Rhino-Orbito-Cerebral Mucormycosis in Patients with Diabetic Ketoacidosis

Gen, Ramazan; Horasan, Elif Şahin; Vaysoğlu, Yusuf; Arpacı, Rabia Bozdoğan; Ersöz, Gülden; Özcan, Cengiz

doi:10.1097/scs.0b013e31827c7eb8

Cited by 23 publications

(30 citation statements)

References 5 publications

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“…In the course of diabetes, monocyte, macrophage, and neutrophil function are impaired, the inflammatory response is suppressed, and the immune response is delayed. Conversely, increased glucose levels favourably affect fungal growth [ 12 , 59 , 61 ]. Infection of the CNS was also observed in 13.3–22% of patients with haematological disorders, and less often in transplant recipients, patients with gastroenteritis or with renal failure [ 56 , 59 , 60 ].…”

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

“…Infection of the CNS was also observed in 13.3–22% of patients with haematological disorders, and less often in transplant recipients, patients with gastroenteritis or with renal failure [ 56 , 59 , 60 ]. Mortality in the course of rhino-orbital-cerebral mucormycosis varies between 30–97% depending on the time of diagnosis and progression of lesions [ 57 , 61 , 62 ].…”

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

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Neuroinfections caused by fungi

2018

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BackgroundFungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences.MethodsOne hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: “fungi and CNS mycoses”, CNS fungal infections”, “fungal brain infections”, " fungal cerebritis”, fungal meningitis”, “diagnostics of fungal infections”, and “treatment of CNS fungal infections”. All were published in English with the majority in the period 2000–2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS.ResultsThe FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS.ConclusionAlthough the number of fungal species causing CNS mycosis is increasing, only som...

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Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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“…Mucormycosis is a saprophytic, filamentous fungal infection caused by Zygomycete fungi of the family Mucoraceae, and includes the genera Rhizopus , Rhizomucor , Mucor , and Absidia . Five classic forms of mucormycosis are recognized, including cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral [ 1 ]. Rhinocerebral mucormycosis is characterized by paranasal sinusitis, facial pain with swelling, headache, fever, rhinitis, granular or purulent nasal discharge, nasal ulceration, epistaxis, hemiplegia or stroke, and decreased mental function.…”

Section: Introductionmentioning

confidence: 99%

“…Fungal invasion, often originating from the paranasal sinuses, leads to intracranial growth usually along the base of the skull. The rhinocerebral form is the most severe and may involve a rapidly progressive, invasive infection with a high mortality rate [ 1 ]. Rhinocerebral mucormycosis frequently occurs in immunosuppressed patients, and diabetes mellitus is often a predisposing risk factor for rhinocerebral mucormycosis [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Basilar Artery Territory Stroke Secondary to Invasive Fungal Sphenoid Sinusitis: A Case Report and Review of the Literature

Fu¹,

Nguyẽ̂n²,

Sanossian³

2015

Case Rep Neurol

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Background: Mucormycosis is a fungal infection with the following 5 classic forms: cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral. The rhinocerebral form can be rapidly progressive and invasive with a high mortality rate. We present a case of a 38-year-old man with invasive mucormycosis that led to a basilar artery territory stroke. Rhinocerebral mucormycosis is an unusual cause of stroke. Case Report: A 38-year-old man with a past medical history of diabetes mellitus presented with altered mental status. A lumbar puncture revealed eosinophilic pleocytosis with a mildly elevated total protein and borderline low glucose level. CT revealed a left medullary and cerebellar infarct confirmed by MRI. MRI also displayed a diffuse marrow signal abnormality in the clivus with contiguous sinus disease. Endoscopic sinus surgery confirmed that the fungal sinusitis was mucormycosis of the Rhizopus genus, which had affected the left sphenoid sinus, invaded through the skull base, and involved the basilar artery. He was given liposomal amphotericin (500 mg i.v.) with posaconazole (400 mg i.v. twice daily). Due to the severity of the invasion and poor prognosis, the patient was discharged with comfort care measures. Discussion: Clinicians should be aware of invasive sinusitis as a rare cause of stroke in diabetics. Once the subarachnoid space and basal arteries of the brain have been invaded, the prognosis is very poor. The key to improvement of outcomes is early recognition and treatment, and examination of the sinuses on neuroimaging in all cases of stroke is vital.

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“…Some infections lead a more serious course in diabetic cases and become complicated at a higher rate. [11][12][13] Preseptal (periorbital) cellulitis and orbital (post-septal) cellulitis are the 2 main orbital infections. Preseptal cellulitis is more frequent, but orbital cellulitis is more dangerous.…”

Section: Discussionmentioning

confidence: 99%

A Rare Complication of Orbital Cellulitis in a Diabetic Case: Cavernous Sinus Thrombosis

Bilir¹

2017

South Clin Ist Euras

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It is that diabetes mellitus increases tendency to develop infections and thrombosis. Impairment of various mechanisms and agents of humoral and cellular immune systems can be expected. Disturbances of platelet function, coagulation factors, and vascular structure predispose diabetics to thrombotic events. The course of both infections and thrombotic events is often worse than in non-diabetic patients. Presently described is 94-year-old male patient with diabetes who had orbital cellulitis that became complicated with cavernous sinus thrombosis (CST). He was admitted to endocrinology clinic with diagnoses of orbital cellulitis, urinary tract infection, hyperosmolar non-ketotic state, acute renal failure, and compensated metabolic acidosis secondary to uremia. Despite immediate antibiotherapy, hydration, and additional required treatment, patient did not respond and died as a result of CST. There must be awareness, especially for diabetic patients, that orbital infections may spread to nearby cavernous sinuses and cause potentially lethal septic CST. Early diagnosis and immediate treatment are essential.

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Rhino-Orbito-Cerebral Mucormycosis in Patients with Diabetic Ketoacidosis

Cited by 23 publications

References 5 publications

Neuroinfections caused by fungi

Neuroinfections caused by fungi

Basilar Artery Territory Stroke Secondary to Invasive Fungal Sphenoid Sinusitis: A Case Report and Review of the Literature

A Rare Complication of Orbital Cellulitis in a Diabetic Case: Cavernous Sinus Thrombosis

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