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Lisboa ML, Grando LJ, Kretzer SL, Tomazelli KB, Bianco BC, Santos da Silva MC, Kosmann C, Meurer MI. Mucormycosis causing oral and nasal osteonecrosis in a case of acute myeloid leukemia. SPECIAL CARE IN DENTISTRY 2023; 43:727-730. [PMID: 36648613 DOI: 10.1111/scd.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
AIMS Mucormycosis is a rare and aggressive fungal infection with a high mortality rate because of its rapidly progressive and destructive nature. The oral cavity is often affected under opportunistic conditions. We report a 34-year-old woman diagnosed with acute myeloid leukemia complained of slight swelling on the right side of her face with toothache and gingival swelling. An incisional biopsy was performed, and the specimen analysis revealed broad aseptate hyphae with a ribbon-like appearance, which is characteristic of opportunistic Mucorales infection. METHODS AND RESULTS The oral lesion worsened, and invasion of the fungal infection into the maxillary sinus, nasal cavity, ethmoidal air cells, and sphenoid and frontal sinuses was observed. Partial maxillectomy was performed concomitantly with the ongoing chemotherapy for leukemia. A maxillofacial prosthesis was used for functional rehabilitation. CONCLUSION Successful management requires a multimodal approach. In this case, the patient required different systemic approaches for treating leukemia and the fungal infection as well as rehabilitation with an obturator prosthesis.
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Affiliation(s)
- Mariah Luz Lisboa
- Núcleo de Odontologia Hospitalar, Hospital Universitário Professor Polydoro Ernani de São Thiago, HU-UFSC/EBSERH, Florianópolis, SC, Brazil
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Liliane Janete Grando
- Departamento de Patologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Sara Letícia Kretzer
- Laboratório de Micologia, Hospital Universitário Professor Polydoro Ernani de São Thiago, HU-UFSC/EBSERH, Florianópolis, SC, Brazil
| | - Karin Berria Tomazelli
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Bianca Carla Bianco
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Cleumara Kosmann
- Secretaria Estadual de Saúde de Santa Catarina, Florianópolis, SC, Brazil
| | - Maria Inês Meurer
- Departamento de Patologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Kalaskar RR, Kalaskar AR, Ganvir S. Oral mucormycosis in an 18-month-old child: a rare case report with a literature review. J Korean Assoc Oral Maxillofac Surg 2016; 42:105-10. [PMID: 27162751 PMCID: PMC4860375 DOI: 10.5125/jkaoms.2016.42.2.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ritesh Rambharos Kalaskar
- Department of Pedodontic & Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Ashita Ritesh Kalaskar
- Department of Oral Diagnosis Medicine & Radiology, VSPM Dental College & Research Centre, Nagpur, India
| | - Sindhu Ganvir
- Department of Oral Pathology & Microbiology, Government Dental College & Hospital, Nagpur, India
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3
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Rhinocerebral mucormycosis: experience in 14 patients. The Journal of Laryngology & Otology 2011; 125:e3. [DOI: 10.1017/s0022215111000843] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjective:Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.Patients and methods:A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.Results:Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.Conclusion:Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.
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Akhrass FA, Debiane L, Abdallah L, Best L, Mulanovich V, Rolston K, Kontoyiannis DP. Palatal mucormycosis in patients with hematologic malignancy and stem cell transplantation. Med Mycol 2011; 49:400-5. [DOI: 10.3109/13693786.2010.533391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bachor R, Baczako K, Kern W. Isolierte Cerebrale Mucormykose bei Leukämie: Isolated Cerebral Mucormycosis in a Patient with Leukemia. Mycoses 2009. [DOI: 10.1111/j.1439-0507.1986.tb03950.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Bonifaz A, Barrón T, Collazo-Jaloma J. Zigomicosis (mucormicosis) cutánea en paciente con leucemia. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76625-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Salisbury PL, Caloss R, Cruz JM, Powell BL, Cole R, Kohut RI. Mucormycosis of the mandible after dental extractions in a patient with acute myelogenous leukemia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:340-4. [PMID: 9084196 DOI: 10.1016/s1079-2104(97)90240-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mucormycosis is a fulminant fungal infection that occurs most often in diabetic and immunocompromised patients including those with hematologic malignancies. In this case, a patient with acute myelogenous leukemia developed mucormycosis in a recent mandibular extraction site. The successful management of this patient demonstrated that early diagnosis, aggressive surgical and medical treatment and resolution of the underlying disease could improve the prognosis for survival. A case is made for the role of smoking as an initiator of mucormycosis, and treatment considerations for controlling periodontal and pulpal disease before chemotherapy are discussed.
