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Yusuf AA, Ibrahim IG, Hirsi IM, Adali A, Hassan YY, Yasar MZ, Abdullahi IM, Hassan MS. Rhino-Orbital Cerebral Mucormycosis in a Healthy Female Child: Case Report. Int Med Case Rep J 2024; 17:241-246. [PMID: 38559497 PMCID: PMC10981427 DOI: 10.2147/imcrj.s454697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is a potentially fatal condition with a high mortality rate, particularly when there is extra nasal involvement, and it is rare for patients with fungal brain disease to survive. It mostly affects patients who are metabolically or immunologically compromised, which constitutes one of the three classical stages of the progression of Rhino-Orbito-Cerebral Mucormycosis (ROCM). Stage I: infection of the nasal mucosa and paranasal sinuses; Stage II: orbital involvement; Stage III: cerebral involvement.Here, we report a case of rhino-orbital cerebral mucormycosis in a 14-year-old girl with no known risk factor who presented with periorbital edema, right eye proptosis, fever, and extreme facial pain, which progressively worsened to confusion and left leg weakness in 3 days after admission. The final diagnosis was rhino-orbital-cerebral mucormycosis. The infection was successfully treated using liposomal amphotericin and surgical debridement to remove infected orbital tissue. Mucormycosis is a potentially fatal disease that necessitates prompt diagnosis and treatment. Children are rarely infected with mucormycosis. The majority of studies show that people are typically between 40 and 50 years old. ROCM is typically diagnosed using clinical symptoms and histopathologic evaluation; however, imaging is critical in determining the presence of intracranial lesions. The standard treatment for ROCM is amphotericin B at a recommended dose of 1.0-1.5 mg/kg/day for weeks or months, depending on the clinical response and severity of adverse drug reactions, particularly nephrotoxicity.Rhino-orbital cerebral mucormycosis in a healthy female child is uncommon; early diagnosis and prompt treatment with Amphotericin B should be necessary. Devastating consequences will result from a delayed diagnosis.
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Affiliation(s)
- Abdisalam Abdullahi Yusuf
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ismail Gedi Ibrahim
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
| | - Ibrahim Mohamed Hirsi
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ali Adali
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Yonis Yusuf Hassan
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mehmet Zeki Yasar
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ismail Mohamoud Abdullahi
- Department of Pathology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Sheikh Hassan
- Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
- Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Dacey S, Velu PS, Wilson N, Levi JR, Paz-Lansberg M. Invasive fungal sinusitis: A comparison of pediatric versus adult cases. Am J Otolaryngol 2024; 45:104143. [PMID: 38101130 DOI: 10.1016/j.amjoto.2023.104143] [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: 09/29/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Invasive fungal sinusitis (IFS) is a rare infection with high mortality, mainly impacting immunocompromised patients. Given its significant mortality, timely recognition and treatment is crucial. This study aims to highlight the differences in presentation of IFS between pediatric and adult patients to aid in prompt diagnosis and treatment of this condition. METHODS A comprehensive literature search of PubMed, EMBASE, Web of Science, Global Index Medicus, Global Health (EBSCO) and Cochrane Database of Systematic Reviews was conducted to identify articles relating to IFS. Patient demographics, comorbidities, presentation, disease characteristics, treatments and outcomes were extracted from the studies, and statistical analyses were conducted to compare these variables between pediatric and adult patients. RESULTS 111 studies identified 22 pediatric and 132 adult patients worldwide. Children were more likely to have hematologic malignancies compared to adults (59.1 % vs. 15.2 %, p < 0.001). Facial symptoms such as pain, edema, and numbness were the most common symptoms for both age groups. In the pediatric population, fever and nasal or oral mucosal lesions were more common presenting symptoms (both p < 0.001). Pediatric patients were more likely to present without disease extension beyond the sinuses (p < 0.001). There was no significant difference in either medication treatment or mortality between the two cohorts. CONCLUSION IFS often presents with non-specific symptoms and a unique presentation in pediatric and adult populations. Clinical awareness of the varying presentations in both populations is important to treat in a timely manner given the rapid progression and high mortality rates of IFS.
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Affiliation(s)
- Sydney Dacey
- Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America
| | - Nicholas Wilson
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America
| | - Jessica R Levi
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
| | - Marianella Paz-Lansberg
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
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Meena V, Barath S, Singh S, Jakhar P, Patel T. Role of Imaging Spectrum Along With Other Diagnostic Modalities in Rhino-Orbital-Cerebral Mucormycosis (ROCM). Cureus 2024; 16:e53962. [PMID: 38469024 PMCID: PMC10926969 DOI: 10.7759/cureus.53962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES Rhino-orbito-cerebral mucormycosis (ROCM), a rare angio-invasive fungal infection, had become a major outbreak during the second wave of the coronavirus disease (COVID-19) pandemic in India, with over 28,000 reported cases. The purpose of this study was to describe the imaging spectrum of ROCM, which may prove useful in prompt diagnosis, considering its grave prognosis in populations with a high load of immunosuppressed patients (e.g., COVID-19, HIV-AIDS, etc.). MATERIAL AND METHODS Evaluation of the clinical data and imaging of patients with symptoms suspicious of mucormycosis of the craniofacial region was done. The diagnosis was made using computed tomography (CT) or magnetic resonance (MR) imaging, a biopsy, and culture. The data analysis was done using descriptive statistical methods. RESULTS The sample group consisted of a total of 36 patients ranging from 33 years to 75 years of age, out of which 31 (86.11%) were male and five (13.8%) were female. A total of 30 (83.33%) patients had a positive correlation with COVID-19 infection, and 29 (80.55%) patients had a positive correlation with diabetes. The major presenting complaints were facial pain and swelling (20 patients; 55.55%). The intracranial spread was seen in 14 (38.88%) patients. Our study demonstrated a mortality rate of 38.88% (14 patients). CONCLUSION ROCM, once considered to occur predominantly in diabetics, is increasingly being seen in other immunosuppressive patients, such as COVID-19. CT and MR imaging help provide an early diagnosis in conjunction with pathologic and microbiological correlations. Immediate correction of immunosuppression with the initiation of amphotericin B therapy combined with extensive and diligent surgical debridement of the diseased tissue is required.
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Affiliation(s)
| | - Sitaram Barath
- Radiology, Geetanjali Medical College & Hospital, Udaipur, IND
| | | | - Prateek Jakhar
- Radiodiagnosis, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Tarang Patel
- Pathology, All India Institute of Medical Sciences (AIIMS) Rajkot, Rajkot, IND
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B H S, Kumbhalkar S, Selvi K, G D, Bidkar V, Dabhekar S, Prathipati K, Sawal A. 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. Cureus 2023; 15:e42674. [PMID: 37649953 PMCID: PMC10463103 DOI: 10.7759/cureus.42674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
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.
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Affiliation(s)
- Shrikrishna B H
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Sunita Kumbhalkar
- General Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kalai Selvi
- Community Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Deepa G
- Anatomy, Datta Meghe Medical College, Nagpur, IND
| | - Vijay Bidkar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Sandeep Dabhekar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kirankumar Prathipati
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Tomar K, Roy ID, Rangan M, Satyanarayan P, Jakka S. Post-Covid Orofacial Mucormycosis: A Clinico-Radiological Classification System and Management Protocol. J Maxillofac Oral Surg 2023:1-10. [PMID: 36776349 PMCID: PMC9897613 DOI: 10.1007/s12663-022-01843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Background In the wake of the second wave of the COVID-19 pandemic, a substantial number of individuals were afflicted by orofacial mucormycosis post-COVID. The immunocompromised state rendered by the SARS-COV2 (Severe Acute Respiratory Syndrome Corona Virus 2) infection provides a breeding ground for the opportunistic mucor invasion. Corticosteroid and COVID-induced hyperglycemia contribute to the unhindered progress of the mucor infection in these patients. The sino-nasal region serves as the entry point and rapid progress of the disease to the oral cavity, mid-face, orbits, and ultimately the brain proves fatal. Aim and Objectives The aim of this study was to present a definitive clinico-radiological staging/classification system for patients of post-covid mid-face mucormycosis based on combined radiographic and clinical features for subsequent convenient staging of maxillofacial mucormycosis. The objectives are being to lay down a comprehensive management protocol for these patients. Methods This retrospective study consisted of a cohort of 31 patients presenting to a tertiary care center over a 12-month period and diagnosed as post-covid mucormycosis. Their clinical features at the time of presentation along with radiographic presentation/extent of anatomical destruction were combined to create a clinico-radiological staging system. Further, a comprehensive management protocol including cultures, surgery and chemotherapy has been laid down. Results This included 18 males and 13 females. Average age of the patients was 53.5 years. As per the clinico-radiological system formulated by the authors, 2 patients (1 males and 1 females) displayed features of Stage 0, 12 patients (7 males and 5 females) of Stage 1-A, 8 patients (5 males and 3 females) of Stage 1-B, 6 patients (4 males and 2 females) and 3 patients (1 male and 2 females) of Stage 3. Conclusion The lacuna of a comprehensive staging/classification system for patients of maxillofacial mucormycosis was felt by the authors while treating those affected by post-covid mucormycosis along with a detailed algorithm for management of the study population. It is to this effect that this clinic-radiological classification system has been suggested by the authors along with a management protocol.
