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Naurka S, Rana N, Singh N, Kishore A, Nagpal K. COVID-19 associated rhino-orbital-cerebral mucormycosis-an institutional series. EAR, NOSE & THROAT JOURNAL 2024; 103:134S-144S. [PMID: 35176884 PMCID: PMC8859478 DOI: 10.1177/01455613221077882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mucormycosis is almost always confined to the patients with altered host defenses amongst which diabetes is considered as the strongest risk factor. COVID-19 only been seen in severe cases but also in mild and moderate cases of SARS-CoV-2 infections. After preliminary clinical and radiological diagnosis, surgical management in the form of endoscopic sinus surgery, debridement, and orbital exenteration (8) was performed. Medical management in the form of antifungal therapy (amphotericin-B, posaconazole, and isavuconazole) was initiated. In this case series, 79 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from mid-April 2021 to mid-September 2021. 67 patients were known diabetics, whereas rest 12 had new onset diabetes mellitus. Of these 79 cases, 27 cases had the disease limited to sinuses (rhino-mucormycosis), 43 had orbital involvement also (rhino-orbital mucormycosis), and 9 had cerebral involvement as well (rhino-orbital-cerebral mucormycosis). During this time-period, a total of 14 mortalities occurred. Most of the patients were discharged after completion of amphotericin-B therapy and rest stayed little longer till their general condition improved. COVID-19 causes dysregulation and alteration of immune response in the body which predispose to invasive fungal infections. In addition, uncontrolled diabetes mellitus and corticosteroid treatment increase the risk of mucormycosis by many folds.
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Affiliation(s)
| | - Nishant Rana
- ENT, Indraprastha Apollo Hospital, New Delhi, India
| | - Neeraj Singh
- Maxillofacial Surgery, Indraprastha Apollo Hospital, New Delhi, India
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Chen X, Xiao J, Wang X, Lu X, An J, Zhao J, Wei J, Wei J, He S, Tian W. Lack of surgical resection is associated with increased early mortality in hematological patients complicated with rhino-orbital-cerebral mucormycosis. Ann Hematol 2023; 102:2933-2942. [PMID: 37421505 DOI: 10.1007/s00277-023-05349-5] [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: 03/06/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
Rhino-orbital-cerebral mucormycosis (ROCM), which is an acute fatal infectious disease with a high mortality rate, is increasingly being diagnosed in patients with hematological diseases worldwide. We aimed to investigate the clinical characteristics, treatment, and prognosis of hematological diseases complicated by ROCM. Our sample comprised a total of 60 ROCM patients with hematological diseases. The most common primary disease was acute lymphoblastic leukemia (ALL) (n=27, 45.0%), while 36 patients (60.0%) were diagnosed with a clear type of pathogen, all belonging to the Mucorales, most commonly Rhizopus (41.7%). Of the 32 patients (53.3%) who died, 19 (59.3%) died of mucormycosis, and 84.2% (n=16) of those died within 1 month. Forty-eight cases (80.0%) received antifungal treatment combined with surgical therapy, 12 of whom (25.0%) died of mucormycosis, amounting to a mortality rate that was significantly lower than in patients who received antifungal therapy alone (n=7, 58.3%) (P=0.012). The median neutrophil value of patients who underwent surgery was 0.58 (0.11-2.80) 103/μL, the median platelet value was 58.00 (17.00-93.00) 103/μL, and no surgery-related deaths were reported. Multivariate analysis showed that patient's advanced age (P=0.012, OR=1.035 (1.008-1.064)) and lack of surgical treatment (P=0.030, OR=4.971 (1.173-21.074)) were independent prognostic factors.In this study, hematological diseases associated with ROCM have a high mortality rate. Lack of surgical treatment is an independent prognostic factor for death from mucormycosis. Surgery may therefore be considered in patients with hematological disease even if their neutrophil and platelet values are lower than normal.
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Affiliation(s)
- Xinyue Chen
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Juan Xiao
- Department of Hematology, Beijing Jingdu Children's Hospital, Beijing, 102208, China
| | - Xinwei Wang
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Xinyi Lu
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
| | - Jing An
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jie Zhao
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
| | - Junni Wei
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jia Wei
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shaolong He
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China.
| | - Weiwei Tian
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030000, Shanxi, China.
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China.
