Rhino‐Orbital and Rhino‐Orbito‐Cerebral Mucormycosis

Talmi, Yoav P.; Goldschmied-Reouven, Anna; Bakon, Mati; Barshack, Iris; Wolf, Michael; Horowitz, Zeev; Berkowicz, Miriam; Keller, Nathan; Kronenberg, Jona

doi:10.1067/mhn.2002.126587

Cited by 185 publications

(177 citation statements)

References 72 publications

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“…The most common finding on computerized tomography (CT) scanning of the head or sinuses is subtle sinus mucosal thickening or thickening of the extraocular muscles. It is also common to detect no abnormalities in the bones of the sinuses despite clinical evidence of progressive disease (149). However, when present, the finding of bony erosion of the sinuses is strongly suggestive of the diagnosis in the appropriate clinical context (e.g., patient in diabetic ketoacidosis with proptosis).…”

Section: Epidemiology and Disease Manifestationsmentioning

confidence: 98%

“…The initial symptoms of rhinocerebral mucormycosis are consistent with either sinusitis or periorbital cellulitis (32,149) and include eye or facial pain and facial numbness, followed by the onset of conjunctival suffusion, blurry vision, and soft tissue swelling (75,118,153). Fever is variable and may be absent in up to half of cases (149); white blood cell counts are typically elevated, as long as the patient has functioning bone marrow (153).…”

Section: Epidemiology and Disease Manifestationsmentioning

confidence: 99%

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Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement

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Section: Epidemiology and Disease Manifestationsmentioning

confidence: 98%

Section: Epidemiology and Disease Manifestationsmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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“…The organism have been Rhizopus with Aspergillus, Candida and Exserohillum. Mucorale with Aspergillus and a case of triple infection with Mucorale, Candida and Rhizopus has also been reported (15,16).…”

Section: Discussionmentioning

confidence: 99%

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

et al. 2016

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Introduction: Rhizopuse Sp. are common infectious agents of invasive rhinosinusitis. Though Alternaria is known to cause allergic rhinosinusitis, invasive sinusitis because of Alternaria Sp. is rare. Coinfections with bacteria and fungus causing rhinosinusitis have been reported as have the Rhizopus infection with other fungus such as Aspergillus, Candida, and Exserohillum. However Rhizopus coinfection with Alternaria has not been reported to the best of our knowledge. Case Presentation: A sixty-year-old woman was admitted with periorbital pain, swelling and complete restriction of movement of her right eye. She had diabetes mellitus for fifteen years. Diagnosis of invasive sinusitis was confirmed by hyperintensities in her right maxillary and bilateral ethmoid sinuses on the MRI on her brain and demonstration of hyphal forms from sinus mucosa. Culture confirmed the presence of Alternariaalternata and Rhizopus arrhizus. Patient responded to treatment with Amphotercin B and had complete resolution. Conclusions: Co-infection with bacteria and mixed fungal infection should be looked for as treatment strategies may differ with different organisms. Presumptive treatment should include agents, which can cover the broadest possible range of organism known to cause invasive sinusitis.

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“…Rhino-orbito-cerebral mucormycosis may have seasonal distribution, with most infections occurring in the fall and early winter (late August to November) [19,20].…”

Section: Epidemiologymentioning

confidence: 99%

Mucormycosis of the Head and Neck

Dan

2011

Curr Infect Dis Rep

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Mucormycosis of the head and neck is the most common form of infection by the order Mucorales, accounting for up to half of all cases. About 70% of rhinocerebral cases develop in diabetic patients. Less often, rhinocerebral mucormycosis occurs in solid organ transplant recipients, those with prolonged neutropenia, and those on deferoxamine therapy. Recently, rhinocerebral disease has been increasingly recognized in patients undergoing hematopoietic stem cell transplantation. A growing number of cases have presented as breakthrough infection in patients receiving voriconazole. The mortality rate of rhinocerebral mucormycosis has remained at 30% to 70% despite aggressive therapy. Early initiation of treatment substantially improves outcome, underscoring the need to maintain a high index of suspicion and promptly biopsy potential lesions. Surgical excision of necrotic tissue is essential. Lipid formulations of amphotericin B have become the standard treatment for mucormycosis. Posaconazole is useful as salvage therapy, but cannot be recommended yet as primary therapy.

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Rhino‐Orbital and Rhino‐Orbito‐Cerebral Mucormycosis

Cited by 185 publications

References 72 publications

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

Mucormycosis of the Head and Neck

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