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Patel EJ, Ahmad M, Schwartz BS, van Zante A, Kersten R, Loftus P. Invasive Fungal Sinusitis in an Immunocompetent Patient After Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps and a Mycetoma. Laryngoscope 2024. [PMID: 38651570 DOI: 10.1002/lary.31463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Acute invasive fungal sinusitis (AIFS) classically presents as an aggressive fungal infection that can spread beyond its origin in the sinuses in immunocompromised patients. Although there have been reports of AIFS in immunocompetent, non-diabetic patients, it is extremely rare and the true mechanism behind it is unknown. A thirty-eight year old immunocompetent, non-diabetic woman underwent bilateral ESS for chronic rhinosinusitis with nasal polyps at a tertiary care center and post-operatively developed AIFS. Patient underwent uncomplicated ESS, was packed with foam containing triamcinolone and discharged on steroid rinses and a prednisone taper. Surgical pathology demonstrated left-sided colonization with non-invasive fungal elements consistent with a mycetoma. She presented on post-operative Day 11 with headache and left-sided retro-orbital pain. A culture of her left nasal cavity grew Rhizopus spp and MRI demonstrated evidence of invasive fungal infection of left sphenoid mucosa as well as inflammatory changes in the left orbit centered at the orbital apex. She was started on amphotericin and underwent a left-sided debridement with biopsies which demonstrated angioinvasive fungal disease. Her vision in her left eye worsened to 20/800 and she was treated with transcutaneous retrobulbar injection of amphotericin B. After stable interval imaging she was discharged on a long-term course of antifungals. Extensive immunologic work-up was unremarkable. We describe a case of an immunocompetent patient who developed AIFS after sinus surgery for CRS and a mycetoma likely as a result of local immune suppression and post-surgical trauma. Laryngoscope, 2024.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Brian S Schwartz
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Robert Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Patricia Loftus
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Ajdari A, Zolfagharypoor A, Firouzifar M, Akbarpour M. Rhinocerebral mucormycosis in immunocompetent patients: a case report and review of literature. Infection 2024; 52:673-684. [PMID: 38153685 DOI: 10.1007/s15010-023-02147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Mucormycosis of the head and neck region is a rare but aggressive fungal infection that usually involves immunocompromised patients. More infrequently, this infection can also occur in people with no otherwise known underlying immunological deficit. This rarity usually causes a delay in diagnosis and may severely decrease the chance of survival in these patients. In this study, we present an extreme case of mucormycosis in an immunocompetent patient. By conducting a thorough review of the literature, we aim to increase our knowledge on this matter. Our goal is to improve diagnosis and start treatment at an earlier stage. CASE PRESENTATION AND METHODS Our patient was a 31-year-old man who presented with bilateral face numbness, neck pain, headache, and a necrotic palatal lesion 45 days after a dental root canal procedure. There was extensive involvement of facial and skull base bony and soft tissues. Through two debridement sessions and intravenous antifungal treatment, the patient was discharged with near-complete disease resolution. We identified 48 cases in the literature that matched our study criteria. We searched the current literature for proven cases of mucormycosis in the head and neck region who didn't have any underlying disease. We extracted their data and added the data of our patient. Then, we re-analyzed them using descriptive analysis, chi-square, and binary logistic regression to better understand the different factors for survival and disease burden in these patients. RESULTS 49 patients were analyzed in this study. The mean age was 46.93 ± 15.75 (min 16 and max78 years old). The most prevalent subsite to be involved was the sino-nasal mucosa, followed by the surrounding soft tissues and the orbit. While both orbit and intracranial tissue involvement differed significantly between surviving and deceased patients, only intracranial tissue involvement could be used to predict survival. The overall survival rate was 91.8%. CONCLUSION Although very rare, mucormycosis can occur in immunocompetent patients. Physicians should consider mucormycosis when faced with refractory conditions and unusual symptoms such as exposed bones, facial numbness, headaches, and intractable pain. Complementary imaging (CT scan with or without MRI) and histopathological examination are critical for timely diagnosis or exclusion of this potentially fatal yet treatable disease.