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Farooq S, Khan NA, Singh A, Khan A, Sharma P, Meena R, Jakhar A, Kumar M, Kochar A. Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe. Cureus 2023; 15:e41010. [PMID: 37519583 PMCID: PMC10372466 DOI: 10.7759/cureus.41010] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.
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Affiliation(s)
- Shaheen Farooq
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Nabab A Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ajeet Singh
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Arif Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Preeti Sharma
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ritu Meena
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ankita Jakhar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Mukesh Kumar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Anju Kochar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
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Tomar K, Roy ID, Natarajan MR, Singh AK, Ramanujam V. Surgical Challenges in the Management of Post COVID-19 Midface Mucormycosis (PCoMM): An Institutional Protocol. J Craniofac Surg 2023; 34:e46-e52. [PMID: 36008879 PMCID: PMC9793999 DOI: 10.1097/scs.0000000000008963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed another serious threat, mucormycosis infection, affecting the maxilla and orbitocerebral region. This condition has not spared world population from its merciless claws. This article addresses the challenges faced by the maxillofacial surgeons in setting the protocols from preoperative diagnosis, surgical management to postoperative care, including short-term and long-term rehabilitation. To manage this relentlessly progressing condition, a multispecialty team approach is to be activated in diagnosing, managing, and rehabilitating the patients. PURPOSE The purpose of this clinical study is to document and analyze the clinical and demographic data, presentation of the lesion, the diagnostic methods followed for early clinical detection, and management of post COVID-19 midface mucormycosis. The article also discusses postoperative medical management and prosthetic rehabilitation. RESULTS Most of the mucormycosis cases reporting to our center were treated and recovered patients of Severe Acute Respiratory Syndrome Coronavirus 2 infection. Thirty-four (n=34) case were operated for post COVID-19 midface mucormycosis between October 2020 and December 2021. Male to Female ratio is 1:42. The average age of the patients was 57.5 years. Maximum patients were in fifth and sixth decade of life. Maxilla was the involved bone. Treatment was primarily surgical debridement to extended or radical maxillectomy. All patients were treated with Liposomal Amphotericin B and tab posaconazole for 3 to 4 weeks depending upon the age, weight, and physiological state of the patients to attain an optimal cumulative load. Three patients succumbed to illness postoperatively (n=3, 1.02%). Average duration of hospital stay was 47 days. The average review period was 5.1 months.
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Khare P, Chaurasia Y, Bhatnagar S. Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement. Indian J Ophthalmol 2022; 70:3638-3642. [PMID: 36190063 PMCID: PMC9789804 DOI: 10.4103/ijo.ijo_938_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019-associated mucormycosis (CAM). Methods: This was a prospective interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re-assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra-orbital anti-fungal therapy, site-centered peri-bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Results Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Conclusion Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site-centered peri-bulbar injections can be considered as an approach for delivering intra-orbital anti-fungal therapy in selected patients.
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Affiliation(s)
- Praveen Khare
- Department of Ophthalmology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
| | - Yogita Chaurasia
- Department of Ophthalmology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India,Correspondence to: Dr. Yogita Chaurasia, Shanti Nagar Colony, Sagar Road, Chhatarpur 471001, Madhya Pradesh, India. E-mail:
| | - Shweta Bhatnagar
- Department of Dentistry, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
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Saluja G, Bhari A, Pushker N, Agrawal S, Meel R, Thakar A, Xess I, Khandelwal A, Narwal A, Bajaj MS. Experience on rhino-orbital mucormycosis from a tertiary care hospital in the first wave of COVID-19: An Indian perspective. Med J Armed Forces India 2022; 79:S0377-1237(22)00009-0. [PMID: 35400798 PMCID: PMC8975717 DOI: 10.1016/j.mjafi.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background To highlight the clinical presentations and management outcomes of rhino-orbital mucormycosis during first wave of COVID-19 pandemic in North India. Methods A retrospective observational study. 15 patients with mucormycosis (orbital disease) who presented during short span of 3 months (October-December 2020) in a tertiary-care referral institution were analysed. Results At presentation, 13 of 15 patients had uncontrolled diabetes. Four had history of COVID-19 infection. All patients had advanced orbital disease with sinusitis; cavernous sinus involvement was in nine and intracranial spread in three patients. Liposomal amphotericin-B was started and prompt orbital exenteration with sinus surgery was performed in 12 patients. All 12 patients survived with an average follow-up of 4.8 months. Conclusion In the present series, cases with orbital spread of mucormycosis were mostly found in non-COVID uncontrolled diabetics. Exenteration was done in 80% of cases with advanced orbital disease. Prevention and early detection of infection at the stage of sino-nasal involvement might help to prevent spread and/or halt the orbital disease.
