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Manjunatha BS, Das N, Sutariya RV, Ahmed T. Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract 2012; 2:e28. [PMID: 24765427 PMCID: PMC3981330 DOI: 10.4081/cp.2012.e28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 12/21/2022] Open
Abstract
A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.
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Affiliation(s)
| | - Nagarajappa Das
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
| | - Rakesh V Sutariya
- Department of Oral Pathology and Microbiology, K.M. Shah Dental College & Hospital
| | - Tanveer Ahmed
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
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Manjunatha BS, Das N, Sutariya RV, Ahmed T. Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract 2012. [PMID: 24765427 DOI: 10.4081/cp.2012.e28.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.
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Affiliation(s)
| | - Nagarajappa Das
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
| | - Rakesh V Sutariya
- Department of Oral Pathology and Microbiology, K.M. Shah Dental College & Hospital
| | - Tanveer Ahmed
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
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Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41:634-53. [PMID: 16080086 DOI: 10.1086/432579] [Citation(s) in RCA: 1866] [Impact Index Per Article: 98.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 04/18/2005] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. METHODS We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. RESULTS The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). CONCLUSIONS Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
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Affiliation(s)
- Maureen M Roden
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Samaranayake LP, K. Cheung L, Samaranayake YH. Candidiasis and other fungal diseases of the mouth. Dermatol Ther 2002. [DOI: 10.1046/j.1529-8019.2002.01533.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Talmi YP, Goldschmied-Reouven A, Bakon M, Barshack I, Wolf M, Horowitz Z, Berkowicz M, Keller N, Kronenberg J. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002; 127:22-31. [PMID: 12161726 DOI: 10.1067/mhn.2002.126587] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rhino-orbito-cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols. METHODS All had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases. RESULTS Sixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end-stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%. CONCLUSIONS ROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival-dependent classification of ROCM are offered.
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Affiliation(s)
- Yoav P Talmi
- Departments of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Israel.
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Stanford TW, Rivera-Hidalgo F. Oral mucosal lesions caused by infective microorganisms. II. Fungi and parasites. Periodontol 2000 1999; 21:125-44. [PMID: 10551179 DOI: 10.1111/j.1600-0757.1999.tb00172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T W Stanford
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA
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Nenoff P, Kellermann S, Schober R, Nenning H, Kubel M, Winkler J, Haustein UF. Rhinocerebral zygomycosis following bone marrow transplantation in chronic myelogenous leukaemia. Report of a case and review of the literature. Mycoses 1998; 41:365-72. [PMID: 9916458 DOI: 10.1111/j.1439-0507.1998.tb00355.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a man suffering from chronic myelogenous leukaemia treated by allogeneic bone marrow transplantation who, in the late post-transplantation phase, developed a hyperacute fatal invasive rhinocerebral zygomycosis. The origin of the ascending infection was the sinus sphenoidalis from which fungal hyphae spread to the central nervous system via the skull and the dura mater. The first symptoms of this severe infection were cerebral convulsions and a bilateral total amaurosis. The isolation of the pathogen from post mortem tissue was not successful. The present case is compared with previous reports of zygomycoses after bone marrow transplantation.
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Affiliation(s)
- P Nenoff
- Department of Dermatology, University of Leipzig, Germany
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Economopoulou P, Laskaris G, Ferekidis E, Kanelis N. Rhinocerebral mucormycosis with severe oral lesions: a case report. J Oral Maxillofac Surg 1995; 53:215-7. [PMID: 7830193 DOI: 10.1016/0278-2391(95)90407-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Economopoulou
- Department of Oral Pathology and Surgery, Faculty of Dentistry, University of Athens, Greece
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Jones AC, Bentsen TY, Freedman PD. Mucormycosis of the oral cavity. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:455-60. [PMID: 8464609 DOI: 10.1016/0030-4220(93)90170-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- A C Jones
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry
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Abstract
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.
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Rosenberg SW, Lepley JB. Mucormycosis in leukemia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1982; 54:26-32. [PMID: 6956824 DOI: 10.1016/0030-4220(82)90413-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Kurrasch M, Beumer J, Kagawa T. Mucormycosis: oral and prosthodontic implications. A report of 14 patients. J Prosthet Dent 1982; 47:422-9. [PMID: 6951043 DOI: 10.1016/s0022-3913(82)80095-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Breiman A, Sadowsky D, Friedman J. Mucormycosis. Discussion and report of a case involving the maxillary sinus. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1981; 52:375-8. [PMID: 6946358 DOI: 10.1016/0030-4220(81)90333-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cohen SG, Greenberg MS. Rhinomaxillary mucormycosis in a kidney transplant patient. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1980; 50:33-8. [PMID: 6994014 DOI: 10.1016/0030-4220(80)90328-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Guerreiro CA, Nobrega JP, Carvalho MP. [Orbito-rhino-cerebral phycomycosis (mucormycosis): report of a case]. ARQUIVOS DE NEURO-PSIQUIATRIA 1980; 38:99-105. [PMID: 7406756 DOI: 10.1590/s0004-282x1980000100013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The case of a 15 year old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two months after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with avaliable literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results obtained with the proposed managment are stressed.
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Gluskin M, Solomon MP, Gold B, Corrado ML, Berger J. Murocmycotic slough of nasal floor and palate in the anephric patient. J Am Dent Assoc 1979; 98:224-7. [PMID: 284067 DOI: 10.14219/jada.archive.1979.0488] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Abstract
Cerebro-rhino-orbital phycomycosis (CROP) occurs predominantly in individuals with diabetes mellitus in a state of metabolic acidosis. Other forms of metabolic acidosis, especially in infants, may predispose to phycomycotic infections. CROP has also been reported in patients with leukemia or lymphoma. CROP usually begins in the palate or paranasal sinuses and rapidly spreads to the orbital contents. Proptosis, loss of vision, and ophthalmoplegia occur and death from cerebral involvement commonly ensues. The fungus tends to invade arteries and cause thrombosis and tissue infarction. Rhizopus is the most commonly isolated genus in CROP, accounting for almost all cases. The diagnosis can be strongly suspected by the characteristic clinical manifestations. Therapy includes treatment of the underlying disease, surgical excision of the necrotic tissue containing fungal elements and the systemic administration of amphotericin-B. The effect of treatment has improved since the disease was first described, but the condition still has a high mortality, especially if it is not diagnosed early.
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