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Affiliation(s)
- Atra Ajdari
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Zolfagharypoor
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maliheh Akbarpour
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Singh VK, Haq A, Sharma S, Kumari A. Early Reconstruction with Locoregional-Free Flaps in Post-COVID-19 Rhino-orbital-cerebral Mucormycosis Craniofacial Deformities: A Single-Center Clinical Experience from India. Surg J (N Y) 2024; 10:e1-e10. [PMID: 38528856 PMCID: PMC10789507 DOI: 10.1055/s-0043-1778652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/13/2023] [Indexed: 03/27/2024] Open
Abstract
Aim of the Study Mucormycosis is a rare invasive and fatal fungal infection and its resurgence in coronavirus disease 2019 (COVID-19) patients has been a matter of grave concern. It is essentially a medical disease, but surgical debridement of necrotic tissues is of paramount importance leading to severe craniofacial deformities. In this case series, we present our experience with the feasibility of early reconstruction after surgical debridement. Case Series As a Dedicated COVID Center (DCH), the institute received the largest population of COVID-19 mucormycosis patients from the entire eastern region of the country between May 2021 and August 2021. More than 5,000 COVID-19 were admitted out of which 218 patients were diagnosed with mucormycosis. Nine patients, seven males and two females, with a mean age of 39 years with craniofacial mucormycosis underwent debridement and early reconstructions (2-4 weeks from first debridement and start of antifungal therapy) with free and pedicled flaps. All flaps survived and showed no evidence of recurrence. The average time of the early reconstruction after surgical debridement was 1.7 weeks once the course of systemic amphotericin B was received. Conclusion After aggressive surgical resection and a short course of antifungal therapy, early reconstruction can be done safely based on clinical criteria, as long as there is no evidence of hyphae invasion on wound edges in the intraoperative pathology examination.
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Affiliation(s)
- Veena K. Singh
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ansarul Haq
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sarsij Sharma
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Anupama Kumari
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
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Kurysheva NI, Kapkova SG, Naumova VI, Smolev DM, Lishchuk SV, Nekrasova EY, Kim VE. [Late diagnosis of rhinocerebral mucormycosis in patients with COVID-19 (case studies)]. Vestn Oftalmol 2023; 139:110-121. [PMID: 38235637 DOI: 10.17116/oftalma2023139061110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
From the beginning of the COVID-19 pandemic, the incidence of secondary infections (both bacterial and fungal) has increased due to immune suppression associated with the use of corticosteroids or broad-spectrum antibiotics as a part of COVID-19 treatment protocol, which may exacerbate a pre-existing fungal disease or cause a new infection. Ophthalmologists are often involved in taking medical and surgical decisions in these complex cases. In this regard, a strong clinical suspicion should be applied to possible secondary fungal infections in COVID-19. Their early diagnosis and treatment may reduce mortality due to COVID-19 associated rhinocerebral mucormycosis (ROCM). This article describes two clinical cases of late detection of ROCM with two different scenarios, and compare the features of these cases with the literature data.
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Affiliation(s)
- N I Kurysheva
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
- Postgraduate Education Academy, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - S G Kapkova
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
- Postgraduate Education Academy, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - V I Naumova
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - D M Smolev
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - S V Lishchuk
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E Yu Nekrasova
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - V E Kim
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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Eker C, Tarkan O, Surmelioglu O, Dagkiran M, Tanrisever I, Yucel Karakaya SP, Ulas B, Onan E, Uguz AH, Ozdemir S. Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients. Eur Arch Otorhinolaryngol 2023; 280:219-226. [PMID: 35768700 PMCID: PMC9244150 DOI: 10.1007/s00405-022-07526-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19. MATERIALS AND METHODS A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared. RESULTS Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741). CONCLUSIONS With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.
