Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis: A retrospective analysis

Abstract

Background and Purpose:Rhino-orbito-cerebral mucormycosis (ROCM) is a rare disease with acute and fulminant manifestation. This infection is associated with high morbidity and mortality rates. Herein, we reviewed the manifestations, underlying conditions, medical treatments, and surgical interventions in ROCM patients admitted to a tertiary referral center in northern Iran over a seven-year period.Materials and Methods:In a retrospective analysis, 15 cases of ROCM were identified from 2007 to 2013 in Bu Ali Sina Hospital, Sari, Iran. All the ROCM cases were clinically diagnosed and confirmed by histopathological and/or mycological examination. The relevant demographic data, clinical, ophthalmic, and neurologic manifestations, underlying conditions, medical treatments, and surgical interventions were recorded and analyzed.Results:The mean age of the patients was 54±11 years (age range: 28–70 years); 26.7% of the patients were male and 73.3% female (male: female ratio of 1: 2.7). Uncontrolled diabetes was noted in at least 86.7% (13/15) of the cases. The maxillary sinuses were the most frequently involved sites (66.7% of the cases) followed by the ethmoid sinus. Amphotericin B in combination with surgical debridement was used in the treatment of 80% of the cases. Furthermore, 73.3% of the patients who were diagnosed early and underwent medical and extensive surgical debridement of the infected tissues survived.Conclusion:Uncontrolled diabetes mellitus is considered to be the main predisposing factor for ROCM. To prevent and reduce mortality rate of this acute disease, early diagnosis based on clinical findings and biopsy is recommended.

Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

“…Typical presentations of mucormycosis in non‐diabetics are pulmonary and disseminated types, even though some present with ROCM 2,4,6,9 . Malignancy has been the most common cause of non‐diabetic ROCM 2,7,10,16,17 . Likewise, this series showed that malignancy was the most underlying disease of non‐diabetic group followed by taking immunosuppressive medications, organ transplantation and renal failure.…”

Rhino-orbital Mucormycosis Manifesting as Orbital Apex Syndrome with CRAO in An Immunocompetent Patient

“…The most common aetiological agents include Rhizopus oryzae, Mucor, Cunninghamella, Apophysomyces and Lichtheimia species. 1 The common forms of mucormycosis are rhinoorbito-cerebral, cutaneous, pulmonary, disseminated, gastrointestinal and isolated renal. The infection has a predilection for immunosuppressed states like diabetic ketoacidosis, immunosuppressive therapy, thermal burns, DJO chronic renal failure, cirrhosis, steroid or cytotoxic therapy, hematological malignancies, malnutrition, solid organ transplantation and HIV infection.…”

“…Early diagnosis of sino-nasal mucormycosis, management of the predisposing factor and prompt therapeutic interventions are critical for arresting intracranial spread of this fatal disease. 1 A multimodality approach with intravenous antifungals, adequate sinus drainage and surgical debridement is warranted.…”

“…This lethal disease invariably affects immunocompromised patients, especially those with diabetic ketoacidosis (60%-81%). 1,2 It is seldom documented in immunocompetent individuals. 1 Rhino-orbital mucormycosis (ROM) presents as an orbital apex syndrome (OAS) characterized by proptosis, ophthalmoplegia and visual loss.…”

“…1,2 It is seldom documented in immunocompetent individuals. 1 Rhino-orbital mucormycosis (ROM) presents as an orbital apex syndrome (OAS) characterized by proptosis, ophthalmoplegia and visual loss. 2 The myriad of atypical clinical manifestations and complexity in demonstration of the causative organism poses a diagnostic challenge, which heralds a poor prognosis.…”