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Affiliation(s)
- Gunjan Saluja
- Senior Resident, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anju Bhari
- Senior Resident, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Neelam Pushker
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sahil Agrawal
- Senior Research Officer, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rachna Meel
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Alok Thakar
- Professor (Otolaryngology), AIIMS, New Delhi, India
| | | | | | | | - Mandeep S. Bajaj
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Murthy R, Gote YS, Bagchi A. Localized surgical debridement for the management of orbital mucormycosis. Indian J Ophthalmol 2022; 70:649-652. [PMID: 35086255 PMCID: PMC9023913 DOI: 10.4103/ijo.ijo_1635_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration. METHODS The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months. RESULTS The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication. CONCLUSION Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.
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Affiliation(s)
- Ramesh Murthy
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Yogita S Gote
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Aadhyaa Bagchi
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Walia S, Bhaisare V, Rawat P, Kori N, Sharma M, Gupta N, Urdhwareshwar S, Thakur S, Arya N. COVID-19-associated mucormycosis: Preliminary report from a tertiary eye care centre. Indian J Ophthalmol 2021; 69:3685-3689. [PMID: 34827023 PMCID: PMC8837340 DOI: 10.4103/ijo.ijo_2085_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: Mucormycosis is a life-threatening infection that has made sudden comeback in COVID-19 era. We conducted this study to determine demography, site of involvement, management, and outcome in these patients. Methods: All cases presenting with signs and symptoms of mucormycosis were thoroughly evaluated and confirmed diagnosis was made on demonstration of fungi in the tissue (or body fluids) either by direct microscopy and/or culture. Patients underwent computerized tomography scan for paranasal sinuses and magnetic resonance imaging scan with contrast orbit and brain to know extent of disease. Results: 540 proven cases of mucormycosis were included. Most common age group affected was 41–50 years with male preponderance (69%). Sinonasal was the most common site of involvement in mucormycosis (100%), followed by orbital (51.85%), cerebral (9.44%), cutaneous (1.85%), and pulmonary (0.18%). Most common presentation was periocular and facial swelling (28%). 97.96% patients had associated diabetes and 89.44% patients had history of COVID-19 with concurrent steroids use (84.85%), higher antibiotics (82.59%), oxygen therapy (52.40%), remdesivir (28.89%), and biological agents (2.56%). Duration from COVID-19 positivity to presentation of mucormycosis was 22.56 days, while 4.44% patients had coexisting COVID-19 with mucormycosis. The mortality rate was 9.25% (50/540). Conclusion: Timely diagnosis and appropriate management can ameliorate the consequences of mucormycosis. With the third wave of COVID-19 coming, epidemiological study to identify risk factors and possible management options can help physicians to develop the treatment strategy.
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Affiliation(s)
- Shweta Walia
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Vijay Bhaisare
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Preeti Rawat
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Neetu Kori
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Manushree Sharma
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Niti Gupta
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Shishir Urdhwareshwar
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Sanchiyka Thakur
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Niharika Arya
- Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
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Bijou W, Abdulhakeem B, Choukry K, Oukessou Y, Rouadi S, Abada R, Roubal M, Mahtar M. Unusual Location of a Fungus Ball: The Concha Bullosa, a Review of the Literature. ALLERGY & RHINOLOGY 2021; 12:21526567211036146. [PMID: 34457373 PMCID: PMC8387603 DOI: 10.1177/21526567211036146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The fungal balls of the paranasal sinuses are usually seen in the maxillary
and sphenoid sinuses. Although, the lesion of the concha bullosa, without
sinus participation, is very uncommon. We report the case of a fungal ball
of concha bullosa in an 88-year-old patient. Objective The objective of our review of literature is to investigate the
epidemiological, clinical, paraclinical, and therapeutic characteristics of
patients diagnosed with fungus ball in concha bullosa. Methods A case of a patient who was diagnosed with concha bullosa of a fungus ball is
reported. Demographic data, clinical presentation, imaging, and treatments
were recorded. Key images were obtained. A review of the literature was also
performed. Results A total of 12 cases have been reported so far in the literature revealed by
different symptoms. The mean age was 38.8 years and the gender ratio was ∼12
(female):1 (male). The endoscopic surgical approach was the most frequently
used treatment and provides good outcomes. Neither postoperative
complications nor recurrences were noted, however, there is insufficient
follow-up data. Conclusion Concha bullosa fungal ball is a rare diagnosis that can be revealed by
different symptoms. It should be considered in patients with and unexplained
chronic facial pain. A preoperative computed tomography scan is an essential
tool in making a diagnosis. Endoscopic surgery is the treatment of choice,
with a low morbidity and recurrence rate.