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Affiliation(s)
- Caglar Eker
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Tarkan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Surmelioglu
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Muhammed Dagkiran
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ilda Tanrisever
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Sevinc Puren Yucel Karakaya
- grid.98622.370000 0001 2271 3229Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Burak Ulas
- grid.98622.370000 0001 2271 3229Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Elvan Onan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Aysun Hatice Uguz
- grid.98622.370000 0001 2271 3229Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Suleyman Ozdemir
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
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Boiko NV, Kolesnikov VN, Khanamirov AA, Lapin MA, Miroshnichenko DI, Stagnieva IV, Pisarenko EA, Anisimova AG. [COVID-19 associated sino-orbital mucormycosis]. Vestn Otorinolaringol 2023; 88:31-37. [PMID: 37184552 DOI: 10.17116/otorino20228802131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To analyze the dynamics of symptoms in patients with COVID-19 associated sino-orbital mucormycosis. MATERIAL AND METHODS We describe a series of 13 patients with COVID-19 associated sino-orbital mucormycosis aged 43 to 80 years diagnosed from August to October 2021. All of the patients had a severe disease and required noninvasive ventilation or intubation and administration of dexamethasone. 12 out of 13 patients (92.3%) suffered from diabetes mellitus. Symptoms of fungal infections of the nose and paranasal sinuses appeared in the interval from 7 to 25 days of hospital stay, most often in the second week (from 8 to 12 days). According to clinical and CT features the patients were divided into three groups, combining similar phenotypes of the disease. Group 1 - 1 patient with sinonasal mucormycosis, destruction of the alveolar ridge and the hard palate. Group 2 - 12 patients with sino-orbital mucormycosis. We noted, that in cases of bilateral sinus lesions orbital complications were unilateral in all patients, on the side of more severe lesion. Group 2 was divided into 2 subgroups: subgroup 2a included 2 patients with the superior orbital fissure syndrome: ptosis, proptosis, ophthalmoplegia, periorbital pain, pain or hypoesthesia of half face; subgroup 2b included 10 patients with the orbital apex syndrome, who, in addition to the above symptoms, had loss of vision and conjunctival chemosis. Group 3 - rhino-sino-cerebral mucormycosis. 2 patients from subgroup 2b were transferred to this group due to the intracranial spread of the process and focal neurological symptoms. CONCLUSION Clinical forms of mucormycosis reflect successive stages of invasive spread of fungi.
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Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia
| | | | - A A Khanamirov
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| | - M A Lapin
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| | | | - I V Stagnieva
- Rostov State Medical University, Rostov-on-Don, Russia
| | - E A Pisarenko
- Regional Consultative and Diagnostic Center, Rostov-on-Don, Russia
| | - A G Anisimova
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
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MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis. Eur J Radiol 2022; 152:110341. [PMID: 35569303 PMCID: PMC9074238 DOI: 10.1016/j.ejrad.2022.110341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 01/31/2023]
Abstract
In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.
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Dong N, Jordan AE, Shen X, Wu X, Guo X, Zhao H, Wang Y, Wang D, Fang Q. Rhino-Orbital Cerebral Mucormycosis in a Patient With Diabetic Ketoacidosis: A Case Report and Literature Review. Front Neurol 2022; 13:815902. [PMID: 35599740 PMCID: PMC9114505 DOI: 10.3389/fneur.2022.815902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background Rhino-orbital cerebral mucormycosis (ROCM) is a rare, invasive, and fatal fungal disease. Due to the lack of specific clinical manifestations and adequate auxiliary examinations, patients are easily misdiagnosed in the early stage. Early diagnosis and timely therapy are essential for successful treatment. Case Report We report a 68-year-old man with diabetic ketoacidosis, presented with orbital apex syndrome (OAS), fever, and pansinusitis, which progressively worsened to death only 4 days after admission. It was finally confirmed as a fungal Rhizopus arrhizus infection by metagenomics cell-free DNA next-generation sequencing (mNGS) testing. Conclusion Orbital apex syndrome could be the initial presentation for mucormycosis. Thus, it is necessary to evaluate the presence of mucormycosis in patients with OAS, especially in diabetic or immunosuppressed hosts, and mNGS testing and timely antifungal therapy should be strongly recommended in highly suspected cases.
