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Zhao Y, Tian W, Yang J, Li X, Lu H, Yu N, Zhang P, Liu C, Chen P, Lei G, Liu Y. Fungal Endophthalmitis in a Case of Rhino-Orbito-Cerebral Mucormycosis: Successfully Treated With Amphotericin B Colloidal Dispersion. Front Microbiol 2022; 13:910419. [PMID: 35783387 PMCID: PMC9240434 DOI: 10.3389/fmicb.2022.910419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rhino-orbito-cerebral mucormycosis (ROCM) is an acute, fulminant, opportunistic fungal infection that usually occurs in diabetes or immunocompromised patients. Amphotericin B combined with surgical debridement remains the standard treatment, although it is controversial due to its lager nephrotoxicity. Thus far, no studies have reported the treatment for ROCM-associated fungal endophthalmitis because the exact pathogenesis and transmission routes in ROCM remain unclear. Here, we reported a case of ROCM complicated with fungal endophthalmitis treated favorably with amphotericin B colloidal dispersion (ABCD) in combination with other antifungals and surgical debridement. Case Presentation A 34-year-old woman with diabetes was admitted to our hospital owing to right-sided headache for 8 days, blindness with swelling in the right eye for 5 days, and blindness in the left eye for 1 day. MRI showed that the patient had sphenoid sinus, sinuses, frontal lobe lesions, and proptosis of the right eye. Metagenomic sequencing revealed that the patient had Rhizopus oryzae infection. During hospitalization, the patient received intravenous ABCD, oral posaconazole, and topical amphotericin B and underwent surgical debridement. After 67 days of treatment, the patient’s condition was significantly improved, and limb muscle strength showed grade V. Rhizopus oryzae showed negative results, and conjunctival swelling decreased. Additionally, no nephrotoxicity occurred during treatment. After discharge, the patient’s treatment was transitioned to oral posaconazole and she was free of complaints during the 30-day follow-up without any additional treatment for ROCM. Conclusion Treatment with ABCD combined with other antifungal drugs and surgical debridement for ROCM complicated with fungal endophthalmitis showed remarkable efficacy and good safety. Hence, this regimen is a promising treatment strategy for this fatal disease.
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Affiliation(s)
- Yinlong Zhao
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenbin Tian
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiankai Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueqing Li
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huaihai Lu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Yu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pei Zhang
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pengfei Chen
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guang Lei
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ya Liu,
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Cheruvu VPR, Khan MM. Reconstruction in Rhino-Orbito-Cerebral Mucormycosis Survivors: A Systematic Review. EPLASTY 2022; 22:e20. [PMID: 35873068 PMCID: PMC9275414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of COVID-19-associated mucormycosis. On June 7th, 2021, the Indian Union Health Minister stated that 28,252 cases of mucormycosis were reported from 28 states/Union territories in the country. METHODS A PubMed search was conducted for English-language studies published from 1988 through May 22, 2021 using the terms "reconstruction AND mucormycosis." RESULTS The search yielded 102 results. After excluding the articles not describing reconstruction in mucormycosis, 53 abstracts were screened. Then 34 articles dealing with reconstruction in non-ROC regions were excluded. The full text of 16 articles was reviewed. Additionally, 3 articles were identified from the reference search. Due to the aggressive debridements, rhino-orbito-cerebral mucormycosis survivors may be left with complex tissue defects with significant functional and aesthetic impairments. It is essential to offer reconstructive solutions that improve their quality of life. As far as the timing of reconstruction is concerned, the consensus is in favor of delayed reconstruction after ensuring that the infection has been eliminated/controlled and that there are no recurrences. The most common defects encountered were the ones that resulted from orbital exenteration and excision of a varying extent of the involved contiguous bony and soft tissue structures. Reconstruction with pedicled flaps was preferred rather than free flaps, especially in the cases where the infection was not eliminated completely. Adjuvant antifungal therapy was used in most of the cases. Long-term follow-up was considered essential to detect and treat recurrences. CONCLUSIONS A multitude of options are available for reconstruction in rhino-orbito-cerebral mucormycosis including skin grafts, pedicled flaps, free flaps and in some cases implants and prosthetics. These can be utilized to give as much as functional and aesthetic restoration as possible to the patient.
