Rhinocerebral Mucormycosis: A Retrospective Study

Kolekar, Jyoti Shailesh

doi:10.1007/s12070-014-0804-5

Cited by 40 publications

(41 citation statements)

References 20 publications

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“…Common side effects of azoles include abdominal distress, headache and pruritus. Generally, amphotericin drug is preferred in terms of efficacy but there are certain limitations because of its potential side effects [21]. Caitlin et al emphasize on the improved efficacy of amphotericin in combination with caspofungin, compared to monotherapy [22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Janjua¹,

Shah²,

Afzal³

et al. 2019

Journal of Surgery and Medicine

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Aim: Rhinomaxillary mucormycosis (RMM) is a detrimental and progressive deep fungal infection which predominantly affects immunocompromised patients. The disease has heterogeneity in clinical manifestation and presents with unfavorable consequences. Despite recent advances in the diagnosis and treatment, the disease has inadequate prognosis overall. The aim of our study is to compare Fluconazole vs. Itraconazole for the management of RMM. Methods: We retrieved demographic, clinical, radiological and histopathological data of patients affected with osteomyelitis in head and neck region and 33 patients exclusively affected with RMM were separated from departmental records. Several characteristics such as Gender, age, Diabetic status, co-morbidity were observed. Patients were randomly distributed in two groups with respect to the azole drug prescribed to them. Group A was given Fluconazole while group B was given Itraconazole. Aggressive surgery with concomitant use of antifungal drug was the mandatory treatment in all patients. Regular monitoring of side effects of drugs and recurrence was carried out for prolonged time. Results: Overall, 18 patients were male and 15 patients were female with a ratio of M:F 1.2. Mean age of patients was 48.21 (11.66) with the age range from 25 years to 70 years. Out of 33 patients, 30 of the patients (90.9%) were diabetic. Fifteen patients in Group A were managed with Fluconazole while 18 patients in group B were treated with Itraconazole. There was no statistically significant difference observed in most of the clinical signs and symptoms presented in both groups as P>0.05 except for bone necrosis (P=0.381). In group A, 4 patients exhibited recurrence (26.6%) while in group B, 5 (27.7%) patients presented with recurrence (P=0.943). Conclusion: Aggressive surgical approach along with supportive antifungal medication remained the mainstay of the treatment. Between Fluconazole and Itraconazole there was no difference observed.

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Section: Discussionmentioning

confidence: 99%

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Janjua¹,

Shah²,

Afzal³

et al. 2019

Journal of Surgery and Medicine

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“…Cranial extension through the cribriform plate of the ethmoid bone is marked by bloody necrotic nasal discharge and obtundation with frontal lobe involvement, 17 while invasion through the orbital apex and cavernous sinus results in acute visual loss, ophthalmoplegia, and fistulae between the cavernous sinus and internal carotid artery. 130,131 CNS involvement of mucormycoses carries a significant burden of mortality, from 62% in rhinocerebral and local cerebral infections to 98% in disseminated disease involving the CNS; this requires early identification of risk factors and symptoms, immediate diagnostic workup, and rapid treatment and interventional management. 14 Despite the need, diagnosis for mucormycosis remains difficult.…”

Section: Mucormycosismentioning

confidence: 99%

Fungal Infections of the Central Nervous System

Jia

Thakur

2019

Semin Neurol

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Fungal central nervous system infections present in a myriad of clinical manifestation and remain a significant diagnostic challenge. Presenting symptoms, cerebrospinal fluid analysis, conventional fungal serum markers and imaging correlates of disease are seldom sensitive or specific; fungal culture growth or histopathologic analysis are often required for definitive diagnoses but limited by feasibility. Novel diagnostic tools (such as the cryptococcal antigen and next-generation sequencing) have increased diagnostic potency when available but require further studies to define their utility.Invasive fungal infections are an emerging health threat in the setting of increased immunomodulatory treatments, advancements in transplant medicine and increased world-wide travel. Therefore, strong clinical suspicion from epidemiologic clues, clinical progression and presence of CNS dissemination risk factors must be exercised to pursue broad diagnostic workups and rapidly initiate medical and surgical management. This article will describe the epidemiology, clinical presentations, diagnostic approach and therapeutic interventions for fungal infections in the central nervous system.

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“…The article by Kolekar [1] made for an interesting read. Their observations on the outcome of rhinocerebral mucormycosis in a predominantly diabetic patient population are succinct and an important addition to the scarce literature on this subject.…”

Section: Sirmentioning

confidence: 99%

Early Diagnosis and Surgery is Crucial to Survival Outcome in Rhinocerebral Mucormycosis

Dayal

Bakshi

2016

Indian J Otolaryngol Head Neck Surg

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The article by Kolekar [1] made for an interesting read. Their observations on the outcome of rhinocerebral mucormycosis in a predominantly diabetic patient population are succinct and an important addition to the scarce literature on this subject. However we feel that some addition of the crucial clinical data would possibly throw light on the factors responsible for survival outcome of patients.It is widely recognized that a multimodal approach that involves an early diagnosis, aggressive surgical debridement, appropriate antifungal therapy and control of glycemic state improves survival in this invariably fatal condition in patients with diabetes [2,3]. Of the 4 components of this approach, the first 2 are the most critical but are often the most difficult to achieve [2]. The diagnosis is often delayed due to non-specific symptoms and signs and the need for invasive procedures for confirmation [3]. The sinonasal debridement surgery needs to be performed before the infection spreads to other adjoining areas particularly the brain [2]. In this context, the missing information regarding number of days (mean and range) taken to confirm mucormycosis and the timing of surgical debridement is very important. In our recent study on 4 children with Type 1 diabetes (T1D) and rhinosinus mucormycosis, the mean time to confirm the diagnosis was 3.5 days (range 1-7 days) and endoscopic or open surgery was performed within a week of hospitalization in all patients [4]. Our experience with invasive filamentous fungal infections in patients with T1D, predominantly caused by zygomycetes, is similar with the mean time from presentation to diagnosis of 5.8 ± 4.7 days (range 1-14 days) and debridement surgeries performed immediately after confirmation of diagnosis [5]. The relatively better outcome in our patients was probably a result of earlier diagnosis and treatment effected by a very dedicated team of pediatric endocrinologists, otolaryngologists, mycologists, histopathologists, intensivists, and pediatric surgeons at our center [4,5]. The overall survival rate of 55 % in the study by Kolekar, although at par with most centers in the world, could be related to the differences in the timings of diagnosis and surgery in their patients. It is possible that the 11 patients who survived were operated earlier as compared to those who died. Thus addition of this crucial information may allow us to determine that the outcome was influenced by the timing of diagnosis and surgery. This information can be easily retrieved from the hospital records of these patients and presented in a subsequent issue of IJOHNS. Also the addition of information regarding the predisposing factors for mucormycosis such as poor glycemic control and ketoacidotic state in the studied patients will be very useful to the readers [5].

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Rhinocerebral Mucormycosis: A Retrospective Study

Cited by 40 publications

References 20 publications

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Fungal Infections of the Central Nervous System

Early Diagnosis and Surgery is Crucial to Survival Outcome in Rhinocerebral Mucormycosis

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