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Affiliation(s)
- Nan Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Ashly E. Jordan
- Independent Research Epidemiologist, New York, NY, United States
| | - Xiaozhu Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuan Wu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianghong Guo
- Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yajuan Wang
- Genoxor Medical Science and Technology Inc., Shanghai, China
| | - Dapeng Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Dapeng Wang
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Qi Fang
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Kumar A, Verma M, Hakim A, Sharma S, Meena R, Bhansali S. Epidemiology of Mucormycosis Cases During the Second Wave of COVID-19 in a Tertiary Care Institute in Western Rajasthan, India. Cureus 2022; 14:e22973. [PMID: 35415040 PMCID: PMC8994050 DOI: 10.7759/cureus.22973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction: Mucormycosis is a serious but rare fungal infection that showed a sharp surge during the second wave of coronavirus disease 2019 (COVID-19) in India. This study aimed to describe the epidemiological aspects of mucormycosis cases presenting to a tertiary care centre of Western Rajasthan, India, as well as to identify potential risk factors for Mucormycosis. Methods: This cross-sectional descriptive study included 55 patients admitted with a diagnosis of mucormycosis between May and June, 2021, covering the second wave's post-COVID-19 period. Data was collected using a pre-designed, semi-structured questionnaire and hospital case sheets. Results: The mean age of the patients was 54.4±12.53 years, with a male-to-female ratio of 1.89:1. Of the patients, 49% were obese and had no prior history of diabetes. Most COVID-19 patients (54.6%) were treated at home and did not require oxygen support during their COVID-19 course. The majority (89%) were on steroid medication, which was mainly intravenous (93.8%) and lasted 5-10 days in most patients. Rhinoorbitocerebral mucormycosis was the most common type seen in this setting, with symptoms appearing 15-30 days after the onset of COVID-19 symptoms. During the fungal infection, about 61.8% of patients had random blood sugar readings of more than 140 mg/dl. Mortality occurred in 14.5% of patients with mucormycosis. Mortality was observed to be associated with high BMI, raised glycated haemoglobin (HBA1C), and urban residency. Conclusion: Mucormycosis appears to be caused by impaired glycemic control due to pre-existing or new-onset diabetes, which may be exacerbated by unintentional glucocorticoid use. It is necessary to use steroids with caution and maintain care for at least 15-30 days after the onset of COVID-19 symptoms.
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Affiliation(s)
- Arun Kumar
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
| | - Manoj Verma
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
| | - Afzal Hakim
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
| | - Savitri Sharma
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
| | - Rita Meena
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
| | - Suman Bhansali
- Community Medicine, Dr. Sampurnanand (SN) Medical College, Jodhpur, IND
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New insights on mucormycosis and its association with the COVID-19 pandemic. Future Sci OA 2022; 8:FSO772. [PMID: 35059222 PMCID: PMC8686842 DOI: 10.2144/fsoa-2021-0122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
COVID-19 continues to cause significant fatality worldwide. Glucocorticoids prove to play essential roles in COVID-19 management; however, the extensive use of steroids together with the virus immune dysregulation may increase the danger of secondary infections with mucormycosis, an angioinvasive fungal infection. Unfortunately, a definite correlation between COVID-19 and elevated mucormycosis infection cases is now clear worldwide. In this review, we discuss the historical record and epidemiology of mucormycosis as well as pathogenesis and associated host immune response, risk factors, clinical presentation, diagnosis and treatment. Special emphasis is given to its association with the current COVID-19 pandemic, including latest updates on COVID-19-associated mucormycosis cases globally, with recommendations for efficacious management. A definite correlation between COVID-19 and elevated mucormycosis infection cases is now clear worldwide. This article can be used as comprehensive tool to help clinicians and the healthcare team in getting a clearer look on the historical record and epidemiology of mucormycosis as well as pathogenesis and associated host immune response. Risk factors, clinical presentation, diagnosis, treatment options and also the latest updates on COVID-19-associated mucormycosis are also discussed, which will help in the understanding of the fatal mucormycosis infection.
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Management Challenge of Rhino-Orbito-Cerebral Mucormycosis in Covid 19 Era: A Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 2021; 74:3485-3491. [PMID: 34722223 PMCID: PMC8540873 DOI: 10.1007/s12070-021-02947-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/02/2021] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis is an uncommon but a fatal fungal infection that usually affects patients with altered immunity. The Rhizopus Oryzae is most common type and responsible for nearly 60% of mucormycosis cases in humans and also accounts for 90% of the Rhino-orbital-cerebral (ROCM) form. Our aim and objective was to study, the site of mucormycosis in nose and paranasal sinuses, adjacent site like orbit palate or intracranial involvement, co-morbid condition and management to be done in confirm mucormycosis patients. The most common sinuses involved are the ethmoid, maxillary followed by the frontal and sphenoid sinus. Diabetes mellitus is often associated with mucormycosis of the paranasal sinuses, as is corona virus infection; uncontrolled diabetes further increases the risk. Intra-orbital involvement is common, but intracranial involvement is rare. Extensive steroid and broad-spectrum antibiotic use for Covid-19 management may cause or exacerbate fungal disease. All the patients required surgical intervention along with medical treatment.