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Affiliation(s)
- Kapil Tomar
- Dept of Dental Surgery & Oral Health Sciences, Division of Oral and Maxillofacial Surgery, Armed Forces Medical College, Solapur Road, Pune, Maharashtra 411040 India
| | - I. D. Roy
- Dept of Dental Surgery & Oral Health Sciences, Division of Oral and Maxillofacial Surgery, Armed Forces Medical College, Solapur Road, Pune, Maharashtra 411040 India
| | - Mohan Rangan
- Dept of Dental Surgery & Oral Health Sciences, Division of Oral and Maxillofacial Surgery, Armed Forces Medical College, Solapur Road, Pune, Maharashtra 411040 India
| | - P. Satyanarayan
- Dept of Dental Surgery & Oral Health Sciences, Division of Oral and Maxillofacial Surgery, Armed Forces Medical College, Solapur Road, Pune, Maharashtra 411040 India
| | - Sabareesh Jakka
- Dept of Dental Surgery & Oral Health Sciences, Division of Oral and Maxillofacial Surgery, Armed Forces Medical College, Solapur Road, Pune, Maharashtra 411040 India
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Sharma AK, Nagarkar NM, Gandhoke CS, Sharma S, Juneja M, Kithan ZM, Aggarwal A, Arora RD, Mehta R, Syal S, Anjankar SD, Thangaraju P. Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India. Surg Neurol Int 2023; 14:15. [PMID: 36751448 PMCID: PMC9899475 DOI: 10.25259/sni_1065_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. Methods After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. Results About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. Conclusion We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.
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Affiliation(s)
- Anil Kumar Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nitin M. Nagarkar
- Director and CEO (ENT Surgeon), All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Charandeep Singh Gandhoke
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.,Corresponding author: Charandeep Singh Gandhoke, Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
| | - Siddharth Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mohit Juneja
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Zijano M. Kithan
- Department of General Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Aakash Aggarwal
- Department of ENT, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ripu Daman Arora
- Department of ENT, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Rupa Mehta
- Department of ENT, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Simran Syal
- Department of Paediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Shailendra D. Anjankar
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Chaurpagar R, Chiplunkar B, Doifode P, Athawale N. Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2023; 75:867-874. [PMID: 36684821 PMCID: PMC9838433 DOI: 10.1007/s12070-022-03430-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60 years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.
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Affiliation(s)
| | | | - Parag Doifode
- Department of ENT, Government Medical College, Akola, Maharashtra India
| | - Neha Athawale
- Department of ENT, Government Medical College, Akola, Maharashtra India
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Post COVID-19 Mucormycosis-The Horizon. Indian J Otolaryngol Head Neck Surg 2022:1-6. [PMID: 36540726 PMCID: PMC9756729 DOI: 10.1007/s12070-022-03315-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Acute Invasive Fungal Rhinosinusitis is a rare condition which recently has gained attention due to its increased occurrence in the post COVID-19 patients past the second wave. The current study retrospectively evaluates the occurrence of Acute Invasive Fungal Rhinosinusitis (Mucormycosis) in post COVID-19 (Corona Virus Disease-19) patients. METHODS A descriptive study included patients diagnosed with Acute Invasive Fungal Rhinosinusitis (Mucormycosis) after recent COVID-19 infection. 110 patients were evaluated retrospectively with histopathological confirmation of Mucormycosis. Surgical treatment was restricted to patients who tested Real Time Polymerase Chain Reaction (RT PCR) negative for COVID-19 except for three patients who were tested positive. Antifungal agents were given to patients following surgery. RESULTS A total of 110 patients with a mean age of 48.42 years were included. The most common risk factor was diabetes mellitus (88.2%). Sino-nasal, orbital, palatal and intracranial involvement were 57.9%, 48.5%, 12.7% and 5.6% respectively. Histopathological confirmation revealed mucormycosis. The most common reported symptoms were periorbital oedema (20.5%), headache (20.3%), gingival swelling (18.5%) facial pain (18.4%) and facial swelling (18.2%). All the patients were treated with surgical debridement and antifungal medications. The overall survival rate was 95.32%. CONCLUSION Acute Invasive Fungal Rhinosinusitis is a life-threatening opportunistic infection. Patients with moderate to severe COVID-19 infection are more susceptible to it. Uncontrolled diabetes mellitus and intake of corticosteroids increase the risk of developing Acute Invasive Fungal Rhinosinusitis. Early diagnosis and timely management can improve survival rates of the patients.
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Tadros D, Tomoum MO, Shafik HM. Orbital Complications of Acute Invasive Fungal Rhinosinusitis: A New Challenge in the COVID-19 Convalescent Patients. Clin Ophthalmol 2022; 16:4011-4019. [PMID: 36514418 PMCID: PMC9741827 DOI: 10.2147/opth.s391188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Increased incidence of acute invasive fungal rhinosinusitis (AIFR) in the setting of COVID-19 is undeniable. This can be attributed to its effect on innate immunity and extensive use of corticosteroids. The goal of our study was to assess the orbital complications of AIFR and its management in the COVID-19 convalescent patients. Methods Our longitudinal prospective study included 45 patients with orbital complications of AIFR in recently recovered COVID-19 patients. We performed otorhinolaryngological, ophthalmological, and neurological examinations to monitor the manifestations of the disease. Computed tomography and contrast enhanced magnetic resonance imaging were performed to detect the extent of infection. Antifungal medications, surgical intervention, and general condition management were all provided to all the patients. Results We reported pre-septal cellulitis, orbital cellulitis, and orbital apex syndrome in 18, 13, and 10 patients, respectively. Four patients had cavernous sinus thrombosis. Mucormycosis and Aspergillus species were detected in 80% and 11.11% of our patients, respectively, while the mixed infection was found in 8.88% of our patients. Diabetes mellitus was the most common cause of immunocompromise (95.55% of our patients). Orbital pain and ophthalmoplegia were the most common ocular manifestations, followed by proptosis and relative afferent pupillary defect. All patients underwent surgical intervention, except for one patient who was unfit for surgery. One patient had orbital exenteration. The ophthalmological manifestations were reversible in cases of orbital and pre-septal cellulitis. The overall survival rate was 66.67%. Conclusion Early diagnosis and treatment of AIFR can decrease the morbidity and mortality rate of affected patients.
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Affiliation(s)
- Dina Tadros
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt,Correspondence: Dina Tadros, Tanta University Hospital, Department of Ophthalmology, El-Geesh Street, Tanta, El-Gharbia, 31515, Egypt, Tel +201224093354, Email
| | - Mohamed O Tomoum
- Department of Otorhinolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba M Shafik
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Jain R, Agarwal D, Singh AB, Verma V, Singh HP, Kumar S. Post-Covid mucormycosis presenting as retropharyngeal abscess: a rare case report. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC9284500 DOI: 10.1186/s43163-022-00274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Post-Covid retropharyngeal mucormycosis is a rare presentation, and no case has been reported in literature until date. Case presentation A-32-year-old female post Covid presented to our OPD with history of dysphagia and with a history of steroid intake. Radiology confirmed it as retropharyngeal abscess. Endoscopic-guided aspiration was done. HPE (histopathological examination) revealed classic broad aseptate hyphae of mucormycosis. Patient was managed conservatively with broad-spectrum antifungal. Conclusion Retropharyngeal mucormycosis is a rare entity in Covid era. Rapid diagnosis and management are needed to save life of an individual, or results could be fatal.
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Kumar M, Alagarsamy R, Madi M, Pentapati KC, Vineetha R, Shetty SR, Sharma A. Rhinocerebral mucormycosis: a systematic review of case reports and case series from a global perspective. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:708-716. [PMID: 36184407 DOI: 10.1016/j.oooo.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/03/2022] [Accepted: 06/11/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis. STUDY DESIGN An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results. RESULTS A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%. CONCLUSIONS The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.
