mucormycosis acquired after a short course. Rhinocerebral mucormycosis rcm is the most common form and is known to invade the skull base and its associated blood vesselsleading to mycotic aneurysms, ischemic infarcts, and intracerebral hemorrhage. Recent advances in the understanding and management of. Rhinocerebral mucormycosis acquired after a short course of prednisone therapy you will receive an email whenever this article is corrected, updated, or cited in the literature. Mpro full text journal articles about rhinocerebral. Devastating rhinoorbitalcerebral and pulmonary infections are the most common syndromes caused by these fungi.
Rhinocerebral mucormycosis rcm is a rare, fulminating opportunistic fungal infection caused by a fungus of order mucorales. Download fulltext pdf download fulltext pdf endoscopic sinus surgery for rhinocerebral mucormycosis article pdf available in american journal of rhinology 2. Mucormycosis is a very rare infection, and as such, it is hard to note histories of patients and incidence of the infection. It is now clear that early initiation of therapy results in substantially better outcomes, underscoring the need to maintain a high index of suspicion and aggressively biopsy potential lesions. Rhinocerebral mucormycosis with isolated sixth nerve palsy in. Invasive mucormycosis is an opportunistic fungal infection in patients with predisposing factors. 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.
There is some controversy over the terminology used to refer to infections due to. Rhinocerebral mucormycosis is also referred to as rhinoorbitocerebral mucormycosis in the respective literature to denote involvement of the orbital structures. The patient, a 37 yearold male, was hospitalized because of right facial pain and blurred vision. It is common in diabetics and other immunocompromised patients but the disease is reported even in normal individuals, especially zygomycetes fungi3,4. Diabetes is a wellknown risk factor for invasive mucormycosis with rhinocerebral involvement. Rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi. Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis. Rhinocerebral mucormycosis commonly occurs in patients with diabetes and presents with headache, visual changes, sinusitis, and, later, proptosis. Mucormycosis is a rapidly progressive, angioinvasive fungal infection that has a predilection for the paranasal sinuses and adjacent mucosa. Long beach medical center has been recognized as a major regional provider of medical and surgical services. Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Pdf emerging therapeutic options in fulminant invasive.
The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuse. Rhinocerebral phycomycosis jama otolaryngologyhead. Iron metabolism, hypoxia and metabolic ketoacidosis play key roles in its pathophysiology. Death rates range from 2585% depending on the body area involved. These fungi are ubiquitus, subsisting on decaying vegetation and diverse organic material. The fact that mucormycosis is a rare human infection reflects the.
Aspergillosis is the clinical syndrome caused by species of aspergillus, most often a. Case report a case report of mucormycosis and myocardial. Rhinocerebral mucormycosis most commonly presents in an acute setting mimicking symptoms of sinusitis or periorbital cellulitis. Mucormycosis is the second most frequent fungal infection following aspergillus. Rhinoorbital mucormycosis rom is a rare disease with an overall prevalence in 0. Pdf imaging findings of rhinocerebral mucormycosis. A successful treatment of rhinocerebral mucormycosis due to. Recent advances in the treatment of mucormycosis springerlink.
Long beach medical center consistently achieves national accolades for its quality care, including being named as one of the u. Roentgen analysis of focal bone destruction and uniform mucosal thickening will frequently suggest the diagnosis. Mucormycosis is an emerging infection associated with high mortality. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. This case report of a combined rhinocerebral fungal infection is of interest because it developed a few. An aggressive surgical approach combined with antifungal therapy is usually necessary. The rhinocerebral form of the disease, which comprises nearly one half of recently reported cases, is most often found in uncontrolled. Rhinocerebral mucormycosis is the most common form in patients. Table i provides a quick overview of rhinocerebral mucormycosis.