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Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, Kumar S, Bansal S, Prakash A, Avti P, Thota P, Reddy DH, Gautam BS, Medhi B. Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review. Indian J Pharmacol 2021; 53:317-327. [PMID: 34414911 PMCID: PMC8411962 DOI: 10.4103/ijp.ijp_419_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.
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Affiliation(s)
- Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Bathinda, Punjab, India
| | - Phulen Sarma
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Dibya Jyoti Sharma
- Department of Internal Medicine, Silchar Medical College and Hospital, Assam, India
| | - Karuna Kumar Das
- Department of Anaesthesia, Assam Medical College and Hospital, Assam, India
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Subodh Kumar
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Seema Bansal
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Prasad Thota
- Scientific Officer, Department of Pharmacology, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | | | | | - Bikash Medhi
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
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Risk Based Decision Algorithms for Management of COVID-19 Associated Rhino-orbital Mucormycosis. Indian J Otolaryngol Head Neck Surg 2021; 74:3447-3454. [PMID: 34367935 PMCID: PMC8324444 DOI: 10.1007/s12070-021-02692-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction COVID associated mucormycosis is a challenging problem with significant morbidity and mortality implications. COVID affliction, pre-existing medical conditions especially diabetes and steroid prescription are supposed contributors for development of this opportunistic fungal infection. Surgery remains the mainstay of treatment with adequate post-op anti-fungal therapy. Materials and methods This is a retrospective analysis of prospectively maintained database of all surgical patients between March-May 2021 at a single centre. Prognosticators such as severity of COVID affliction, use of steroids, extent of rhino-orbital mucormycosis, extent of surgery and outcomes were studied. Descriptive statistics was used to analyse frequency of different variables and chi square test was used to analyse prognostic factors. P value < 0.05 were deemed significant. Results 74 patients with an average 30 day follow-up were included. All patients had preceding COVID infection and 71.6% were diabetic and 25.7% were diagnosed during the course of their COVID treatment. Multiple sinus involvement being most common (52.61%), 10.81% underwent orbital exenteration and 24.32% palatectomies were performed. Revision surgeries were warranted in 16.21% patients. 9 patients succumbed to disease/ underlying medical and treatment related complications. Conclusion We propose a risk assessment based on general condition of patient and severity of mucormycosis infection to decide appropriate strategy for surgical intervention. Early detection and timely and adequate surgery are essential pre-requisites to good outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02692-9.
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Kumari A, Rao NP, Patnaik U, Malik V, Tevatia MS, Thakur S, Jaydevan J, Saxena P. Management outcomes of mucormycosis in COVID-19 patients: A preliminary report from a tertiary care hospital. Med J Armed Forces India 2021; 77:S289-S295. [PMID: 34334896 PMCID: PMC8313063 DOI: 10.1016/j.mjafi.2021.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) continues to be a significant health problem worldwide. The unprecedented surge of mucormycosis in patients with COVID-19 is a new emerging challenge. Although a few studies documenting high incidence of mucormycosis in COVID -19 patients have recently emerged in literature, data pertaining to treatment outcomes in such cohorts is lacking. Here, we report our experience in management of mucormycosis in COVID-19 patients at our tertiary care centre. Method The clinical, imaging, histopathological and treatment data of 20 patients with mucormycosis (in setting of COVID-19) was analysed. Results 35% and 65 % of cases developed mucormycosis in setting of active and recovered COVID-19 infections respectively. Diabetes mellitus was documented in 80% cases, with 55% demonstrating HbA1c >10%. Steroid was administered in 80% during COVID-19 illness. Imaging demonstrated paranasal sinus (PNS), orbital and intracranial extension in 100%, 55% and 20% patients respectively. All received amphotericin and underwent endoscopic debridement, 20% underwent orbital decompression and 5% maxillectomy with orbital exenteration. 6/20(30%) patients died (4 with rhino-orbito-cerebral disease, 1 with extensive orbito-maxillary involvement and 1 sino-nasal disease). All 6 patients received steroids and documented poor glycaemic control. Conclusion The strong association of hyperglycemia and steroid intake with mucormycosis in COVID-19 cases warrants judicious use of corticosteroids and optimal glycaemic control. Our study highlights that good clinical outcome can be achieved in invasive mucormycosis provided prompt treatment is instituted with aggressive surgical debridement and antifungal medication.