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Affiliation(s)
- Walid Bijou
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Bushra Abdulhakeem
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Karim Choukry
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Youssef Oukessou
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Sami Rouadi
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Reda Abada
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Mohammed Roubal
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Mohammed Mahtar
- ENT and Head and Neck Surgery, Hospital August 20 1953, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco, University Hospital Center IBN ROCHD, Casablanca, Morocco
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Mitra S, Janweja M, Sengupta A. Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control. Eur Arch Otorhinolaryngol 2021; 279:2417-2422. [PMID: 34309754 PMCID: PMC8312209 DOI: 10.1007/s00405-021-07010-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 02/01/2023]
Abstract
Objective To document and analyse demographic data, clinical presentation, possible interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM). Method 32 patients having history of SARS-CoV-2 infection with features of ROCM were observed in terms of their history, presenting features, clinical, microbiological examination, type of surgical intervention, surgical sites of involvement which were subsequently analyzed. Results The mean (± S.D.) age of patients was 57 ± 13 years. All patients were diabetic. Mean (± S.D.) time of onset of ROCM symptoms, since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients received steroid therapy; 28.1% received high flow nasal oxygen. 87.5% patients had blurring of vision, 65.62% headache, 59.37% cheek and eyelid swelling, 50% proptosis, 46.87% ophthalmoplegia, 40.62% ptosis, 40.62% loss of sensation over cheek, 25% orbital pain. Examination of specimen with KOH mount revealed Mucor spp. in all patients. 87.5% patients underwent endoscopic sinus surgery with debridement with/without orbital clearance; 56.25% maxillectomy; 25% orbital exenteration. 87.5% patients had paranasal sinus involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had involvement of pterygopalatine fossa±infratemporal fossa. 50% patients had disease in Vidian canal and pterygoid wedge. 25% of patients had involvement of palate and 56.25% cheek and eyelid soft tissues. Conclusion A judicious COVID treatment protocol, high index of suspicion, close monitoring of high-risk patients and early institution of treatment can prevent case severity and reduce mortality.
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Affiliation(s)
- Sandipta Mitra
- Institute of Otorhinolaryngology and Head & Neck Surgery, Institute of Post-Graduate Medical Education & Research, Kolkata, India
| | - Mridul Janweja
- Institute of Otorhinolaryngology and Head & Neck Surgery, Institute of Post-Graduate Medical Education & Research, Kolkata, India.