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Affiliation(s)
- Mathangi Kumar
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ragavi Alagarsamy
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Medhini Madi
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindranath Vineetha
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shishir Ram Shetty
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, United Arab Emirates
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12
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Samir A, Abdel-Gawad MS, Elabd AM, Abed WM, Mahmoud A, Gaweesh TY, Youssef A. Early CT and MRI signs of invasive fungal sinusitis complicating COVID-19 infection: case report. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC8800432 DOI: 10.1186/s43163-022-00206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Corticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19). Despite their importance to decrease patients’ mortality, they can cause serious side effects like fulminant fungal infection that can damage lungs or invade the sinuses then rapidly spread to the orbit and even intra-cranially. Unless early diagnosed and properly managed, patients can lose their vision or die from cavernous sinus thrombosis or other intracranial complications. Case presentation A 71-year-old diabetic male patient presented with dry cough, fever, and dyspnea for 6 days. PCR test for COVID-19 was ordered and declared positive. The oxygen saturation on day 7 started to decline to reach 90%. Eight ampules of intra-muscular dexamethasone were prescribed. The patient’s dyspnea improved, and the oxygen saturation reached 94% by day 13. Oral prednisone was prescribed in a withdrawal protocol. Unfortunately, on day 15, the patient complained of mild left-sided cheek swelling and noticeably dropped left angle of mouth. Neurological consultation suspected facial palsy and asked for brain MRI examination. Limited lower cuts of the MRI study that covered the left maxillary antrum revealed mild fullness of the pre-maxillary fat planes with mucosal thickening. Complimentary dedicated MRI and CT cuts over the left maxillary sinus showed localized signs of invasive fungal sinusitis without orbital or intracranial complications. The patient received antifungal therapy even before evident endoscopic findings appeared. He underwent endoscopic debridement few days after and he had an excellent outcome without any progression or significant morbidities. Conclusion Early CT/MRI radiological signs of invasive fungal sinusitis that complicated COVID-19 infection aid in the diagnosis and proper timely management of this fatal disease.
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Saneesh PS, Morampudi SC, Yelamanchi R. Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience. World J Radiol 2022; 14:209-218. [PMID: 36160626 PMCID: PMC9350613 DOI: 10.4329/wjr.v14.i7.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 02/06/2023] Open
Abstract
Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.
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Affiliation(s)
- P S Saneesh
- Department of Radiology, Aster MIMS, Kannur 670007, Kerala, India
| | - Satya Chowdary Morampudi
- Department of Radiodiagnosis, Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram 521101, Andhra Pradesh, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, Delhi, India
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14
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Dwivedi S, Choudhary P, Gupta A, Singh S. The cross-talk between mucormycosis, steroids and diabetes mellitus amidst the global contagion of COVID-19. Crit Rev Microbiol 2022; 49:318-333. [PMID: 35324372 DOI: 10.1080/1040841x.2022.2052795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mucormycosis is an opportunistic fungal disease that targets individuals having an impaired immune system due to a wide array of risk factors including HIV-AIDS, immunosuppressive therapy, diabetes mellitus, etc. The current explosive outbreak of coronavirus disease 2019 (COVID-19) has become the latest threat to such patients who are already susceptible to secondary infections. Physiological outcomes of COVID-19 end up in a cascade of grave alterations to the immunological profile and irreparable harm to their respiratory passage, heart and kidneys. Corticosteroidal treatment facilitates faster recovery and alleviates the adverse pathological effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). But clinical reports lend this approach a darker perspective especially if these patients have pre-existing diabetes mellitus. The mucormycotic fungal genera belonging to the order Mucorales not only survive but thrive under the comorbidity of COVID-19 and diabetes, often staying undetected until they have inflicted irreversible damage. Steroidal usage has been noted to be a common thread in the sudden spurt in secondary fungal infections among COVID-19 cases. Once considered a rare occurrence, mucormycosis has now acquired a notoriously lethal status in mainstream medical hierarchy. We set out to investigate whether corticosteroidal therapy against COVID-19 emboldens the development of mucormycosis. We also assess the conditions brought forth by steroidal usage and uncontrolled progression of diabetes in COVID-19 cases and their effect on the susceptibility towards mucormycosis.
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Affiliation(s)
- Shrey Dwivedi
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Princy Choudhary
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Ayushi Gupta
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Sangeeta Singh
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
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15
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Muraleedharan M, Panda NK, Angrish P, Arora K, Patro SK, Bansal S, Chakrabarti A, Rudramurthy SM, Bakshi J, Mohindra S, Gupta R, Virk RS, Verma RK, Ramavat AS, Nayak G. As the virus sowed, the fungus reaped! A Comparative Analysis of the Clinico-epidemiological Characteristics of Rhino-orbital Mucormycosis before and during Covid -19 Pandemic. Mycoses 2022; 65:567-576. [PMID: 35289000 PMCID: PMC9115264 DOI: 10.1111/myc.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
Background The sudden surge of mucormycosis cases which happened during the second wave of COVID‐19 pandemic was a significant public health problem in India. Objectives The aim of this study was to analyse the clinico‐epidemicological characteristics of the mucormycosis cases to determine the changes that had occurred due to COVID‐19 pandemic. Methodology A retrospective cross‐sectional study was conducted at the Department of Otolaryngology Head and Neck Surgery, PGIMER, Chandigarh, India. Patients diagnosed with rhino‐orbital mucormycosis were categorised into the following groups: Pre‐pandemic(May 2019 to April 2020), Pandemic Pre‐epidemic (May 2020 to April 2021) and Epidemic (1 May 2021 to 12 July 2021). The epidemiological, clinical and surgical data of all the patients were retrieved from the hospital records and analysed. Results The epidemic period had 370 cases, compared with 65 during pandemic period and 42 in the pre‐pandemic period. Diabetes mellitus was seen in 87% of cases during epidemic period, 92.9% in the pre‐pandemic period and 90.8% in the pre‐pandemic pre‐epidemic period. The proportion of patients suffering from vision loss, restricted extra‐ocular movements, palatal ulcer and nasal obstruction was higher in the pre‐epidemic groups, and the difference was significant (p, <.01). There was no history of oxygen use in 85.9% of patients and no steroid use in 76.5%. The death rates were the lowest during epidemic (10%). Conclusion COVID‐19 has caused a statistically significant increase in the number of mucormycosis infections. The mortality and morbidity which showed an increase during the first wave of COVID‐19 decreased significantly during the epidemic period.
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Affiliation(s)
- Manjul Muraleedharan
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naresh Kumar Panda
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Prerna Angrish
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kanika Arora
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sourabha Kumar Patro
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Bansal
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Jaimanti Bakshi
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Satyawati Mohindra
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rijuneeta Gupta
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ramandeep Singh Virk
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Roshan Kumar Verma
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anurag Snehi Ramavat
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gyanaranjan Nayak
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Baghel SS, Keshri AK, Mishra P, Marak R, Manogaran RS, Verma PK, Srivastava AK, Kumar R, Mathialagan A, Bhuskute G, Dubey AK, Dhiman RK. The Spectrum of Invasive Fungal Sinusitis in COVID-19 Patients: Experience from a Tertiary Care Referral Center in Northern India. J Fungi (Basel) 2022; 8:jof8030223. [PMID: 35330225 PMCID: PMC8954380 DOI: 10.3390/jof8030223] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to determine the patient demographics, risk factors, which include comorbidities, medications used to treat COVID-19, and presenting symptoms and signs, and the management outcome of COVID-19-associated invasive fungal sinusitis. A retrospective, propensity score-matched, comparative study was conducted at a tertiary care center, involving 124 patients with invasive fungal sinusitis admitted between April 2021 and September 2021, suffering from or having a history of COVID-19 infection. Among the 124 patients, 87 were male, and 37 were female. A total of 72.6% of patients received steroids, while 73.4% received antibiotics, and 55.6% received oxygen during COVID-19 management. The most common comorbidities were diabetes mellitus (83.9%) and hypertension (30.6%). A total of 92.2% had mucor, 16.9% had aspergillus, 12.9% had both, and one patient had hyalohyphomycosis on fungal smear and culture. The comparative study showed the significant role of serum ferritin, glycemic control, steroid use, and duration in COVID-19-associated invasive fungal disease (p < 0.001). Headache and facial pain (68, 54.8%) were the most common symptoms. The most involved sinonasal site was the maxillary sinus (90, 72.6%). The overall survival rate at the three-month follow-up was 79.9%. COVID-19-related aggressive inflammatory response, uncontrolled glycemic level, and rampant use of steroids are the most important predisposing factors in developing COVID-19-associated invasive fungal sinusitis.
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Affiliation(s)
- Surendra Singh Baghel
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
| | - Amit Kumar Keshri
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226001, India;
| | - Rungmei Marak
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226001, India;
| | - Ravi Sankar Manogaran
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
- Correspondence:
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (P.K.V.); (A.K.S.); (R.K.)
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (P.K.V.); (A.K.S.); (R.K.)