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Affiliation(s)
- Abha Kumari
- Classified Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | | | - Uma Patnaik
- Senior Advisor & Head (ENT), Command Hospital (Southern Command), Pune, India
| | - Virender Malik
- Classified Specialist (Imaging & Intervention Radiology), Army Institute of Cardio Thoraicic Sciences, Pune, India
| | | | - Shivali Thakur
- Graded Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | - Jijesh Jaydevan
- Resident (ENT), Command Hospital (Southern Command), Pune, India
| | - Pavitra Saxena
- Resident (ENT), Command Hospital (Southern Command), Pune, India
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Mucormycosis - An opportunistic infection in the aged immunocompromised individual: A reason for concern in COVID-19. Maturitas 2021; 154:58-61. [PMID: 34364730 PMCID: PMC8295237 DOI: 10.1016/j.maturitas.2021.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 02/08/2023]
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16
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Das S, Dhar S. Mucormycosis Following COVID-19 Infections: an Insight. Indian J Surg 2021; 84:585-586. [PMID: 34276145 PMCID: PMC8270771 DOI: 10.1007/s12262-021-03028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/03/2021] [Indexed: 10/26/2022] Open
Affiliation(s)
- Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoud, Muscat 123, Sultanate of Oman
| | - Subhra Dhar
- Wizdermpathlab, 1/503 Gariahat Road, Kolkata, 700068 West Bengal India
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17
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Abstract
Mucormycosis is a rare but aggressive fungal disease that mainly affects patients with poorly controlled diabetes mellitus and those who are severely immunocompromised, including patients with hematological malignancies and solid organ transplant recipients. Early recognition of infection is critical for treatment success, followed by prompt initiation of antifungal therapy with lipid formulation amphotericin B. Posaconazole and isavuconazole should be used for stepdown and salvage therapy. Surgical debridement is key for tissue diagnosis and treatment and should be pursued urgently whenever possible. In addition to surgery and antifungal therapy, reverting the underlying risk factor for infection is important for treatment response.
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Affiliation(s)
- Julie M Steinbrink
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Hanes House, Duke University Medical Center, 315 Trent Drive, Durham, NC 27710, USA
| | - Marisa H Miceli
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, F4005 UH-South- SPC 5226, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol 2021; 135:442-447. [PMID: 33827722 PMCID: PMC8060545 DOI: 10.1017/s0022215121000992] [Citation(s) in RCA: 198] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease. METHODS A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection. RESULTS Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment. CONCLUSION New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.
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Affiliation(s)
- S Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - M Grover
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - S Bhargava
- Department of Pathology, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - S Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - T Kataria
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
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Razem B, Dennai Y, Slimani F. Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report. Int J Surg Case Rep 2021; 82:105882. [PMID: 33865198 PMCID: PMC8079271 DOI: 10.1016/j.ijscr.2021.105882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Mucormycosis is an opportunistic fungal infection caused by molds within the order Mucorales. The rhino-orbital-cerebral localization is the most frequent. It is a destructive, necrotizing and potentially fatal disease. The treatment involves aggressive surgical debridement combined with antifungal drugs. The course is quickly fatal in the event of delayed diagnosis and / or treatment. This infection usually affects immunocompromised and diabetic patients, but cases of mucormycosis in immunocompetents are increasingly reported. Chronic mucormycosis is extremely rare and affects both immunocompromised and immunocompetent patients, its clinical evolution is nonspecific and its treatment is not standardized. We report the case of a destructive rhino-orbital and pulmonary involvement in a 59 years old immunocompetent patient who presented a right periorbital edema associated and a vision loss and a notion of nasal obstruction and progressive onset headache four months before admission. Her condition progressed with rapidly extensive necrosis. She underwent extensive surgical resection but soon succumbed to multiple organ failure. The diagnosis of mucormycosis was confirmed post mortem on the excisional piece. The purpose of this article is to draw attention to chronic mucormycosis in the immunocompetent and to emphasize the importance of early diagnosis and adequate management of this fatal infection.