Early diagnosis and prompt initiation of treatment is essential for a successful outcome. Rhinocerebral mucormycosis is the commonest form of systemic mucormycosis1,2. Mucormycosis is an uncommon fungal infection in immunocompromised patients. In this report, we describe the successful, personalized medical and. It can invade blood vessels and cause thrombosis and necrosis. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhinoorbitalcerebral mucormycosis. Typically an airborne infection, primary disease is initiated in the upper or lower airways and is associated with the clinical development of sinusitis, rhinocerebral mucormycosis, or pulmonary infection. The rhizopus is the most commonly isolated organism causing the human disease mucormycosis. Rhinocerebral mucormycosis an emerging threat sciencedirect.
Rhinocerebral mucormycosis is an invasive, opportunistic fungal infection usually seen in immunocompromised patients, and particularly in the setting of diabetes or immune deficiency. Mucormycosis, also known as zygomycosis and phycomycosis, is a rare opportunistic fungal infection with a fulminant course and high mortality rate. For other fungal topics, visit the fungal diseases homepage. In this case report, we present the clinical findings and therapeutic outcomes of four rhinoorbital mucormycosis patients. Case reports in medicine hindawi publishing corporation. Survival of a rhinocerebral mucormycosis in a ketoacidosis. Mucormycosis symptoms, diagnosis and treatment bmj. Mucormycosis clinical infectious diseases oxford academic.
Such growth is inhibited by correction of acidosis. Mucormycosis of intestine in an immunocompetent individual ranjini kudva, annappa kudva dept of pathology, kasturba medical college, manipal, manipal university, india dept of surgery, kasturba medical college, manipal, manipal university, india abstract mucormycosis is a relatively uncommon opportunistic infection caused by fungus mucor. Increasing data support the need for surgical excision of infected andor necrosed tissue whenever feasible. A successful treatment of rhinocerebral mucormycosis due. Late diagnosis may result in dissemination, leading to high. We report an unusual case of rhinocerebral mucormycosis in an immunocompetent patient. For people who have weakened immune systems, there may be some ways to lower the chances of developing mucormycosis. Its rhinocerebral variant is an acute invasive fungal infection which normally affects immunocompromised patients with uncontrolled diabetes, organ transplant and hematological malignancies. Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. Your comments on videos will be key as we iterate content. Acidosis, hyperglycaemia, decreased ability of neutrophils to phagocytose and adhere to the endothelial walls, marked diabetic patients more prone to mucormycosis mathebula 2006. Rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic. A report of two cases venkateswarlu nallapu, hima bindu vuppalapati, sailaja sambhana, bhavya balasankulu department of oral medicine and radiology, government dental college and hospital, hyderabad, telangana, india.
The most common form of mucormycosis in diabetes and immunosuppressive patients is rhinocerebral mucormycosis. Highlights mucormycosis is a lifethreatening fungal infection common in immunocompromised patients. Rhinocerebral mucormycosis is a rare fungal infection of the nasal cavity and sinuses that can spread to the orbits and cranium within days. Studies show increasing success without or with minimal. At one time these fungi were called zygomycota, but this scientific name has recently been changed. Facial and cerebral ct scan is essential and is systematically abnormal in case of sinonasal mucormycosis. In developing countries such as india, most of the cases occur in patient,,, the infection spreads rapidly from sinus to orbit, cavernous sinus, and cranium, and if not diagnosed early and treated promptly, results in death. Although the radiological findings of rhinocerebral mucormycosis are similar to bacterial sinusitis, soft tissue invasion and bone wall erosion can be detected in some cases 5. In the mri of our case, thickening in the ethmoid and maxillary sinus and an increase in the density filling the sinuses were detected figure 3. Mucormycosis refers to the disease caused by a growing number of members of the mucorales. Mucormycosis of intestine in an immunocompetent individual. This paper presents a case of rhinocerebral mucormycosis in a 22yearold female patient with type i diabetes mellitus, who was successfully treated with surgery and longterm antifungal medication. Rhinocerebral and pulmonary mucormycosis present commonly with high mortality rates. Antibiotics, immunosuppressive drugs and hematological malignancies are common risk factors.
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