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (P.K.V.); (A.K.S.); (R.K.)
| | - Arulalan Mathialagan
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
| | - Govind Bhuskute
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
| | - Abhishek Kumar Dubey
- Neurootology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India; (S.S.B.); (A.K.K.); (A.M.); (G.B.); (A.K.D.)
| | - Radha Krishan Dhiman
- Head Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India;
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Mazzai L, Anglani M, Giraudo C, Martucci M, Cester G, Causin F. Imaging features of rhinocerebral mucormycosis: from onset to vascular complications. Acta Radiol 2022; 63:232-244. [PMID: 33615823 DOI: 10.1177/0284185120988828] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Rhinocerebral mucormycosis (RCM) may result in severe intracranial ischemic and hemorrhagic lesions. Both computed tomography (CT) and magnetic resonance imaging (MRI) play an essential role in the diagnosis of RCM, but whereas CT is better for assessing bone erosion, MRI is superior in evaluating soft tissue, intraorbital extension, and in assessing intracranial and vascular invasion. Specific CT and MRI techniques, such as CT angiography or enhanced MR angiography, and more advanced MRI sequences such as gadolinium-3D Black Blood imaging, contribute to the assessment of the extension of vascular invasion.In this pictorial review, we describe specific CT and MRI signs of RCM, mainly focusing on its life-threatening complications due to vascular involvement.
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Affiliation(s)
- Linda Mazzai
- Neuroradiology UOC, Department of Diagnostics, San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Mariagiulia Anglani
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Chiara Giraudo
- Institute of Radiology, Department of Medicine (DiMED), University of Padova, Padova, Italy
| | - Matia Martucci
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Giacomo Cester
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Francesco Causin
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
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18
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Gökbulut Bektaş Ş, Kandemir AB, Ayaz ÇM, Yilmaz AN, İzdeş S. COVID-19-Related Rhino-Orbital-Cerebral Mucormycosis in a Renal Transplant Recipient. EXP CLIN TRANSPLANT 2022; 20:213-217. [PMID: 34981710 DOI: 10.6002/ect.2021.0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 increases transplant recipients' susceptibility to rare opportunistic infections as a consequence of the impairment that COVID-19 can cause in the immune system. Mucormycosis is a rare complication but has a high risk of fatal outcome. A 50-year-old woman who received a kidney transplant 10 years previously was admitted to the hospital with COVID-19. During follow-up by the inpatient service, the patient developed pain, edema, and proptosis in the right eye. She was diagnosed with rhino-orbitalcerebral mucormycosis. This is the first reported case of rhino-orbital-cerebral mucormycosis in a renal transplant recipient with COVID-19 infection.
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19
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Kumar S, Kumar H, Mali M, Meena BL. A study of rhino-orbito-cerebral mucormycosis with COVID-19: A new challenge in North West of Rajasthan. Ann Afr Med 2022; 21:383-389. [PMID: 36412339 PMCID: PMC9850881 DOI: 10.4103/aam.aam_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Mucormycosis is a life-threatening fungal disease in immunocompromised patients. There has been increase in the number of mucormycosis associated with COVID-19 patients in second wave. Now country battle with both COVID-19 and mucormycosis. An invasive mucormycosis infection has been a significant burden in India after COVID-19. It has been recently emerged a notifiable disease by the Rajasthan government. Our aim is to develop awareness regarding the importance of early detection and treatment of mucormycosis with COVID-19 and reduce the morbidity and mortality. Materials and Methods This is a Prospective longitudinal study including 34 patients diagnosed with acute invasive fungal infection by contrast enhancement magnetic resonance imaging studies of paranasal, orbit and brain or nasal biopsy for KOH/culture. Diagnosis is made through routine blood tests, biopsy, and radiological imaging. The patients taken for the study were COVID-19 reverse transcription-polymerase chain reaction positive or recent post COVID-19 (within 15 days) or symptoms of COVID-19 with bilateral pneumonitis. The study was conducted with 34 patients admitted to the department of medicine with mucormycosis within a month may 2021. Results A total of 34 patients with a mean age of 50.92 years old and male female ratio 24/10 (70.5/29.41) were included in this study. The most common comorbidity was diabetes mellitus (23 patients 67.64%). Nine patients were newly diagnosed or recent onset of diabetes with or after COVID-19 infection. Twenty-four (70.58%) patients were COVID-19 positive or recent (within 15 days) history of COVID-19 positive. Seven (20.58) patients had the history of steroid as a treatment during COVID-19 and 5 (14.70) patients was on oxygen inhalation. One (2.94%) patient was fully vaccinated, and 5 (14.70) patients had the history of steam inhalation. The most common involvement was naso-orbital mucormycosis found in 28 patients (82.35%) followed by nasal-and orbital 26 (76.47) and 18 (52.94), respectively. Naso-Orbito-Cerebral was seen in 16 (47.05) patients. The more common reported symptoms and signs were headache (76.47), facial numbness (64.70), Nasal discharge (52.94), and ophthalmoplegia (52.94). Cranial nerve involvement was seen in 10 patients (facial palsy in 8 patients and bulbar palsy in 2 patients). Total mortality was 7 (7/34 20.58%). Conclusion COVID-19 infection associated with the wide range of invasive mucormycosis. Early diagnosis and Clinical suspicion of acute invasive fungal sinusitis among COVID-19 patients is essential for better outcomes and higher survival.
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Affiliation(s)
- Surendra Kumar
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
| | - Harish Kumar
- Department of Emergency Medicine, S P Medical College, Bikaner, Rajasthan, India,Address for correspondence: Dr. Harish Kumar, B-3 Shastri Nagar, Bikaner - 334 001, Rajasthan, India. E-mail:
| | - Manoj Mali
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
| | - Babu Lal Meena
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
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20
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S. Krishna Sasanka KSB, Arora R, Nagarkar N, Thangaraju P, Mehta R, Satpute S, Chakravarty S, Keche A, Aggarwal A, Sree Sudha TY. Epidemic in pandemic: Fungal sinusitis in COVID-19. J Family Med Prim Care 2022; 11:807-811. [PMID: 35360777 PMCID: PMC8963616 DOI: 10.4103/jfmpc.jfmpc_1352_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/09/2021] [Accepted: 10/16/2021] [Indexed: 11/04/2022] Open
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21
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Durairaj R. Orbital Mucormycosis in Covid- 19: A Case Presentation. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Singhal A, Jain S, Sharma S, Kottiyath VC, Khandelwal G. A multicentric observational study of imaging findings in COVID-19-related rhino-orbito-cerebral mucormycosis: a new Pandora’s box. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8527445 DOI: 10.1186/s43055-021-00631-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background There is a sudden rise of fungal infection with corona virus disease. This is attributed to the immunomodulation by the disease and the drugs used, diabetes mellitus, steroid use, oxygen inhalation using dirty water, use of zinc and iron supplements, etc. Early diagnosis and prompt medical and surgical intervention is the mainstay of treatment. This can greatly reduce the high morbidity and mortality associated with this disease. The objective of the study is to describe the imaging findings of acute invasive rhino-orbito-cerebral mucormycosis (ROCM) in 25 patients with severe acute respiratory syndrome corona virus 2, from three different centers with proven mucormycosis. Special emphasis is placed on the signal enhancement patterns of sinonasal mucosa, the earliest and most common findings. Statistical analysis was performed using descriptive statistics. Results Computed tomography (CT) and magnetic resonance imaging (MRI) of 25 patients showed most commonly involved sinuses as maxillary and ethmoid sinuses (19, 76%) together. Sino-nasal mucosal thickening was the most common finding (24, 96%). Periantral infiltration (18, 72%) preceded before orbital (15, 60%), cerebral (5, 20%) and vascular (2, 8%) complications, with grossly intact bones. Sinus wall erosions were seen in only 2 patients (8%). Palatal (22%) and maxillary alveolar arch erosion (39%) were frequent findings. CT showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T1 and T2 iso- to hypointense mucosal thickening (62%) and intense (43%) and no (33%) contrast enhancement as the main finding. Conclusions Contrast enhanced MRI is better at demonstrating early mucosal abnormalities, turbinate necrosis, non-enhancing devitalized tissues, orbital apex involvement and intra-cerebral extension. Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses in premaxillary, retroantral fat, facial muscles, pterygopalatine fossa, temporal, infratemporal fossa and extraconal orbital fat along with typical patterns of sinonasal mucosal enhancement should raise the suspicion of acute invasive fungal etiology given the short duration of history and immunocompromised status. High incidence of periantral and orbital extension of the disease is suggestive of acute invasive form of fungal infection. Also the rapidly progressive inflammatory changes without much bone involvement should suggest the suspicion of ROCM. Bony, cerebral and vascular involvements are relatively late complications. Supplementary Information The online version contains supplementary material available at 10.1186/s43055-021-00631-w.