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Affiliation(s)
- Bahaa Razem
- Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco.
| | - Yassine Dennai
- Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Faiçal Slimani
- Faculté de Médecine et Pharmacie, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco; Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
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20
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Sharma H, Pole S, Sabatina G, Saraf R, Joshi S, Dahipale D, Mishrikotkar P. Infection of mucormycosis inpatients in Covid-19: an experience at the tertiary medical center in Maharashtra, India. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Amanati A, Barzegar H, Pouladfar G, Sanaei Dashti A, Abtahi MB, Khademi B, Ashraf MJ, Badiee P, Hamzavi SS, Kashkooe A. Orbital mucormycosis in immunocompetent children; review of risk factors, diagnosis, and treatment approach. BMC Infect Dis 2020; 20:770. [PMID: 33076815 PMCID: PMC7574198 DOI: 10.1186/s12879-020-05460-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. CASE PRESENTATION Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. CONCLUSIONS Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamide Barzegar
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran.
| | - Gholamreza Pouladfar
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Sanaei Dashti
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Bagher Abtahi
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran
| | - Bijan Khademi
- Department and Research Center of Otolaryngology, Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Parisa Badiee
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Sedigheh Hamzavi
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran.
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22
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Roy A, Verma N, Ahuja CK. Intracranial invasive mycosis mimicking hepatic encephalopathy in a patient with cirrhosis. BMJ Case Rep 2019; 12:12/11/e231548. [PMID: 31776153 DOI: 10.1136/bcr-2019-231548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 45-year-old man with alcohol-related decompensated cirrhosis presented with jaundice, fever, headache and altered sensorium. At presentation, he had tachycardia, disorientation to time and place, asterixis, icterus and upgoing plantar response. Investigations showed anaemia, thrombocytopenia, leucocytosis, hyperbilirubinemia and elevated arterial ammonia. Despite management with antihepatic coma measures and normalisation of ammonia, broad-spectrum antibiotics, 20% albumin, the patient worsened. On day 3, the patient developed generalised tonic-clonic seizure prompting mechanical ventilation. Examination showed right proptosis, chemosis and pupillary anisocoria. MRI brain showed multifocal infarcts in the right temporal lobe, right cerebellum and brainstem with inflammation in the right orbit, infratemporal fossa with right internal carotid artery thrombosis, and suspicious maxillary sinus thickening. Nasal scrapings showed aseptate fungal hyphae and serum galactomannan index was positive. Despite receiving liposomal amphotericin-B, patient had an unfavourable outcome. Intracranial invasive mycosis can mimic hepatic encephalopathy and is associated with high mortality in cirrhotics. A high index of suspicion, positive biomarkers and diagnostic radiology may provide the key to the diagnosis.
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Affiliation(s)
- Akash Roy
- Hepatology, Post Graduate Institute of Medical Education and Research (PIGMER), Chandigarh, India
| | - Nipun Verma
- Hepatology, Post Graduate Institute of Medical Education and Research (PIGMER), Chandigarh, India
| | - Chirag Kamal Ahuja
- Neuroradiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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23
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Chermetz M, Gobbo M, Rupel K, Ottaviani G, Tirelli G, Bussani R, Luzzati R, Di Lenarda R, Biasotto M. Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma-Case Report and Review of Literature. Mycopathologia 2016; 181:723-33. [PMID: 27350324 DOI: 10.1007/s11046-016-0021-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.
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Affiliation(s)
- Maddalena Chermetz
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Margherita Gobbo
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Katia Rupel
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital, Trieste, Italy
| | - Roberto Di Lenarda
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Matteo Biasotto
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
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Rhinocerebral Mucormycosis Treated With Posaconazole. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. [Disseminated mucormycosis in immunocompetent patients: A disease that also exists]. Rev Iberoam Micol 2014; 32:63-70. [PMID: 25543322 DOI: 10.1016/j.riam.2014.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/01/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022] Open
Abstract
Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.
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Affiliation(s)
- Juan Carlos Pozo Laderas
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Córdoba, España.