| | - Arunabha Sengupta
- Institute of Otorhinolaryngology and Head & Neck Surgery, Institute of Post-Graduate Medical Education & Research, Kolkata, India
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11
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Sen M, Honavar SG, Bansal R, Sengupta S, Rao R, Kim U, Sharma M, Sachdev M, Grover AK, Surve A, Budharapu A, Ramadhin AK, Tripathi AK, Gupta A, Bhargava A, Sahu A, Khairnar A, Kochar A, Madhavani A, Shrivastava AK, Desai AK, Paul A, Ayyar A, Bhatnagar A, Singhal A, Nikose AS, Bhargava A, Tenagi AL, Kamble A, Nariani A, Patel B, Kashyap B, Dhawan B, Vohra B, Mandke C, Thrishulamurthy C, Sambare C, Sarkar D, Mankad DS, Maheshwari D, Lalwani D, Kanani D, Patel D, Manjandavida FP, Godhani F, Agarwal GA, Ravulaparthi G, Shilpa GV, Deshpande G, Thakkar H, Shah H, Ojha HR, Jani H, Gontia J, Mishrikotkar JP, Likhari K, Prajapati K, Porwal K, Koka K, Dharawat KS, Ramamurthy LB, Bhattacharyya M, Saini M, Christy MC, Das M, Hada M, Panchal M, Pandharpurkar M, Ali MO, Porwal M, Gangashetappa N, Mehrotra N, Bijlani N, Gajendragadkar N, Nagarkar NM, Modi P, Rewri P, Sao P, Patil PS, Giri P, Kapadia P, Yadav P, Bhagat P, Parekh R, Dyaberi R, Chauhan RS, Kaur R, Duvesh RK, Murthy R, Dandu RV, Kathiara R, Beri R, Pandit R, Rani RH, Gupta R, Pherwani R, Sapkal R, Mehta R, Tadepalli S, Fatima S, Karmarkar S, Patil SS, Shah S, Shah S, Shah S, Dubey S, Gandhi S, Kanakpur S, Mohan S, Bhomaj S, Kerkar S, Jariwala S, Sahu S, Tara S, Maru SK, Jhavar S, Sharma S, Gupta S, Kumari S, Das S, Menon S, Burkule S, Nisar SP, Kaliaperumal S, Rao S, Pakrasi S, Rathod S, Biradar SG, Kumar S, Dutt S, Bansal S, Ravani SA, Lohiya S, Rizvi SWA, Gokhale T, Lahane TP, Vukkadala T, Grover T, Bhesaniya T, Chawla U, Singh U, Une VL, Nandedkar V, Subramaniam V, Eswaran V, Chaudhary VN, Rangarajan V, Dehane V, Sahasrabudhe VM, Sowjanya Y, Tupkary Y, Phadke Y. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol 2021; 69:1670-1692. [PMID: 34156034 PMCID: PMC8374756 DOI: 10.4103/ijo.ijo_1565_21] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
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Affiliation(s)
| | | | | | | | - Raksha Rao
- Narayana Netralaya, Bengaluru, Karnataka, India
| | - Usha Kim
- Aravind Eye Care, Madurai, Tamil Nadu, India
| | | | | | - Ashok K Grover
- Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi, India
| | - Abhidnya Surve
- Department of Ophthalmology, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Abhishek Budharapu
- Department of Head and Neck Surgery, Apollo Cancer Hospital, Hyderabad, Telangana, India
| | - Abhishek K Ramadhin
- Department of Otorhinolaryngology, Dr Abhishek K. Ramadhin Hospital and Avyaan Research Centre, Ranchi, Jharkhand, India
| | | | - Adit Gupta
- Mumbai Eye Plastic Surgery, Maharashtra, India
| | - Aditya Bhargava
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Animesh Sahu
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Anjali Khairnar
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Anju Kochar
- Department of Ophthalmology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Ankita Madhavani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Ankur K Shrivastava
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anuja K Desai
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Aparna Singhal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Archana Sunil Nikose
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
| | - Arun Bhargava
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Arvind L Tenagi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Karnataka Lingayat Education Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Ashish Kamble
- Department of Ophthalmology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Ashiyana Nariani
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Bhavin Patel
- Department of Otorhinolaryngology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | - Bodhraj Dhawan
- Department of Ophthalmology, Alexis Hospital, Nagpur, Maharashtra, India
| | - Busaraben Vohra
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Charuta Mandke
- Department of Ophthalmology, Hinduhridaysamrat Balasaheb Thackeray Medical College & Dr. R. N. Cooper Municipal Hospital, Mumbai, Maharashtra, India
| | - Chinmayee Thrishulamurthy
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Chitra Sambare
- Department of Ophthalmology, Jehangir Hospital, Pune, Maharashtra, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Dhwani Maheshwari
- Department of Ophthalmology, Sir Sayajirao Gaekwad Hospital, Vadodra, Gujarat, India
| | | | - Dipti Kanani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Diti Patel
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | | | - Frenali Godhani
- Department of Ophthalmology, Jagjivan Ram Railway Hospital, Mumbai, Maharashtra, India
| | - Garima Amol Agarwal
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Gayatri Ravulaparthi
- Department of Ophthalmology, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Hansa Thakkar
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Hardik Shah
- Department of Otorhinolaryngology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | | | - Harsha Jani
- Department of Ophthalmology, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Jyoti Gontia
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Jyotika P Mishrikotkar
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | | | - Kamini Prajapati
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Kavita Porwal
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Kirthi Koka
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | | | - Manorama Saini
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | | | - Mausumi Das
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Maya Hada
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mehul Panchal
- Department of Microbiology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | | | | | - Nagaraju Gangashetappa
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Neelima Mehrotra
- Department of Ophthalmology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Neha Bijlani
- Vision Care & Research Centre, Bhopal, Madhya Pradesh, India
| | | | - Nitin M Nagarkar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Palak Modi