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Choudhary NK, Jain AK, Soni R, Gahlot N. Mucormycosis: A deadly black fungus infection among COVID-19 patients in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 12:100900. [PMID: 34746515 PMCID: PMC8559302 DOI: 10.1016/j.cegh.2021.100900] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/04/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023] Open
Abstract
After first phase of Covid-19, the second wave affects a lot to the Indians with mysterious fungal infection known as Mucormycosis. Here, we reviewed clinical pathogenesis, signs, symptoms and treatment against black fungus. The conclusion revealed that use of immunosuppressant to combat Covid-19 also increases the risk to get infected with mucormycosis. Patients with hyperglycemia, ketoacidosis, solid organ or bone marrow transplantion, liver cirrhosis, neutropenia are more susceptible to get attacked by Mucormycosis moulds. Early diagnosis, removal of predisposing factors, timely antifungal therapy with surgical removal of all infected tissues and adjunctive therapies are four major factors to eradicate Mucormycosis.
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Affiliation(s)
| | - Amit K Jain
- B R Nahata College of Pharmacy, Mandsaur University, Mandsaur, 458001, India
| | - Rupesh Soni
- B R Nahata College of Pharmacy, Mandsaur University, Mandsaur, 458001, India
| | - Neha Gahlot
- B R Nahata College of Pharmacy, Mandsaur University, Mandsaur, 458001, India
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Asdaq SMB, Rajan A, Damodaran A, Kamath SR, Nair KS, Zachariah SM, Sahu RK, Fattepur S, Sreeharsha N, Nair A, Jacob S, Albahrani HA, Alkhaldi EH, Mohzari Y, Alrashed AA, Imran M. Identifying Mucormycosis Severity in Indian COVID-19 Patients: A Nano-Based Diagnosis and the Necessity for Critical Therapeutic Intervention. Antibiotics (Basel) 2021; 10:1308. [PMID: 34827246 PMCID: PMC8615244 DOI: 10.3390/antibiotics10111308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 infection caused by the new SARS-CoV-2 virus has been linked to a broad spectrum of symptoms, from a mild cough to life-threatening pneumonia. As we learn more about this unusual COVID-19 epidemic, new issues are emerging and being reported daily. Mucormycosis, also known as zygomycosis or phycomycosis, causes severe fungal illness to individuals with a weakened immune system. It is a devastating fungal infection, and the most frequent kind is the rhino cerebral type. As a devastating second wave of COVID-19 sweeps India, doctors report several instances involving a strange illness-sometimes known as the "black fungus"-among returning and recovered COVID-19 patients. This paper analyzes the existing statistical data to address the severity of prevalence and further notes the nano-based diagnostic parameters, clinical presentations, its connection with other conditions like diabetes, hypertension, and GI disorders, and the importance of anti-fungal therapy in treating the same. Anti-fungal therapies, as well as surgical interventions, are currently used for the treatment of the disease. Proper and timely diagnosis is necessary, along with the reduction in the spread of COVID-19. From the review, it was found that timely pharmacologic interventions and early diagnosis by using a nano-based diagnostic kit can help control the disease. Additionally, this paper provides novel information about the nanotechnology approaches such as fungal detection biosensors, nucleic acids-based testing, point-of-care tests, and galactomannans detection, in the diagnosis of mucormycosis, and thereby reinforces the need for further research on the topic.
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Affiliation(s)
| | - Arya Rajan
- Amrita School of Pharmacy, AIMS Health Science Campus, Amrita Vishwa Vidyapeetham, Kochi 682041, India; (A.R.); (A.D.); (S.R.K.); (K.S.N.)
| | - Aswin Damodaran
- Amrita School of Pharmacy, AIMS Health Science Campus, Amrita Vishwa Vidyapeetham, Kochi 682041, India; (A.R.); (A.D.); (S.R.K.); (K.S.N.)
| | - Shivali R. Kamath
- Amrita School of Pharmacy, AIMS Health Science Campus, Amrita Vishwa Vidyapeetham, Kochi 682041, India; (A.R.); (A.D.); (S.R.K.); (K.S.N.)
| | - Krishnanjana S. Nair
- Amrita School of Pharmacy, AIMS Health Science Campus, Amrita Vishwa Vidyapeetham, Kochi 682041, India; (A.R.); (A.D.); (S.R.K.); (K.S.N.)
| | - Subin Mary Zachariah
- Amrita School of Pharmacy, AIMS Health Science Campus, Amrita Vishwa Vidyapeetham, Kochi 682041, India; (A.R.); (A.D.); (S.R.K.); (K.S.N.)
| | - Ram Kumar Sahu
- Department of Pharmaceutical Science, Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia;
- Department of Pharmaceutical Science, Assam University (A Central University), Silchar 788011, India
| | - Santosh Fattepur
- School of Pharmacy, Management and Science University, Shah Alam 40100, Malaysia;
| | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Hofuf 31982, Saudi Arabia; (N.S.); (A.N.)
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Bangalore 560035, India
| | - Anroop Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Hofuf 31982, Saudi Arabia; (N.S.); (A.N.)
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates;
| | | | - Eman H. Alkhaldi
- Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Yahya Mohzari
- Clinical Pharmacy Department, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Ahmed A. Alrashed
- Pharmaceutical Services Administration, Inpatient Department, Main Hospital, King Fahad Medical City, Riyadh 11564, Saudi Arabia;
| | - Mohd. Imran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia;
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Saad RH, Mobarak FA. The diversity and outcome of post-covid mucormycosis: A case report. Int J Surg Case Rep 2021; 88:106522. [PMID: 34692373 PMCID: PMC8522488 DOI: 10.1016/j.ijscr.2021.106522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction and importance The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival. Case presentation The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap. Clinical discussion The dual effect of both covid-19 and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is recommended. Conclusion Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology. Medical device related pressure injuries (MDRPIs) is an iatrogenic injury, and its prevention and management should be prioritized. Mucormycosis should be investigated in COVID-19 infected and recovered patients. Cutaneous Mucormycosis is common among the immunocompetent patients, and knowledge of its types and subtypes is essential. The authors highlight the value of clinical and radiographic investigation in aiding early diagnosis of Mucormycosis. Surgical debridement of necrotic tissues is a life-saving measure, and should not be delayed due to an unavailable or negative histopathology.
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Affiliation(s)
- Reem Hassan Saad
- Department of Cranio-Maxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt.
| | - Fahmy A Mobarak
- Head of Department of Cranio-Maxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt
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Management Challenge of Rhino-Orbito-Cerebral Mucormycosis in Covid 19 Era: A Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 2021; 74:3485-3491. [PMID: 34722223 PMCID: PMC8540873 DOI: 10.1007/s12070-021-02947-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/02/2021] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis is an uncommon but a fatal fungal infection that usually affects patients with altered immunity. The Rhizopus Oryzae is most common type and responsible for nearly 60% of mucormycosis cases in humans and also accounts for 90% of the Rhino-orbital-cerebral (ROCM) form. Our aim and objective was to study, the site of mucormycosis in nose and paranasal sinuses, adjacent site like orbit palate or intracranial involvement, co-morbid condition and management to be done in confirm mucormycosis patients. The most common sinuses involved are the ethmoid, maxillary followed by the frontal and sphenoid sinus. Diabetes mellitus is often associated with mucormycosis of the paranasal sinuses, as is corona virus infection; uncontrolled diabetes further increases the risk. Intra-orbital involvement is common, but intracranial involvement is rare. Extensive steroid and broad-spectrum antibiotic use for Covid-19 management may cause or exacerbate fungal disease. All the patients required surgical intervention along with medical treatment.
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Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients. J Fungi (Basel) 2021; 7:jof7090720. [PMID: 34575758 PMCID: PMC8466761 DOI: 10.3390/jof7090720] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words "fungal infections COVID-19", between 2020-2021.
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Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, Rao PS, Haldipur D, Bonanthaya K. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg 2021; 20:418-425. [PMID: 33716414 PMCID: PMC7936599 DOI: 10.1007/s12663-021-01532-1] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Collate and analyse data of maxillofacial/rhino-cerebro-orbital fungal infections reported during the era of the Covid-19 pandemic, with the aim of investigating the common contributing factors leading to such infections and of highlighting the significance of this surge seen in patients infected with SARS-CoV-2. METHOD This retrospective observational multi-centric study analysed patient data collected from clinicians belonging to different specialties in Bangalore, India. The data included the presentation and management of patients presenting with aggressive maxillofacial and rhino-cerebro-orbital fungal infections and explored the relationship between SARS-CoV-2, corticosteroid administration and uncontrolled diabetes mellitus. RESULTS All 18 patients were Covid positive. Sixteen of the 18 patients received steroids for Covid treatment and 16 patients were diabetic (of whom 15 patients who were diabetics received steroids for Covid-19 treatment). Loss of vision was noted in 12 of the 18 patients and 7 of them underwent orbital exenteration. The fungi noted was mucormycosis in 16 patients, aspergillosis in 1 patient and a mixed fungal infection in 1 patient. Eleven of the patients survived, 6 died and 1 was lost to follow-up. There was a significantly higher incidence of diabetes (p = 0.03) amongst these cohort of patients who were Covid-19 positive with mucormycosis. A significantly higher number (p = 0.0013) of patients were administered steroids at some point during the treatment. CONCLUSION Despite the limited sample size, it is evident that there is a significant increase in the incidence of angioinvasive maxillofacial fungal infections in diabetic patients treated for SARS-CoV-2 with a strong association with corticosteroid administration.
