Rhinocerebral mucormycosis: experience in 14 patients

Ketenci, İbrahim; Ünlü, Yaşar; Kaya, Hasan; Somdas, Mehmet Akıf; Kontaş, Olgun; Öztürk, Mustafa; Vural, Alperen

doi:10.1017/s0022215111000843

Cited by 51 publications

(48 citation statements)

References 45 publications

(163 reference statements)

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“…11 Amphotericin B along with aggressive surgical debridement remains the mainstay of treatment, particularly in the presence of significant comorbidities. 11,12 Due to the severe side effect profile of amphotericin B, a liposomal form of the drug may be considered, particularly in combination with micafungin. 11–14 There is also a potential role for hyperbaric oxygen as an adjunctive therapy that has been described.…”

Section: Discussionmentioning

confidence: 99%

Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center

Farooq¹,

Patel²,

Lin³

et al. 2015

Orbit

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Purpose To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center. Methods Retrospective case series. Results From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn’s disease. Another patient had a history of alcoholic liver cirrhosis, Crohn’s disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization. Conclusions Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.

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Section: Discussionmentioning

confidence: 99%

Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center

Farooq¹,

Patel²,

Lin³

et al. 2015

Orbit

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“…Frequency of exenteration has not been compared between the two groups in most of the publications 9,15,17,18,20 . On the other hand, the number of non‐diabetics was not high enough (usually less than 10) to draw a conclusion in other studies 7,8,10,11 . However, its frequency has been 11%‐42% in diabetics 3,7,8,10,11,16 and 0%‐40% in non‐diabetics 7,8,10,11,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Nearly half of the patients with mucormycosis die 2,5,6 . Some reported better 7,8 and some worse 9‐11 outcomes for diabetic ROCM as compared with the other immunocompromised patients. On the other hand, no study has previously compared diabetic and non‐diabetic ROCM with regard to the presenting symptom, exenteration rate and visual outcome.…”

Section: Introductionmentioning

confidence: 99%

Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

Abdolalizadeh

Kashkouli

Khademi

et al. 2020

Mycoses

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| INTRODUC TI ONRhino-orbito-cerebral mucormycosis (ROCM) is the most common presentation of mucormycosis that defined as paranasal sinuses infection spreading to contiguous structures like orbit, nose or brain.Diabetes is the most common predisposing factor for mucormycosis. 1 The role of the diabetes is more prominent in ROCM than other types. 2 Therefore, some series specifically evaluated the clinical pictures and outcomes of diabetic ROCM. 3,4 Nearly half of the patients with mucormycosis die. 2,5,6 Some reported better 7,8 and some worse 9-11 outcomes for diabetic ROCM as compared with the other immunocompromised patients. On the other hand, no study has previously compared diabetic and non-diabetic ROCM with regard to the presenting symptom, exenteration rate and visual outcome.We recently reported the outcomes of 63 patients with ROCM in whom patients', globe and vision survivals were 57%, 43% and 25%. 12 This is the second part of a research project on patients with ROCM in which the aim is to compare characteristics and the outcomes between the diabetic versus non-diabetic ROCM. | ME THODSMedical records of patients with ophthalmic manifestations of ROCM who were referred to a university-based hospital (Rassoul Summary Objective: To compare the characteristics and outcomes of rhino-orbito-cerebral mucormycosis (ROCM) in diabetic versus non-diabetic patients. Method:It is a retrospective comparative case series on consecutive patients with biopsy-proven ROCM. Systemic and ophthalmic manifestations, imaging, management and final outcomes were compared between diabetic versus non-diabetic ROCMs referred the eye clinic of a university-based hospital (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Results: Forty-three diabetics (55 eyes) with mean age of 54.6 (SD:12.5) years and 20 nondiabetics (24 eyes) with mean age of 57.5 (SD:13.8) years were enrolled. Patients' survival was observed in 51% of diabetics and 70% of non-diabetics (P = .1). The mortality rate was 7.4 times (CI95%: 1.85-29.96) higher in diabetic ROCM treated with non-liposomal amphotericin (P = .01). Exenteration did not significantly change the mortality rate in either group. Globe survival was 40% and 50% in diabetics and non-diabetics (P = 1), respectively. Vision survival was observed in 20% of diabetics and 37% of non-diabetics (P = .2). Conclusion:Patients', globe and vision survivals were not different between diabetic and non-diabetic patients with ROCM. They were 51%, 40% and 20% in diabetic and 70%, 50% and 37% in non-diabetic ROCM.

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“…44 Continuous positive airway pressure therapy in diabetic patients with obstructive sleep apnea may not improve metabolic control unless there is also weight loss, at least in short-term follow-up. 48 Pulmonary mucormycosis mimics invasive aspergillosis and is found mostly in patients with diabetes, hematologic malignancy, or organ transplantation or in patients on glucocorticoid or deferoxamine therapy. Angioinvasion is a hallmark of infections with mucormycosis.…”

Section: Diabetes Mellitusmentioning

confidence: 99%