A Case of Rhinoorbital Mucormycosis in a Leukemic Patient with a Literature Review from Turkey

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.

A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis—has anything changed in the past 20 years?

“…In total, 210 case reports were identified from the literature search and reviewed, of which 175 contained sufficient clinical data to be analysed. These were derived from a total of 140 papers (some papers contained multiple case reports) . Larger case series were usually excluded due to a lack of chronological data (refer to Figure for PRISMA flow diagram).…”

Bacteriome and mycobiome associations in oral tongue cancer

“…The fact that tumor samples exhibited decrease in abundance of Emericella could suggest that the corresponding increase in Campylobacter , Fusobacterium and Porphyromonas may be happening concomitantly as the levels of Lichtheimia (the fungus Mucor ) are increasing. Lichtheimia is associated with infections in immunocompromised (including cancer) patients [ 30 - 33 ], while the bacterial genera Fusobacterium and Porphyromonas (known periodontal pathogens) and Campylobacter (common in GI infections) are major constituents of the “mobile microbiome” originating in the oral cavity but also associated with extra-oral infections and inflammation [ 34 ]. The correlations observed in the current study with oral tongue cancer patients may indicate that microbial dysbiosis reflects changes in the immune status due to the underlying disease.…”

Update on invasive fungal infections in the Middle Eastern and North African region

“…Another 10-year assessment indicated the prevalence of the rhino-cerebral form (95%) among the total diagnosed mucormycoses [118]. In addition, a case of rhino-orbital mucormycosis caused by Rhizopus oryzae was reported in an acute lymphoblastic leukemia patient [119]. Among children with hematological malignancies, mucoromycetes were responsible for 11.5% of IFIs and accounted for 53.3% mortality [120].…”