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Affiliation(s)
- Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trust-Well Hospital, Bangalore, India
- Department of Oral and Maxillofacial Surgery, Rangadore Memorial Hospital, 1st Cross Rd, Shankarapuram, Basavanagudi, Bangalore, Karnataka 560004 India
- Department of Oral and Maxillofacial Surgery, Apollo Hospitals, Bangalore, India
| | - Rohith Gaikwad
- Department of Oral and Maxillofacial Surgery, Trust-Well Hospital, Bangalore, India
- Department of Oral and Maxillofacial Surgery, Rangadore Memorial Hospital, 1st Cross Rd, Shankarapuram, Basavanagudi, Bangalore, Karnataka 560004 India
| | - Shreya Krishna
- Department of Oral and Maxillofacial Surgery, Rangadore Memorial Hospital, 1st Cross Rd, Shankarapuram, Basavanagudi, Bangalore, Karnataka 560004 India
| | - Raghuraj Hegde
- Opthalmic Plastic Surgery and Opthalmic Oncology Service, Department of Opthalmology, Manipal Hospital, Bangalore, India
| | - K. K. Tripathi
- School of Behavioural Sciences, National Forensic Sciences University, Gandhinagar, Gujarat India
| | - Preeti G. Kale
- Department of Opthalmology, Trust-Well Hospital, Bangalore, India
| | - P. Subramanya Rao
- Department of ENT, Rangadore Memorial Hospital, Bangalore, India
- Department of ENT, Columbia Asia Hospital, Yeshwanthpur, Bangalore, India
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Vasudevan B, Hazra N, Shijith KP, Neema S, Vendhan S. Mucormycosis: The Scathing Invader. Indian J Dermatol 2021; 66:393-400. [PMID: 34759398 PMCID: PMC8530042 DOI: 10.4103/ijd.ijd_477_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mucormycosis is an invasive fungal infection that has been increasing in incidence over the years. Increase in the number of diabetics, malignancy patients, and use of immunosuppressants has mainly led to this gradual upward surge. Mucormycosis has various clinical forms, including rhino-orbito-cerebral, pulmonary, gastrointestinal, and cutaneous. Fungi belonging to Mucorales are thermotolerant and ubiquitous, found growing on organic substrates such as bread, decaying fruits and vegetables, crop debris in soil, compost, and animal excreta. During this second wave of the COVID-19 pandemic, the number of cases of mucormycosis has increased manifold in a short span of time. Associated comorbidity of diabetes mellitus, increased use of higher doses and prolonged duration of systemic corticosteroids, the glucogenic and prothrombotic propensity of the virus, hypoxic environment, COVID pneumonia, increased hospitalization, ICU admissions, and mechanical ventilation have all contributed toward this high rise in numbers. The rhin-orbito-cerebral form is the commonest manifestation of mucormycosis in COVID. Rhizopus oryzae, the main species causing mucormycosis, is identified by hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching ribbon-like hyphae with rhizoids. For the early diagnosis of this infection, 10% KOH mount is very important. These fungi are very rapidly growing and thus can be differentiated from their main ally, Aspergillus. Treatment is mainly in the form of extensive surgical debridement along with liposomal amphotericin B. Posaconazole and isavuconazole are second-line agents, which can also be used for maintenance. Control of diabetes and COVID-19, along with judicious use of antibiotics and systemic corticosteroids, are equally important as management strategies in these pandemic times.
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Affiliation(s)
- Biju Vasudevan
- From the Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Nandita Hazra
- Department of Microbiology, Command Hosp (Southern Command), Pune, Maharashtra, India
| | - KP Shijith
- Department of Radiology, Army Hosp (R & R), New Delhi, India
| | - Shekhar Neema
- From the Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Senkadhir Vendhan
- From the Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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ASLAN Ş, OMAR I, DURAK VA, ÇIKRIKLAR Hİ, ÖZDEMİR F. RHINOCEREBRAL MUCORMYCOSIS CASE IN THE EMERGENCY ROOM. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.932160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Can imaging suggest the aetiology in skull base osteomyelitis? A systematic literature review. Pol J Radiol 2021; 86:e309-e321. [PMID: 34136049 PMCID: PMC8186306 DOI: 10.5114/pjr.2021.106470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group – 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
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El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive Fungal Sinusitis in Post COVID-19 Patients: A New Clinical Entity. Laryngoscope 2021; 131:2652-2658. [PMID: 34009676 PMCID: PMC8242424 DOI: 10.1002/lary.29632] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022]
Abstract
Objectives Occurrence of invasive fungal respiratory superinfections in patients with COVID‐19 has gained increasing attention in the latest studies. Yet, description of acute invasive fungal sinusitis with its management in those patients is still scarce. This study aims to describe this recently increasing clinical entity in relation to COVID‐19 patients. Study Design Longitudinal prospective study. Methods Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID‐19 infection. Antifungal agents given included amphotericin B, voriconazole, and/or posaconazole. Surgical treatment was restricted to patients with PCR negative results for COVID‐19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow‐up for survived patients was maintained regularly for the first postoperative month. Results A total of 36 patients with a mean age of 52.92 ± 11.30 years old were included. Most common associated disease was diabetes mellitus (27.8%). Mycological analysis revealed infection with Mucor and Aspergillus species in 77.8% and 30.6% of patients, respectively. Sino‐nasal, orbital, cerebral, and palatine involvement was found in 100%, 80.6%, 27.8%, and 33.3% of patients, respectively. The most common reported symptoms and signs are facial pain (75%), facial numbness (66.7%), ophthalmoplegia, and visual loss (63.9%). All patients were treated simultaneously by surgical debridement with antifungal medications except for two patients with PCR‐positive swab for COVID‐19. These two patients received antifungal therapy alone. Overall survival rate was 63.89% (23/36). Conclusion Clinical suspicion of acute invasive fungal sinusitis among COVID‐19 patients and early management with antifungal therapy and surgical debridement is essential for better outcomes and higher survival. Level of Evidence 4 Laryngoscope, 131:2652–2658, 2021
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Affiliation(s)
- Noha Ahmed El-Kholy
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Musaad Abd El-Fattah
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yasser W Khafagy
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol 2021; 135:442-447. [PMID: 33827722 PMCID: PMC8060545 DOI: 10.1017/s0022215121000992] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease. METHODS A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection. RESULTS Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment. CONCLUSION New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.
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Affiliation(s)
- S Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - M Grover
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - S Bhargava
- Department of Pathology, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - S Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - T Kataria
- Department of Otorhinolaryngology and Head Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, India
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Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report. Eur J Ophthalmol 2021; 32:NP11-NP16. [PMID: 33843287 PMCID: PMC9294610 DOI: 10.1177/11206721211009450] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To report two cases of COVID-19 under treatment with a corticosteroid; in one
case rhino-orbitocerebral mucormycosis and in another one rhino-orbital
mucormycosis developed. Case presentation: A 40-year old woman and a 54-year old man with severe COVID-19 underwent
corticosteroid therapy for immune-related lung injuries. The first case
presented with a bilateral visual loss and complete ophthalmoplegia of the
right eye. The second case presented with vision loss, proptosis, orbital
inflammation, and complete ophthalmoplegia on the left side.
Histopathologic, nasal endoscopic examinations, and radiologic findings
confirmed mucormycosis in both patients. The patients denied orbital
exenteration and were managed with systemic amphotericin B and daily
endoscopic sinus debridement and irrigation with diluted amphotericin B.
Because of the intracranial space involvement, the first case died. The
second case was successfully managed surgically and medically. Conclusion: Rhino-orbital/cerebral mucormycosis may be developed in COVID-19 patients
under treatment with corticosteroid, and requires prompt diagnosis and
management.
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Affiliation(s)
- Amirreza Veisi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Bagheri
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Eshaghi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Hasan Rikhtehgar
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Farjad
- Depatment of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies.