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Affiliation(s)
- P L Salisbury
- Department of Dentistry, Bowman Gray School of Medicine, Winston-Salem, N.C., USA
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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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10
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Abstract
Mucormycosis is a highly aggressive fungal infection affecting diabetic, immunocompromised, and, occasionally, healthy patients. This infection is associated with significant mortality. We have reviewed 208 cases in the literature since 1970, 139 of which were presented in sufficient detail to assess prognostic factors, and added data from six of our patients. The histories of these 145 patients were analyzed for the following variables: 1) underlying conditions associated with mucormycotic infections; 2) incidence of ocular and orbital signs and symptoms; 3) incidence of nonocular signs and symptoms; 4) interval from symptom onset to treatment; and 5) the pattern of sinus involvement seen on imaging studies and noted at the time of surgery. Factors related to a lower survival rate include: 1) delayed diagnosis and treatment; 2) hemiparesis or hemiplegia; 3) bilateral sinus involvement; 4) leukemia; 5) renal disease; and 6) treatment with deferoxamine. The association of facial necrosis with a poor prognosis fell just short of statistical significance, but appears clinically important. This is the first review that documents the heretofore intuitive claim that early diagnosis is necessary to cure this disease. Standard treatment with amphotericin B and aggressive surgery are reviewed and adjunctive therapeutic modalities are discussed, including local amphotericin B irrigation, hyperbaric oxygen, and optimizing the immunosuppressive regimen in transplant patients. Hyperbaric oxygen was found to have a favorable effect on prognosis. In addition, possible treatment options for patients with declining renal function are reviewed.
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Affiliation(s)
- R A Yohai
- Wright State University School of Medicine, Dayton, Ohio
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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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Musial CE, Cockerill FR, Roberts GD. Fungal infections of the immunocompromised host: clinical and laboratory aspects. Clin Microbiol Rev 1988; 1:349-64. [PMID: 3069198 PMCID: PMC358059 DOI: 10.1128/cmr.1.4.349] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Fungal infections of the immunocompromised host are being seen with greater frequency than ever before. In addition, a growing list of unusual and unexpected etiologic agents presents a unique and difficult challenge to the clinician and microbiologist. The clinical manifestations of opportunistic fungal infections are often not characteristic and, in many instances, may prevent a rapid diagnosis from being made. Clinical microbiology laboratories should consider any organism as a potential etiologic agent. This requires that all fungi recovered from immunocompromised patients be thoroughly identified and reported so that their clinical significance may be assessed. This review presents a brief discussion of the clinical and laboratory aspects of some fungal infections seen in this important group of patients.
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Affiliation(s)
- C E Musial
- Section of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota 55905
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Espinel-Ingroff A, Oakley LA, Kerkering TM. Opportunistic zygomycotic infections. A literature review. Mycopathologia 1987; 97:33-41. [PMID: 3550467 DOI: 10.1007/bf00437328] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This is a literature review of 361 opportunistic fungal infections caused by the Zygomycetes. The clinical and laboratory diagnosis, pathogenesis, management, treatment, and outcome of infection are discussed. The Zygomycetes are a group of opportunistic fungi (orders Mucorales and Entomophthorales) which cause severe infections which may be fatal. Early clinical recognition, prompt diagnostic procedures, control of underlying disease and treatment with high doses of amphotericin B and aggressive surgery increases survival in an otherwise lethal infection.
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Abstract
A young woman with acute myelocytic leukemia developed acute lower gastrointestinal bleeding immediately after a first remission induction of her leukemia. After the site of bleeding was located in the descending colon, a necrotic bleeding ulcer was resected. Histologic examination of the ulcer established the diagnosis of gastrointestinal mucormycosis. Treatment with amphotericin B was administered because of the high risk of dissemination. The patient has been followed for 9 months with no evidence of relapse of infection. Survival after gastrointestinal mucormycosis in acute leukemia has not previously been reported in the English language literature. Success in managing mucormycosis depends on the adherence to the recommended principles of early aggressive diagnostic measures, excisional surgery, amphotericin B therapy, and control of the underlying predisposing condition.
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Benbow EW, Delamore IW, Stoddart RW, Reid H. Disseminated zygomycosis associated with erythroleukaemia: confirmation by lectin stains. J Clin Pathol 1985; 38:1039-44. [PMID: 2413080 PMCID: PMC499355 DOI: 10.1136/jcp.38.9.1039] [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: 12/31/2022]
Abstract
Zygomycosis is not often diagnosed in the United Kingdom, and so the possible importance of the findings in a patient with disseminated zygomycosis who had been treated with chemotherapy for erythroleukaemia was not appreciated until histological examination of specimens obtained at necropsy provided a presumptive diagnosis. No attempt had therefore been made to identify the organism by culture, and lectin binding methods were used to try to compensate for this. The characteristics of the hyphae on staining with lectins were similar to those previously shown in Rhizopus oryzae and were unlike those of a wide range of other hyphal fungi. Although definite speciation of the fungus was not achieved, these findings confirm that this was a case of zygomycosis and would seem to represent the first such reported confirmation in the absence of culture.
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