| | | | - Carmen Pozo Salido
- Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España
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Mishra P, Chandran R, Pawar DK, Maitra S, Valakkada J. Internal jugular vein thrombosis from rhino-cerebral mucormycosis: Be careful before cannulation. Indian J Crit Care Med 2014; 18:546-7. [PMID: 25136200 PMCID: PMC4134635 DOI: 10.4103/0972-5229.138167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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27
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Dimaka K, Mallis A, Naxakis SS, Marangos M, Papadas TA, Stathas T, Mastronikolis NS. Chronic rhinocerebral mucormycosis: a rare case report and review of the literature. Mycoses 2014; 57:699-702. [PMID: 25039925 DOI: 10.1111/myc.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/07/2014] [Accepted: 06/12/2014] [Indexed: 12/17/2022]
Abstract
Rhinocerebral mucormycosis is an invasive infection caused by filamentous fungi of the Mucoraceae family. The rhinocerebral form of the disease represents the most common form and has two distinct clinical entities. The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality. In the present paper we report a rare case of chronic rhinocerebral mucormycosis. An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. The patient was unresponsive to ciprofloxacin treatment, developing necrotic areas of the nasal septum suspicious for rhinocerebral mucormycosis. Admission to the ENT clinic followed, with histopathologic evaluation of the vomer bone confirming the diagnosis. The patient was treated with amphotericin B and was discharged 3 weeks later on oral posaconazole therapy. Chronic rhinocerebral mucormycosis may present with atypical symptoms or coinfection with another agent. A high degree of clinical suspicion is required for correct diagnosis and prompt initiation of appropriate treatment.
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Hamdi T, Karthikeyan V, Alangaden GJ. Mucormycosis in a renal transplant recipient: case report and comprehensive review of literature. Int J Nephrol 2014; 2014:950643. [PMID: 24688793 PMCID: PMC3944654 DOI: 10.1155/2014/950643] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/27/2013] [Indexed: 12/15/2022] Open
Abstract
Mucormycosis is a rare but devastating infection. We present a case of fatal disseminated mucormycosis infection in a renal transplant patient. Uncontrolled diabetes mellitus and immunosuppression are the major predisposing factors to infection with Mucorales. Mucorales are angioinvasive and can infect any organ system. Lungs are the predominant site of infection in solid organ transplant recipients. Prompt diagnosis is challenging and influences outcome. Treatment involves a combination of surgical and medical therapies. Amphotericin B remains the cornerstone in the medical management of mucormycosis, although other agents have been used. Newer agents are promising.
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Affiliation(s)
- Tamim Hamdi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, CFP-514, Detroit, MI 48202, USA
| | - Vanji Karthikeyan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, CFP-514, Detroit, MI 48202, USA
| | - George J. Alangaden
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
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Dusart A, Duprez T, Van Snick S, Godfraind C, Sindic C. Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery? Acta Neurol Belg 2013; 113:179-84. [PMID: 23135781 DOI: 10.1007/s13760-012-0151-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022]
Abstract
Mucormycosis is a rare opportunistic fungal infection. Rhinocerebral form of the disease mainly affects diabetic or immunocompromised patients. Mucormycosis have specific tropism for blood vessels leading to mucorthrombosis and less often to mycotic aneurysms. We report on a patient initially presenting with a severe sphenoid sinusopathy, who progressively evolved to cavernous sinus syndrome, internal carotid aneurysm followed by spontaneous thrombosis, chronic meningitis and ultimately fatal hypertensive hydrocephalus. Necropsy revealed a purulent infiltrate containing thin-walled, aseptate, right-angle branching, hyphae consistent with mucormycosis. His only relevant previous medical history was a transsphenoidal surgery for pituitary macroadenoma 21 years before. We hypothesize that post-surgical mucosal changes in the sphenoid sinus have been a favoring factor for delayed and invasive mucor infection.
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González Ballester D, González-García R, Moreno García C, Ruiz-Laza L, Monje Gil F. Mucormycosis of the head and neck: report of five cases with different presentations. J Craniomaxillofac Surg 2011; 40:584-91. [PMID: 22082732 DOI: 10.1016/j.jcms.2011.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/06/2011] [Accepted: 10/10/2011] [Indexed: 12/12/2022] Open
Abstract
Mucormycosis is a lethal fungal disease with a general poor prognosis. Rhinocerebral presentation is the more frequent form. The purpose of this study was to review and show our experience in the management of 5 cases of mucormycosis of the head and neck with different clinical presentations. The high suspicion led us a prompt diagnosis and aggressive surgical treatment that allowed a good outcome in our series.
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Affiliation(s)
- David González Ballester
- Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain.
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Tan S, Aronowitz P. A common fungus, an unusual (and deadly) infection. Am J Med 2011; 124:1023-4. [PMID: 22017779 DOI: 10.1016/j.amjmed.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Susanna Tan
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA.
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A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey. Mycopathologia 2011; 172:397-405. [PMID: 21761152 DOI: 10.1007/s11046-011-9449-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 07/03/2011] [Indexed: 12/18/2022]
Abstract
Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae, Mucor circinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.
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