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A Rare Indolent Course of Rhinocerebral Mucormycosis. Case Rep Infect Dis 2021; 2021:4381254. [PMID: 33575046 PMCID: PMC7857922 DOI: 10.1155/2021/4381254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
Mucormycosis is a highly invasive and rapidly progressing form of fungal infection that can be fatal. The infection usually begins after oral or nasal inhalation of fungal spores and can enter the host through a disrupted mucosa or an extraction wound. The organism becomes pathogenic when the host is in an immunocompromised state. There are several clinical presentations of mucormycosis including rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous forms. The most common clinical presentation of mucormycosis is the rhinocerebral form which has a high predilection for patients with diabetes and metabolic acidosis. An indolent disease course taking weeks to months of this infection is rare making it difficult to diagnose. Therefore, early detection and prompt treatment with surgical and antifungal therapy are very important in achieving good treatment outcomes.
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Juneja A, Anand K, Bhowmik S, Mahajan R, Dubey M. Anterior Cavernous and Internal Carotid Artery Thrombosis - A Rare Complication of Rhino-orbito-cerebral Mucormycosis. Neurol India 2021; 69:1876-1877. [DOI: 10.4103/0028-3886.333469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yamamoto K, Mawatari M, Fujiya Y, Kutsuna S, Takeshita N, Hayakawa K, Nakamura M, Takanabe Y, Maruoka Y, Inoue M, Hara T, Nagasaka S, Tayama N, Miyazaki Y, Umeyama T, Ohmagari N. Survival case of rhinocerebral and pulmonary mucormycosis due to Cunninghamella bertholletiae during chemotherapy for acute myeloid leukemia: a case report. Infection 2020; 49:165-170. [PMID: 32720129 DOI: 10.1007/s15010-020-01491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
A 42-year-old man diagnosed with acute myeloid leukemia complained of progressive swelling of the right side of his face with pain 11 days after the third cycle of consolidation therapy with high-dose arabinosylcytosine-cytarabine. Head and neck magnetic resonance imaging showed a mass lesion in his right maxillary sinus with parapharyngeal involvement, which included the right masseter muscle, intraorbital involvement, and an abscess in his brain. Chest computed tomography revealed peribronchial small nodules in his right upper lobe and a necrotic tumor in his right lower lobe. Molds identified as Cunninghamella bertholletiae were isolated from the necrotic ulcer. According to these results, chemotherapy for leukemia was discontinued. High-dose liposomal amphotericin (10 mg/kg/day) was initiated. Because renal dysfunction occurred, the dosage was decreased to 6 mg/kg and combined with 150 mg/day micafungin. Debridement of necrotic tissue in the right maxillary sinus and establishment of the fenestration between the sinus and oral cavity were performed. Subsequently, brain and lung lesions were surgically removed. Rhinocerebral mucormycosis was successfully treated without relapse over 3 years by a 112-day course of intravenous anti-fungal therapy and 223-day course of terbinafine and partial surgical removal, respectively, to maintain masticatory and ocular functions. To our knowledge, there has been no other report of a long-term survival case of rhinocerebral mucormycosis due to C. bertholletiae.
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Affiliation(s)
- Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.
| | - Momoko Mawatari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiro Fujiya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Miki Nakamura
- Department of Hematology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Takanabe
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Takashi Umeyama
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
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Shariati A, Moradabadi A, Chegini Z, Khoshbayan A, Didehdar M. An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies. Infect Drug Resist 2020; 13:2329-2354. [PMID: 32765009 PMCID: PMC7369308 DOI: 10.2147/idr.s254478] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
In patients with hematologic malignancies due to immune system disorders, especially persistent febrile neutropenia, invasive fungal infections (IFI) occur with high mortality. Aspergillosis, candidiasis, fusariosis, mucormycosis, cryptococcosis and trichosporonosis are the most important infections reported in patients with hematologic malignancies that undergo hematopoietic stem cell transplantation. These infections are caused by opportunistic fungal pathogens that do not cause severe issues in healthy individuals, but in patients with hematologic malignancies lead to disseminated infection with different clinical manifestations. Prophylaxis and creating a safe environment with proper filters and air pressure for patients to avoid contact with the pathogens in the surrounding environment can prevent IFI. Furthermore, due to the absence of specific symptoms in IFI, rapid and accurate diagnosis reduces the mortality rate of these infections and using molecular techniques along with standard mycological methods will improve the diagnosis of disseminated fungal infection in patients with hematologic disorders. Amphotericin B products, extended-spectrum azoles, and echinocandins are the essential drugs to control invasive fungal infections in patients with hematologic malignancies, and according to various conditions of patients, different results of treatment with these drugs have been reported in different studies. On the other hand, drug resistance in recent years has led to therapeutic failures and deaths in patients with blood malignancies, which indicates the need for antifungal susceptibility tests to use appropriate therapies. Life-threatening fungal infections have become more prevalent in patients with hematologic malignancies in recent years due to the emergence of new risk factors, new species, and increased drug resistance. Therefore, in this review, we discuss the different dimensions of the most critical invasive fungal infections in patients with hematologic malignancies and present a list of these infections with different clinical manifestations, treatment, and outcomes.
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Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Moradabadi
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Khoshbayan
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
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Abdolalizadeh P, Kashkouli MB, Khademi B, Karimi N, Hamami P, Es'haghi A. Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis. Mycoses 2020; 63:573-578. [DOI: 10.1111/myc.13078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Parya Abdolalizadeh
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Mohsen Bahmani Kashkouli
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Behzad Khademi
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Nasser Karimi
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Parisa Hamami
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Acieh Es'haghi
- Eye and skull base Research Centers The Five Senses Institute Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
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Shields BE, Rosenbach M, Brown-Joel Z, Berger AP, Ford BA, Wanat KA. Angioinvasive fungal infections impacting the skin. J Am Acad Dermatol 2019; 80:869-880.e5. [DOI: 10.1016/j.jaad.2018.04.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/19/2023]
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Cohen Atsmoni S, Brener A, Roth Y. Diabetes in the practice of otolaryngology. Diabetes Metab Syndr 2019; 13:1141-1150. [PMID: 31336457 DOI: 10.1016/j.dsx.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is the most common endocrine disease, characterized by chronic hyperglycemia. The hyperglycemic milieu leads to endothelial injury in blood vessels of variant size, which results in microangiopathy and macroangiopathy (atherosclerosis). Consequential ischemia of nerves and hyperglycemia by itself lead to nerve degeneration and generalized neuropathy, affecting most often the sensory peripheral nerves and the autonomic nervous system. Auditory, vestibular and olfactory sensorium may be compromised by DM. People with DM have an increased susceptibility to infection, as a result of neutrophil dysfunction and impaired humoral immunity. Therefore DM predisposes to certain infectious diseases, such as fungal sinusitis or malignant otitis externa, which are rare in general population. Recovery from infections or from injuries may be compromised by coexisting DM. In this review we discuss complications of DM in the head and neck region. Otolaryngologists and general practitioners should be alert to specific conditions related to DM and be minded of the relevant complications and consequences.
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Affiliation(s)
- Smadar Cohen Atsmoni
- Department of Otolaryngology-Head and Neck Surgery, The Edith Wolsfon Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Avivit Brener
- Pediatric Endocrinology & Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head and Neck Surgery, The Edith Wolsfon Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Therakathu J, Prabhu S, Irodi A, Sudhakar SV, Yadav VK, Rupa V. Imaging features of rhinocerebral mucormycosis: A study of 43 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Pathak VK, Saxena R, Awasthi S, Gaur S, Singh SK. Rhinoorbitocerebral Mucormycosis with Maggots in a Neglected Diabetic Patient. Indian J Otolaryngol Head Neck Surg 2017; 70:156-158. [PMID: 29456961 DOI: 10.1007/s12070-017-1171-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 07/17/2017] [Indexed: 11/24/2022] Open
Abstract
Mucormycosis is a rare opportunistic fungal infection in immunocompromised patients, Rhizopus species are most common, sometimes mucormycosis can be life threatening we report a case of rhinoorbitocerebral mucormycosis a patient with diabetic ketoacidosis secondarily infected by maggots with altered consciousness and metabolic decompensation.