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Piyushi Sao
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Prajakta Salunkhe Patil
- Department of Ophthalmology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Pramod Giri
- Max Vision Eye Hospital, Nagpur, Maharashtra, India
| | - Priti Kapadia
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Priti Yadav
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Purvi Bhagat
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Ragini Parekh
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | - Rajashekhar Dyaberi
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Rajender Singh Chauhan
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajwinder Kaur
- Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bhatinda, Punjab, India
| | - Ram Kishan Duvesh
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Ravi Varma Dandu
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Ravija Kathiara
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Renu Beri
- Department of Ophthalmology, Civil Hospital Ambala Cantonment, Haryana, India
| | - Rinal Pandit
- Department of Ophthalmology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | - Rita Hepsi Rani
- Department of Ophthalmology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
| | | | - Ruchi Pherwani
- Department of Ophthalmology, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | - Rujuta Sapkal
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | - Rupa Mehta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sameeksha Tadepalli
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Samra Fatima
- Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
| | - Sandeep Karmarkar
- Department of Otorhinolaryngology, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Sanjana Shah
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Sankit Shah
- Department of Ophthalmology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | - Sapan Shah
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Sarika Dubey
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | | | - Savitha Kanakpur
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Shalini Mohan
- Department of Ophthalmology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | | | - Sheela Kerkar
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Shivani Jariwala
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Shivati Sahu
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | | | - Shruti Kochar Maru
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Shubha Jhavar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Shubhda Sharma
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Shweta Gupta
- Sankara Eye Foundation, Indore, Madhya Pradesh, India
| | - Shwetha Kumari
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sima Das
- Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Smita Menon
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Snehal Burkule
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subramanya Rao
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Sudipto Pakrasi
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Sujatha Rathod
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sunil G Biradar
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College, Chandigarh, India
| | - Susheen Dutt
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Svati Bansal
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Swati Amulbhai Ravani
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Sweta Lohiya
- Department of Otorhinolaryngology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Syed Wajahat Ali Rizvi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | | | - Triveni Grover
- Department of Ophthalmology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Trupti Bhesaniya
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Urmil Chawla
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Usha Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali L Une
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Varsha Nandedkar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | | | - Vidya Eswaran
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Vidya Nair Chaudhary
- Department of Ophthalmology, Aakash Healthcare Super-Specialty Hospital, New Delhi, India
| | | | - Vipin Dehane
- Department of Oral and Maxillofacial Surgery, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Vivek M Sahasrabudhe
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Yashaswini Tupkary
- Department of Medicine, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Yogita Phadke
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
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12
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J Ophthalmol 2021; 69:244-252. [PMID: 33463566 PMCID: PMC7933891 DOI: 10.4103/ijo.ijo_3774_20] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.
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Affiliation(s)
- Mrittika Sen
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India
| | - Sumeet Lahane
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Ragini Parekh
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Santosh G Honavar
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India
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Hamed-Azzam S, AlHashash I, Briscoe D, Rose GE, Verity DH. Rare Orbital Infections ~ State of the Art ~ Part II. J Ophthalmic Vis Res 2018; 13:183-190. [PMID: 29719648 PMCID: PMC5905313 DOI: 10.4103/jovr.jovr_202_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Infections of the orbit and periorbita are relatively frequent. Identifying unusual organisms is crucial because they can cause severe local and systemic morbidity, despite their rarity. Opportunistic infections of the orbit should be considered mainly in debilitated or immunocompromised patients. The key to successful management includes a high index of suspicion, prompt diagnosis, and addressing the underlying systemic disease. This review summarizes unusual infectious processes of the orbit, including mycobacterial, fungal, and parasitic infections, as well as their pathophysiology, symptoms, signs, and treatment.
