Mucormycosis (phycomycosis) involving the maxilla. Report of a case with survival

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

Oral mucormycosis in an 18-month-old child: a rare case report with a literature review

Oral mucormycosis is a fungal infection observed mainly in elderly immunocompromised patients. In rare instances, the disease occurs in healthy individuals and those patients that are below preschool age. Although this condition mainly involves the maxilla, it may also manifest in any part of the oral cavity based on the source of infection. Mucormycosis of the maxilla spreads rapidly, leading to necrosis of the palatal bone and palatal perforation. Such patients are usually rehabilitated using bone grafting or free flap surgeries. However, when surgeries are delayed, palatal prosthesis is an interim treatment modality that can prevent nasal regurgitation and aspiration of food or fluids. Palatal prostheses also help with mastication, speech, and swallowing. The present case describes a rare case of oral mucormycosis in an 18-month-old male involving the maxilla that was managed by palatal prosthesis.

Eradication of invasive mucormycosis--effectiveness of the Echinocandin FK463

BACKGROUND

Invasive rhinocerebral mucormycosis is a rare and often fatal opportunistic fungal infection. It is encountered in immunocompromised hosts exemplified by those with diabetes, human immunodeficiency viruses and particularly haematologic malignancies typically after high-dose chemotherapy and stem cell transplantation. In contrast to the more usual outcome with rapid progression and death. We now describe a successful eradication attributable to the use of a newly available antifungal agent.

SETTING

Haematology department and bone marrow transplantation unit.

MATERIAL AND METHOD

Two patients are contrasted. The first with acute leukaemia developed rapidly progressive facial swelling with mucormycosis proven on biopsy. Treatment over 2 months with maximally tolerated doses of amphotericin failed to halt intracranial extension and death resulted. The second, presented with acute lymphoblastic leukaemia in August 1997, underwent successful autologous bone marrow transplantation in February 1998. Relapse followed in March 1999 and after reinduction and consolidation receive a matched unrelated volunteer allograft in September 1999. A second recurrence was documented in April 2000 and in spite of achieving remission he developed a fever that was managed empirically with intravenous amphotericin and, on discharge, oral itraconazole. Left-sided facial swelling expanded rapidly and biopsy showed extensive invasion of the maxillary sinus with mucormycosis. FK463 was added on 5 June 2000 with gradual reduction in facial pain and within 1 month all clinical signs and resolved. Serial biopsies that included histopathologic investigation and microbiologic cultures confirmed eradication of the invasive mucor. In view of the potential danger of recrudescence this treatment regimen was continued through further chemotherapy and, once again disease-free, a second matched unrelated volunteer allograft took place in August 2000. Full reassessment at the time failed to demonstration any residual fungus. Engraftment was confirmed but neutropenic sepsis resulted in severe inflammatory response syndrome with progression to multiple organ dysfunction to which he succumbed without any evidence of leukaemic or systemic mycosis.

CONCLUSION

Echinocandin FK463 is of documented value in managing invasive candidiasis and aspergillosis. This is believed to be the first case of successful outcome with one of the angiotrophic zygomycetes.

Mucormycosis of the oral cavity

Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection caused by a saprophytic fungus found in soil, bread molds, and decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. This report presents two cases of oral mucormycosis. One case occurred in the maxilla in a patient with well-controlled diabetes. The other involved the mandible and overlying gingiva in a patient with acute myelogenous leukemia. A review of the literature concerning oral mucormycosis is also presented.

Temporofacial zygomycosis in a pregnant woman

A 38-year-old Omani woman, seven months pregnant, developed extensive zygomycosis involving maxillary and temporal bones. No evidence of any underlying immune deficiency was detected except that which may be attributed to pregnancy. After delivery the patient was treated with repeated courses of amphotericin B, which resulted in a complete clinical resolution. Zygomycosis in uncomplicated pregnancy has not been previously described.

Mucormycosis in an apparently normal host. Case study and literature review

Mucormycosis refers to an opportunistic fungal infection most often related to predisposing conditions, especially uncontrolled diabetes. It can occur as a rapidly extending rhinocerebral infection presenting a high mortality rate. The same micro-organism has, however, been identified in benign paranasal infections in the absence of a general debilitating condition, suggesting that host factors are of the utmost importance in the outcome of paranasal mucormycosis.

Large asymptomatic antrolith of the maxillary sinus. Report of a case

A case of an unusually large antrolith of the maxillary sinus is presented. Because of the size of the mass, benign neoplasms were considered in the differential diagnosis. Surgery was the treatment of choice, and recurrence of the lesion is not expected.

Orofacial mucormycosis

Two cases of orofacial mucormycosis are reported. The first patient represents the typical progression of rhinocerebral mucormycosis with infiltration of the sinuses, the orbit, and the brain. The second patient had a tumorous maxillary lesion resembling fibrous dysplasia clinically and radiographically. Microscopically, the fungal infection in case 2 was associated with new bone formation. The significance of this phenomenon is discussed, and the importance of early diagnosis and possible treatment regimens are highlighted.

