Combination Polyene‐Caspofungin Treatment of Rhino‐Orbital‐Cerebral Mucormycosis

Abstract

Background It has been axiomatic that echinocandins (e.g., caspofungin) are ineffective against mucormycosis. However, on the basis of preclinical data, we recently began treating rhino-orbital-cerebral mucormycosis (ROCM) with combination polyene-caspofungin therapy. Methods To determine the impact of polyene-caspofungin therapy, ROCM cases identified by an International Classification of Diseases, Ninth Revision search were retrospectively reviewed to gather data on demographic characteristics, clinical history, and outcomes. The predefined primary end point was success (i.e., the patients was alive and not in hospice care) at 30 days after hospital discharge. Results Forty-one patients with biopsy-proven ROCM were identified over 12 years; 23 (56%) of these patients were Hispanic, and 34 (83%) were diabetic. Patients treated with polyene-caspofungin therapy (6 evaluable patients) had superior success (100% vs. 45%; P = .02) and Kaplan-Meier survival time (P = .02), compared with patients treated with polyene monotherapy. Patients treated with amphotericin B lipid complex had inferior success (37% vs. 72%; P = .03) and a higher clinical failure rate (45% vs. 21%; P = .04), compared with patients who received other polyenes. However, patients treated with amphotericin B lipid complex plus caspofungin had superior success (100% vs. 20%; P = .009) and survival time (P = .01), compared with patients who received amphotericin B lipid complex alone. The benefit of combination therapy, compared with monotherapy, was most pronounced in patients with cerebral involvement (success rate, 100% vs. 25%; P = .01). In multivariate analysis, only receipt of combination therapy was significantly associated with improved outcomes (odds ratio, 10.9; 95% confidence interval, 1.3–∞; P = .02). Conclusions Combination polyene-caspofungin therapy represents a promising potential alternative to polyene monotherapy for patients with ROCM. Randomized, prospective investigation of these findings is warranted.

Rhinocerebral Mucormycosis in a Patient with Diabetes Type 1 Presenting as Ptosis and Facial Palsy Report from Alborz Hospital of Karaj from Iran

“…Liposomal AMB is preferred to AMB and also to amphotericin B lipid complex (ABLC). In some animal studies, results from treatment of (ROCM) by (LAMB), (AMB) were significantly better than that with (ABLC) [14]. In these recent days there is emphasizes on combination of antifungal therapy instead of single therapy [15].…”

A fatal case of gastrointestinal mucormycosis in immunosuppressed host

“…Additionally, limited data exists on combination AmB-echinocandins in rhinocerebral mucor. 8 Whether this combination offers mortality benefit in other organ involvement remains unknown and has to be addressed in additional randomized control studies. In conclusion early diagnosis, surgical debridement when possible along with prompt initiation of AmB seems to improve survival in Fig.…”

Mucormycoses rhino-orbito-cérébrales

“…Après inhalation des spores, l'infection débute au niveau des cavités Alors que le traitement chirurgical des mucormycoses rhino-orbito-cérébrales est rapporté par de nombreux auteurs [1][2][3][4][5][6][7][8][9][10], l'extension de la résection chirurgicale reste débattue. Certains auteurs prônent la simple résection des tissus nécrotiques alors que d'autres sont favorables à l'obtention d'un contrôle local de la mala-ptérygo-palatine comme un témoin de la progression de l'infection.…”

“…Ces techniques de chirurgie endonasale par voie endoscopique permettent : (1) un bilan lésionnel complet ; (2) un diagnostic précoce [7] ; (3) une évaluation précise de l'étendue de l'infection avec prélèvements locaux ; et (4) la possibilité de répéter les interventions chirurgicales pour le contrôle de la maladie. Plusieurs études rapportent l'intérêt des examens anatomopathologiques extemporanés pour guider l'étendue de la résection chirurgicale [8,14,15]. La coloration par Calcofluor a notamment été utilisée pour analyser des marges de résection en améliorant la détection de tissus atteints par l'infection [16].…”