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Affiliation(s)
| | - Manal M Khan
- All India Institute of Medical Sciences, Bhopal, India
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Palou EY, Ramos MA, Cherenfant E, Duarte A, Fuentes-Barahona IC, Zambrano LI, Muñoz-Lara F, Montoya-Ramirez SA, Cardona-Ortiz AF, Valle-Reconco JA, Montenegro-Idrogo JJ, Bonilla-Aldana DK, Paniz-Mondolfi AE, Rodriguez-Morales AJ. COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis-A Case Report from Honduras. Vaccines (Basel) 2021; 9:826. [PMID: 34451951 PMCID: PMC8402527 DOI: 10.3390/vaccines9080826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. CASE A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. CONCLUSIONS Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.
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Affiliation(s)
- Elsa Yolanda Palou
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
| | | | - Emec Cherenfant
- Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Adoni Duarte
- Department of Morphological Sciences, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Itzel Carolina Fuentes-Barahona
- Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Department of Gynecology and Obstetrics, Hospital Escuela, Tegucigalpa 11101, Honduras
| | - Lysien I. Zambrano
- Unit of Scientific Research (UIC), Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
| | - Fausto Muñoz-Lara
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
- Department of Internal Medicine, Hospital Escuela, Tegucigalpa 11101, Honduras;
| | | | - Alex Francisco Cardona-Ortiz
- Post-Graduate Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Jorge Alberto Valle-Reconco
- Deanship, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Juan J. Montenegro-Idrogo
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima 15046, Peru
- Infectious and Tropical Diseases Service, Hospital Nacional Dos de Mayo, Lima 15072, Peru
| | - D. Katterine Bonilla-Aldana
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Semillero de Investigación en Zoonosis (SIZOO), Grupo de Investigación GISCA, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira 660003, Colombia
| | - Alberto E. Paniz-Mondolfi
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Laboratory of Microbiology, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Instituto de Investigaciones Biomédicas IDB/Incubadora Venezolana de la Ciencia, Barquisimeto 3001, Venezuela
| | - Alfonso J. Rodriguez-Morales
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Risaralda 660003, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15046, Peru
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Use of topical amphotericin in a case of refractory sino-orbital angioinvasive mucormycosis. Med Mycol Case Rep 2021; 33:21-25. [PMID: 34295641 PMCID: PMC8282967 DOI: 10.1016/j.mmcr.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
The standard of care for treatment of sino-orbital mucormycosis involves aggressive surgical debridement and liposomal amphotericin, and the roles of adjunctive and topical therapies are less clear. Here we describe a case of severe refractory sino-orbital mucormycosis in an immunocompetent patient who responded to combination therapy with liposomal amphotericin, isavuconazole, micafungin, and topical amphotericin deoxycholate after failing to achieve negative surgical margins.
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Pałka Ł, Gaur V. The importance of mucormycosis infections on
example of Rhino Orbital Cerebral Mucormycosis. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, characterized by high morbidity and mortality
and is strongly dependent on the patient’s general health condition, initial site of infection,
and the time from diagnosis to treatment commencement. It has been reported that the
occurrence of mucormycosis has increased rapidly, also among immunocompetent patients.
Moreover, the rise in number is expected to continue. Among all clinical manifestations of
mucormycosis, the rhino-orbital-cerebral type (ROCM) is the most common. The aim of this
article is to increase the awareness of mucoral infections, especially ROCM, and to describe its
first symptoms, as proper treatment requires immediate surgical and medical intervention.
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Affiliation(s)
| | - Vivek Gaur
- Jaipur Dental College, Maharaj Vinayek Global University, Jaipur, India
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