Orbital cellulitis due to mucormycosis. A case report

A case of orbital cellulitis caused by mucormycosis developed in a patient subsequent to cataract extraction and during systemic steroid treatment for postoperative complications. Fatal mucormycosis is a rare disease usually beginning with a subcutaneous inflammatory lesion. As the subsequent development of orbital cellulitis is very rare, little has been published on this subject. In cases of subcutaneous mucormycosis, the diagnosis can easily be made by means of histologic examination of the lesion. However, early diagnosis is difficult in cases with orbital involvement, because the most common cause of orbital cellulitis is bacterial. Thus, orbital cellulitis caused by mucormycosis is often wrongly treated with antibacterial agents only, as histologic examination is neither easy nor part of any routine investigation. Therefore, a combined treatment using antibiotics and antifungal agents in immunusuppressed patients with this disease is advocated.

Mucormycosis of the mandible

A case of mucormycosis of the mandible and adjacent soft tissue is presented. The rampant osteomyelitis that developed over a two-month period shows the necessity of early medical and surgical intervention. The management of these patients includes aggressive medical management of underlying problems, high-dose amphotericin B administration, and early surgical debridement of all involved tissues.

Mucormycosis in leukemia

Rhinocerebral mucormycosis is a virulent, rapidly progressive, potentially fatal illness which demands early diagnosis and aggressive medical and possible surgical therapy. Although most commonly reported in persons with poorly controlled diabetes, it may occur in other immunosuppressed hosts. In persons with leukemia the disease has been uniformly fatal. A well-documented case of fatal rhinocerebral mucormycosis in a leukemic patient is presented to illustrate the diagnostic and therapeutic dilemmas often faced. A review of the 233 cases thus far reported in the literature is used as a spring-board for a discussion of the pathogenesis, diagnosis, and management of this disease.

Mucormycosis: oral and prosthodontic implications. A report of 14 patients

This report includes 14 patients with rhinocerebral mucormycosis treated at the UCLA Medical Center since 1970. This disease has an extremely high mortality and morbidity. It is of interest to dentists because of the common presenting symptoms of periorbital cellulitis and sinusitis and the occasional presenting symptoms of dental pain or subperiosteal swelling. It is of further interest because of the intraoral and extraoral midfacial defects that result from disease extension and the necessary surgical débridement. The resultant facial and oral defects are far more difficult to restore than similar defects secondary to resection of head and neck neoplasms.

Rhinomaxillary mucormycosis in a kidney transplant patient

Rhinomaxillary mucormycosis is an uncommon but important pathologic entity with a rapidly fatal course if treatment is delayed. This is of particular interest to dentists, since many of the earliest clinical signs appear in the oral and perioral regions. Successful therapy demands early diagnosis by biopsy, institution of amphotericin B therapy, and surgical débridement. A case of nonfatal rhinomaxillary mucormycosis is presented, and all other reported cases in transplant patients are reviewed.

Nasopharyngeal mucormycotic osteitis: a new syndrome characterized by initial presentation of multiple cranial nerve palsies

Rhinocerebral mucormycosis, a highly lethal fungal infection of the head and neck, is commonly recognized by its classic appearance. Two cases of this newly recognized clinical syndrome with isolated unilateral peripheral cranial nerve V, VI, VII, IX, X, XI, and XII palsies and initial sparing of the eighth cranial nerve are presented. Examination revealed that each patient had ulceration of the nasopharynx and osteitis of the base of the skull. Nose, orbits, paranasal sinuses, and intracranial nervous systems were initially spared. The cause of this obscure cranial nerve paralysis was diagnosed from biopsy specimens of the nasopharyngeal tissues and the demonstration of nonseptate hyphae. Review of the literature did not indicate that this syndrome had previously been recognized. The name nasopharyngeal mucormycotic osteitis is suggested.

Murocmycotic slough of nasal floor and palate in the anephric patient

A case of nasopalatine mucormycosis in a patient with chronic renal failure is reported. Early recognition is contingent on histopathological examination of tissue and culturing. Vigorous treatment with amphotericin B and surgical intervention averted possible orbital-cranial involvement and effected a cure. When a chronically debilitated patient has signs of intraoral necrosis or facial swelling and necrosis, or both, the clinician should be alert to the possibility of a mucormycotic infection.

Rhinocerebral mucormycosis

Rhinocerebral mucormycosis is a fungal diseases that has a 50% mortality. Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that mya compromise the immunologic defenses of the host or alter the normal flora. The earliest signs, ulceration and pain, may appear in the mouth. In the patient described in this report, the autopsy showed that mucormycosis had entered the brain cells.

Mucormycosis

Three cases of mucormycosis are presented; two with unusual aspects: one with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis. Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

Oral complications of cancer chemotherapy

No part of the body reflects the complications of cancer chemotherapy as visibly and vividly as the mouth. The hemorrhagic, infectious, nutritional, cytotoxic, and neurologic signs of drug toxicity are registered in the mouth by changes in the color, character, and continuity of the mucosa. Although some of the complications are an inevitable part of the price of treatment, each constitutes a threat that must be kept within manageable limits.

Rhinocerebral mucormycosis: diagnosis and treatment. Report of two cases

Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.

Cerebral mucormycosis following open head trauma. Case report

The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.