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Affiliation(s)
- Shirin Hamed-Azzam
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
| | | | | | - Geoffrey E Rose
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - David H Verity
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
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15
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Plowes Hernández O, Prado Calleros HM, Soberón Marmissolle Daguerre GS, Sadek González A. Rhino-Orbito-Cerebral Mucormycosis. Management Strategies to Avoid or Limit Intracraneal Affection and Improve Survival. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Karadeniz Uğurlu Ş, Selim S, Kopar A, Songu M. Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases. Turk J Ophthalmol 2015; 45:169-174. [PMID: 27800226 PMCID: PMC5082276 DOI: 10.4274/tjo.82474] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/21/2014] [Indexed: 12/19/2022] Open
Abstract
In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration.
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Affiliation(s)
| | - Sedat Selim
- Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Aylin Kopar
- Katip Çelebi University Faculty of Medicine, Atatürk Teaching and Research Hospital, Clinic of Ear-Nose and Throat, İzmir, Turkey
| | - Murat Songu
- Katip Çelebi University Faculty of Medicine, Atatürk Teaching and Research Hospital, Clinic of Ear-Nose and Throat, İzmir, Turkey
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Rhino-orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:348-52. [PMID: 26048708 DOI: 10.1016/j.otorri.2015.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 12/26/2022]
Abstract
Mucormycosis is a rare opportunistic infection. The aim of the study was to review the cases presented in our department with rhino-orbital mucormycosis and to describe the clinical protocol, diagnosis and therapy used in these patients. We conducted a retrospective, longitudinal, descriptive study, in which we evaluated the records of patients with rhino-orbital mucormycosis in the period from January to October 2013. We found 5 cases. Pterigomaxillary fossa disease was found in 100% of our patients. Medical and surgical treatment performed early by extensive endoscopic debridement (including debridement and resection of pterygomaxillary fossa) and orbital exenteration in patients presenting with orbitary apex syndrome in conjunction with the ophthalmology department of our hospital, with excellent results in the survival of our patients (all patients survived).
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Abstract
Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling is pertinent to informed consent and in addressing patients' expectations. A retrospective review from one tertiary care centre was undertaken for a cohort of patients who were exenterated for orbital malignancy between 1998 and 2010. The cases were identified using an International Classification of Diseases 10th Revision (ICD-10)-derived database and were analysed using Prism statistical software (V.5.04). Cause of death was ascertained by liaising with the general practitioner and the National Registrar Office for Births, Deaths, and Marriages, Southport, UK. In total, 41 men and 32 women were identified. Mean age was 72 years with 47 cases living and 26 deceased at the time of review. The overall 5-year survival rate in this study was 64%. Kaplan-Meier analysis for basal cell carcinoma (BCC) against non-BCC returned a p value of 0.0199, with an HR of 0.3927 (CI 0.1788 to 0.8626). Kaplan-Meier analysis for cleared against non-cleared margins returned a p value of 0.2890, with an HR of 0.6571(CI 0.3024 to 1.428). Our results represent the highest 5-year survival data to date. However, the overall prognosis for patients who undergo orbital exenteration for malignancy remains poor. We hypothesise that the causes are multi-factorial. We recommend a multidisciplinary approach to the care of these patients, involving head and neck teams, oncology and other appropriate specialties, to optimise outcomes for this vulnerable patient group.
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Affiliation(s)
| | | | - Anne Cook
- Manchester Royal Eye Hospital, Manchester, UK
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Zhang J, Kim JD, Beaver HA, Takashima M, Lee AG. Rhino-orbital Mucormycosis Treated Successfully with Posaconazole without Exenteration. Neuroophthalmology 2013; 37:198-203. [PMID: 28167988 DOI: 10.3109/01658107.2013.809463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/21/2013] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is a rare and often fatal opportunistic angioinvasive infection seen mostly in immunocompromised patients, such as those with diabetes mellitus, cancer, or renal failure. Ophthalmic manifestations of orbital mucormycosis include ocular pain, periocular oedema, visual loss, ophthalmoplegia, proptosis, and ptosis. Although therapy for orbital mucormycosis consists of maximally tolerated doses of antifungal agents (e.g., amphotericin B) and extensive surgical debridement, treatment remains ineffective in up to 20% of cases. We describe two patients with rhino-orbitalmucormycosis who were successfully treated with posaconazole in conjunction with intravenous (IV) amphotericin B and sinus surgical debridement. These cases highlight several unusual early manifestations of orbital mucormycosis, including disc oedema and amaurosis fugax, as well as the applicability of a new extended-spectrum antifungal agent in management of orbital zygomycosis.