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Affiliation(s)
- Vivek Kumar Pathak
- Department of Otorhinolaryngology, SMS &R, Sharda Univesity, Greater Noida, U.P. India
| | - Rohit Saxena
- Department of Otorhinolaryngology, SMS &R, Sharda Univesity, Greater Noida, U.P. India
| | - Sanjeev Awasthi
- Department of Otorhinolaryngology, SMS &R, Sharda Univesity, Greater Noida, U.P. India
| | - Sushil Gaur
- Department of Otorhinolaryngology, SMS &R, Sharda Univesity, Greater Noida, U.P. India
| | - Sunil Kumar Singh
- Department of Otorhinolaryngology, SMS &R, Sharda Univesity, Greater Noida, U.P. India
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Abstract
BACKGROUND Immunosuppressive therapy places pediatric patients at risk of developing life-threatening sinonasal infections. Diagnosis and treatment are challenging owing to nonspecific signs and symptoms. The aim of this study was to present our department's experience with the surgical management of acute rhinosinusitis in immunosuppressed children. METHODS The records of all children with a hematologic or oncologic disease who underwent endoscopic sinus surgery (ESS) for acute rhinosinusitis from January 2005 to May 2014 were reviewed. Data were retrospectively collected on demographics, clinical and imaging characteristics, microbiology, pathology, treatment and outcome. RESULTS Thirty-four-immunosuppressed children underwent ESS for acute rhinosinusitis. Most patients had a fungal infection. Nineteen patients died at the end of follow-up; 10 deaths were infection-related. Facial swelling was the only symptom that correlated with death of infection. Relapse of the underlying disease, bone marrow transplantation, and long duration of neutropenia correlated with infection-related mortality. Fungal infection, and specifically Aspergillus, correlated with death from infection. CONCLUSIONS ESS is a safe and efficient procedure for diagnosing and treating immunosuppressed pediatric patients with acute rhinosinusitis. Early detection and aggressive medical and surgical treatment, with control of underlying risk factors, are crucial to improve outcome.
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Afroze SN, Korlepara R, Rao GV, Madala J. Mucormycosis in a Diabetic Patient: A Case Report with an Insight into Its Pathophysiology. Contemp Clin Dent 2017; 8:662-666. [PMID: 29326525 PMCID: PMC5754995 DOI: 10.4103/ccd.ccd_558_17] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucormycosis is one of the most rapidly progressing and fulminant forms of fungal infection which usually begins in the nose and paranasal sinuses following inhalation of fungal spores. It is caused by organisms of the subphylum Mucormycotina, including genera as Absidia, Mucor, Rhizomucor, and Rhizopus. The incidence of mucormycosis is approximately 1.7 cases per 1,000,000 inhabitants per year. Mucormycosis affecting the maxilla is rare because of rich blood vessel supply of maxillofacial areas although more virulent fungi such as Mucor can overcome this difficulty. The common form of this infection is seen in the rhinomaxillary region and in patients with immunocompromised state such as diabetes. Hence, early diagnosis of this potentially life-threatening disease and prompt treatment is of prime importance in reducing the mortality rate.
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Affiliation(s)
- Syeda Neelam Afroze
- Department of Oral Pathology and Microbiology, Mamata Dental College, Khammam, Telangana, India
| | - Rajani Korlepara
- Department of Oral Pathology and Microbiology, Mamata Dental College, Khammam, Telangana, India
| | | | - Jayakiran Madala
- Department of Oral Pathology and Microbiology, Mamata Dental College, Khammam, Telangana, India
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Bozorgi V, Talebitaher M, Shalbaf N, Radmanesh N, Nasri F, Ansari-Ramandi MM. Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran. Pan Afr Med J 2016; 24:232. [PMID: 27800087 PMCID: PMC5075458 DOI: 10.11604/pamj.2016.24.232.9688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/21/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran. Methods This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments. Results Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay. Conclusion There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.
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Affiliation(s)
- Vida Bozorgi
- Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Talebitaher
- Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Shalbaf
- Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Radmanesh
- Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nasri
- Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Bakhshaee M, Bojdi A, Allahyari A, Majidi MR, Tavakol S, Najafzadeh MJ, Asghari M. Acute invasive fungal rhinosinusitis: our experience with 18 cases. Eur Arch Otorhinolaryngol 2016; 273:4281-4287. [PMID: 27272179 DOI: 10.1007/s00405-016-4109-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive life threatening infection that is seen most commonly among immunocompromised patients. We present a case series of 18 patients clinically and histopathologically diagnosed with AIFRS with a mean follow-up of 9.11 ± 2.51 months (range 6-17). Demographic data, apparent symptoms and signs, underlying disorders, and outcomes are discussed. The mean age was 39.56 ± 20.66 years (range 2-75). The most common underlying diseases were diabetes mellitus (50 %) and leukemia (44.44 %). Mucosal biopsy confirmed fungal invasion of the nasal mucosa in all cases. The main fungi were Rhizopus oryzae (55.56 %), Absidia mucor (16.67 %), and Aspergillus fumigatus (27.78 %). Headache and facial pain (77.8 %), facial paresthesia (55.6 %), and ophthalmoplegia (33.3 %) were the most common symptoms and signs. Computed tomography and endoscopic findings showed various stages of sinonasal (100 %), pterygopalatine fossa (55.56 %), orbital (44.45 %), and cerebral (5.56 %) involvement. All patients underwent serial surgical debridement (3.78 ± 1.80 times; range 2-8) simultaneously with systemic antifungal therapy and proper management of the underlying disease. The most extreme case with brain involvement survived and recovered with no evidence of recurrent disease following treatment. All patients were considered cured after two endoscopic negative histopathologic evaluations. Three patients (16.67 %) died, one from uncontrolled leukemia and two due to renal failure. AIFRS is a potentially fatal condition, however, early diagnosis and management of the underlying disease accompanied with systemic antifungal and aggressive serial surgical intervention appears to be effective in reducing mortality in most patients.
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Affiliation(s)
- Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Bojdi
- Infectious Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolghasem Allahyari
- Hematology-Oncology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Majidi
- Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Manjunath KS, Shivaswamy S, Kulkarni JD, Kenkare Venkatachalaiah R. Rhino-orbito-cerebral mucormycosis (ROCM) with internal carotid artery stenosis in a diabetic patient with caries tooth and oroantral fistula. BJR Case Rep 2016; 2:20150447. [PMID: 30363653 PMCID: PMC6180894 DOI: 10.1259/bjrcr.20150447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/12/2015] [Accepted: 01/03/2016] [Indexed: 11/15/2022] Open
Abstract
Mucormycosis is a rare, potentially fatal and opportunistic infection caused by fungi belonging to the order Mucorales. Rhinocerebral, gastrointestinal, pulmonary, cutaneous and disseminated are the different forms of mucormycosis. Rhinocerebral mucormycosis is the most common type and presents as a highly destructive infection in immunocompromised hosts, especially in patients with poorly controlled diabetes. The infection originates in the nasal mucosa owing to fungal inoculation and then spreads to the paranasal sinuses, orbits, orbital apex, cavernous sinuses and brain. Our patient was a 36-year-old female with poorly controlled diabetes who presented with orbital symptoms and signs, with very subtle involvement of the sinuses. She had stenosis of the entire left internal carotid artery, with multiple small infarcts in the left frontal and parietal lobes. She incidentally had tooth caries tooth with a periapical cyst and an oroantral fistula. Ours was a histopathologically proven case of rhino-orbito-cerebral mucormycosis.
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Affiliation(s)
| | - Santosh Shivaswamy
- Department of Otorhinolaryngology, Columbia Asia Hospital, Bangalore, India
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Green KK, Barham HP, Allen GC, Chan KH. Prognostic Factors in the Outcome of Invasive Fungal Sinusitis in a Pediatric Population. Pediatr Infect Dis J 2016; 35:384-6. [PMID: 26673979 DOI: 10.1097/inf.0000000000001015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric invasive fungal sinusitis (IFS) is rare, and its prognosticators are poorly understood. The aim of this study was to determine important factors affecting outcome. METHODS A 10-year retrospective review at a tertiary academic children's hospital was performed using an International Classification of Diseases, 9th revision, and a procedure-based search after institutional review board approval. All relevant demographic and clinical information was collected. RESULTS Fourteen immune-compromised patients (male:female = 7:7, mean age = 10 years, range 2-16 years) were identified who had hematologic malignancies (11), diabetes mellitus (2) and unknown predisposing factors (1). Fungal species included Aspergillus (5), Mucor (5), Alternaria (2), Rhizopus (1) and Scopulariopsis (1). The cohort underwent an average of 6.1 (median = 5) endoscopic sinus surgeries and were treated with aggressive antifungal therapy. Four deaths occurred in the study population: 2 were attributable to IFS and 2 attributable to their underlying malignancies. There was a significant difference in the median absolute neutrophil count (ANC) at follow-up after treatment of IFS between the survival and the mortality subgroups, with ANC being 4290.5 and 169, respectively (P < 0.001). CONCLUSIONS Despite the small sample size, this study represents the largest case series in the medical literature on pediatric IFS. Age, gender, underlying cause for immunodeficiency and mycologic agent were not important prognosticators. ANC appears to be the only factor responsible for survival. The role of endoscopic sinus surgeries in survival is indeterminate.
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Affiliation(s)
- Katherine K Green
- From the Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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