Frozen Section-guided Surgical Debridement for Management of Rhino-orbital Mucormycosis

Langford, John D.; McCartney, Daryl; Wang, Robert C.

doi:10.1016/s0002-9394(14)70804-9

Cited by 49 publications

(24 citation statements)

References 4 publications

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“…Moreover, surgery was found to be an independent variable predicting a favorable outcome in patients with mucormycosis (Roden et al 2005). Retrospective data support the use of intraoperative frozen sections to delineate the margins of infected tissues, with sparing of tissues lacking evidence of infection (Langford et al 1997). …”

Section: Treatment Of Mucormycosismentioning

confidence: 86%

Human Fungal Pathogens of Mucorales and Entomophthorales

Mendoza

Vilela

Voelz

et al. 2014

Cold Spring Harbor Perspectives in Medicine

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In recent years, we have seen an increase in the number of immunocompromised cohorts as a result of infections and/or medical conditions, which has resulted in an increased incidence of fungal infections. Although rare, the incidence of infections caused by fungi belonging to basal fungal lineages is also continuously increasing. Basal fungal lineages diverged at an early point during the evolution of the fungal lineage, in which, in a simplified four-phylum fungal kingdom, Zygomycota and Chytridiomycota belong to the basal fungi, distinguishing them from Ascomycota and Basidiomycota. Currently there are no known human infections caused by fungi in Chytridiomycota; only Zygomycotan fungi are known to infect humans. Hence, infections caused by zygomycetes have been called zygomycosis, and the term "zygomycosis" is often used as a synonym for "mucormycosis." In the four-phylum fungal kingdom system, Zygomycota is classified mainly based on morphology, including the ability to form coenocytic (aseptated) hyphae and zygospores (sexual spores). In the Zygomycota, there are 10 known orders, two of which, the Mucorales and Entomophthorales, contain species that can infect humans, and the infection has historically been known as zygomyEditors:

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Section: Treatment Of Mucormycosismentioning

confidence: 86%

Human Fungal Pathogens of Mucorales and Entomophthorales

Mendoza

Vilela

Voelz

et al. 2014

Cold Spring Harbor Perspectives in Medicine

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“…Serial radiological imaging identifies the extent of disease and the response to treatment. A frozen-section-guided surgical debridement technique for biopsy-proven rhinocerebral zygomycosis has recently been described (206) (Table 13), although it may not be possible to use this technique when there are extensive lesions extending to the dura. Reoperation to debride areas of progressive disease should be planned if the morbidity of the often mutilating surgery does not outweigh its potential benefits (35).…”

Section: Clinical Features Predisposing Factors and Management Of Smentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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“…Imaging studies can be helpful here to document the extent of disease after initial surgery. Frozen section-guided debridement has been advocated as a method for operative intervention and as an alternative to the extensive debridement that has traditionally been performed in patients with invasive mucormycosis [6]. Orbital exenteration may be necessary if ocular invasion exists [5].…”

Section: Discussionmentioning

confidence: 99%

Isolated palate ulcer due to mucormycosis

Bist

Varshney

Bisht

et al. 2008

Indian J Otolaryngol Head Neck S

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Mucormycosis is a rare but serious fungal infection that rapidly attacks and kills its untreated victims, who are often immunocompromised. It is one of the most fulminant and often fatal mycotic infections known to human beings. Rhinocerebral mucormycosis is the commonest presentation and its extension to the orbit and brain is quite usual but the palatal involvement is a rare and late occurrence. Isolated location of mucormycosis on the palate in an immunocompetent host is an unusual clinical entity. Here we report a case of deep hard palate ulcer due to mucormycosis in a 56-year-old man without any predisposing factor. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks. By presenting this case report we would like to emphasis that mucormycosis should be included in the differential diagnosis of the hard palate ulcers even in immunocompetent patient.

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Frozen Section-guided Surgical Debridement for Management of Rhino-orbital Mucormycosis

Cited by 49 publications

References 4 publications

Human Fungal Pathogens of Mucorales and Entomophthorales

Human Fungal Pathogens of Mucorales and Entomophthorales

Current Perspectives on Ophthalmic Mycoses

Isolated palate ulcer due to mucormycosis

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