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Affiliation(s)
- Jason Zhang
- Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Baylor College of Medicine, HoustonTexasUSA
| | - James D Kim
- Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Department of Ophthalmology, The University of Texas Medical Branch, GalvestonTexasUSA
| | - Hilary A Beaver
- Department of Ophthalmology, The Methodist Hospital, Houston Texas USA
| | | | - Andrew G Lee
- Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Baylor College of Medicine, HoustonTexasUSA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New YorkNew YorkUSA; Department of Ophthalmology, The University of Texas Medical Branch, GalvestonTexasUSA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa CityIowaUSA
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Aryasit O, Preechawai P, Aui-Aree N. Clinical presentation, aetiology and prognosis of orbital apex syndrome. Orbit 2013; 32:91-94. [PMID: 23514029 DOI: 10.3109/01676830.2013.764439] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To present the clinical features, determine the causes and evaluate the prognosis of orbital apex syndrome in patients of Songklanagarind Hospital. METHODS A retrospective review was conducted of patients diagnosed with orbital apex syndrome between January 1, 2002 and December 31, 2008. RESULTS In our series, the major cause of orbital apex syndrome was carotid-cavernous sinus fistula, for which 30 patients were diagnosed. After excluding those patients whose condition was caused by carotid-cavernous sinus fistula, 50 patients (58 eyes) were analyzed. The mean age of the patients was 47.60 ± 18.88 years (27 male patients and 23 female patients). The most common presenting symptom was blurred vision (86%). The median duration of the presenting symptom was 37.5 d. Of the 50 patients the most frequent aetiology of orbital apex syndrome was neoplasia (48%), of which lymphoma was the most common in this group. After treatment, the vision of 19.4% of the patients improved and proptosis improved by 68.4%. CONCLUSIONS The most common presenting symptom of orbital apex syndrome was blurred vision. The most frequent aetiology of orbital apex syndrome of all patients was carotid-cavernous sinus fistula, while the next most frequent was neoplasm, of which lymphoma was the most common in this group. Patients had a good outlook, after treatment directed at the cause, with a modest improvement in vision and exophthalmos in more than half of patients.
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Affiliation(s)
- Orapan Aryasit
- Faculty of Medicine, Department of Ophthalmology, Prince of Songkla University, Hat Yai, 90112, Thailand.
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An unusual location for a fungus ball: the concha bullosa. The Journal of Laryngology & Otology 2012; 126:844-6. [DOI: 10.1017/s0022215112001247] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:We report an unusual case of a fungus ball in the concha bullosa, without involvement of the paranasal sinuses.Case report:A 29-year-old woman presented complaining of nasal obstruction and postnasal discharge. Paranasal computed tomography demonstrated that the concha bullosa in the right middle turbinate was filled with a high-density material. The patient underwent endoscopic resection of the concha bullosa, during which a dark brown, cheese-like material was found. Histopathological examination of the excised specimen revealed a fungus ball.Conclusion:Fungus balls are non-invasive accumulations of dense fungal concretions that generally affect healthy individuals. In the sinonasal region, they occur most frequently in the maxillary sinus. Although fungus ball formation in the concha bullosa is unusual, it should be considered in the differential diagnoses of middle turbinate and sinonasal pathology.
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Kusunoki T, Kase K, Ikeda K. A case of orbital apex syndrome due to Pseudomonas aeruginosa infection. Clin Pract 2011; 1:e127. [PMID: 24765368 PMCID: PMC3981405 DOI: 10.4081/cp.2011.e127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/03/2011] [Accepted: 11/16/2011] [Indexed: 12/18/2022] Open
Abstract
Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.
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Affiliation(s)
- Takeshi Kusunoki
- Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kaori Kase
- Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo, Japan
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A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey. Mycopathologia 2011; 172:397-405. [PMID: 21761152 DOI: 10.1007/s11046-011-9449-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 07/03/2011] [Indexed: 12/18/2022]
Abstract
Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae, Mucor circinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.
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Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B. The Journal of Laryngology & Otology 2011; 125:807-10. [DOI: 10.1017/s0022215111001289] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractObjective:Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.Subjects and methods:Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.Results:The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.Conclusion:Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.
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Current world literature. Curr Opin Ophthalmol 2008; 19:435-43. [PMID: 18772678 DOI: 10.1097/icu.0b013e32830d5da2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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