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Acuña-Rocha VD, Ramírez-Vázquez JA, González Torres LA, López-Zamarrón JC, Tarín-Arzaga LDC. Coexisting Chronic Rhino-Cerebral Mucormycosis and Actinomyces Infection: A Case Report and Review of the Literature. Cureus 2024; 16:e59694. [PMID: 38841036 PMCID: PMC11150172 DOI: 10.7759/cureus.59694] [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: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Fungal rhino-orbital-cerebral infections present significant treatment challenges, especially in immunocompromised individuals, such as those with diabetes. These infections seldom occur with bacterial co-infections, which complicate their management. This report presents the case of a 74-year-old diabetic male with a long-standing history of left malar pain who experienced rhinorrhea, nasal congestion, and confusion. Diagnostic imaging revealed angioinvasive fungal sinusitis, ultimately attributed to chronic mucormycosis (CM) with concurrent Actinomyces infection, a rarely reported occurrence. We employed a comprehensive treatment strategy, which resulted in a successful recovery after 24 days. Although CM is rare, accounting for approximately 5.6% of cases with mucormycosis, it requires thorough diagnostic evaluation and prolonged treatment. The rarity of co-infections like the one we describe underscores the need for an integrated management approach. Histopathological analysis serves as the gold standard for diagnosis, with treatment typically involving surgical and extensive antifungal interventions.
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Affiliation(s)
- Victor D Acuña-Rocha
- Internal Medicine, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - José A Ramírez-Vázquez
- Internal Medicine, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Luis A González Torres
- Gastroenterology and Digestive Endoscopy, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
- Internal Medicine, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Jenny C López-Zamarrón
- Internal Medicine, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Luz Del Cármen Tarín-Arzaga
- Hematology, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, MEX
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Chen CH, Chen JN, Du HG, Guo DL. Isolated cerebral mucormycosis that looks like stroke and brain abscess: A case report and review of the literature. World J Clin Cases 2023; 11:1560-1568. [PMID: 36926404 PMCID: PMC10011993 DOI: 10.12998/wjcc.v11.i7.1560] [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: 11/25/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Cerebral mucormycosis is an infectious disease of the brain caused by fungi of the order Mucorales. These infections are rarely encountered in clinical practice and are often misdiagnosed as cerebral infarction or brain abscess. Increased mortality due to cerebral mucormycosis is closely related to delayed diagnosis and treatment, both of which present unique challenges for clinicians.
CASE SUMMARY Cerebral mucormycosis is generally secondary to sinus disease or other disseminated disease. However, in this retrospective study, we report and analyze a case of isolated cerebral mucormycosis.
CONCLUSION The constellation of symptoms including headaches, fever, hemiplegia, and changes in mental status taken together with clinical findings of cerebral infarction and brain abscess should raise the possibility of a brain fungal infection. Early diagnosis and prompt initiation of antifungal therapy along with surgery can improve patient survival.
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Affiliation(s)
- Cai-Hong Chen
- Department of Neurology, Hangzhou Ninth People's Hospital, Hangzhou 311225, Zhejiang Province, China
| | - Jing-Nan Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang Province, China
| | - Hang-Gen Du
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang Province, China
| | - Dong-Liang Guo
- Department of Neurology, Hangzhou Ninth People's Hospital, Hangzhou 311225, Zhejiang Province, China
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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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Chegini Z, Didehdar M, Khoshbayan A, Rajaeih S, Salehi M, Shariati A. Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series. Mycoses 2020; 63:1264-1282. [PMID: 32965744 DOI: 10.1111/myc.13187] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM). METHOD We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. RESULTS Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries. CONCLUSION Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.
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Affiliation(s)
- Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Amin Khoshbayan
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Rajaeih
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aref Shariati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol 2018; 43:1454-1464. [PMID: 29947167 DOI: 10.1111/coa.13175] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 06/22/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon yet potentially lethal fungal infection. Although most cases originate from developing countries, an ageing population and increased prevalence of chronic illness may mean some clinicians practicing in developed countries will encounter ROCM cases in their careers. Yohai et al published a systematic review of 145 case reports from 1970 to 1993 assessing prognostic factors for patients presenting with ROCM. We present an updated review of the literature and assess whether survival outcomes have changed in the two decades since that seminal paper. SEARCH STRATEGY An extensive Medline literature search was performed for case reports published between 1994 and 2015. RESULTS In total, 210 published cases were identified from the literature review, of which 175 patients from 140 papers were included in this review. Fifty-five were female, with an overall mean age of 43 years. Overall survival rate was 59.5%, which was not significantly better than the previous series reported (60%) reported by Yohai et al. Survival rates in patients with chronic renal disease had improved, from 19% to 52%, and in patients with leukaemia (from 13% to 50%). Facial necrosis and hemiplegia remained poor prognostic indicators (33% and 39% survival rates, respectively). Early commencement of medical treatment related to better survival outcomes (61% if commenced within first 12 days of presentation, compared to 33% if after 13 days). Timing of surgery had less of an effect on overall survival. However, in 28 cases that did not receive any surgical treatment, survival was only 21%. CONCLUSIONS Although overall survival rates have not improved, survival in patients with renal disease were better, potentially due to the introduction of liposomal amphotericin B which is less nephrotoxic. Prompt recognition of ROCM, reversal of predisposing co-morbidities and aggressive medical treatment remain the cornerstone of managing this highly aggressive disease.
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Affiliation(s)
- Casey Vaughan
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Amanda Bartolo
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Nimisha Vallabh
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Kudo K, Hasegawa H, Sato E, Kaneko T, Ishida D, Kanno C, Endo M. A case of rhinocerebral mucormycosis extending into the skull. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gutiérrez-Delgado EM, Treviño-González JL, Montemayor-Alatorre A, Ceceñas-Falcón LA, Ruiz-Holguín E, Andrade-Vázquez CJ, Lara-Medrano R, Ramos-Jiménez J. Chronic rhino-orbito-cerebral mucormycosis: A case report and review of the literature. Ann Med Surg (Lond) 2016; 6:87-91. [PMID: 26981237 PMCID: PMC4776268 DOI: 10.1016/j.amsu.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/27/2022] Open
Abstract
Mucormycosis is a life-threatening disease, were rhinocerebral infection is most commonly seen in the clinical setting. Chronic mucormycosis is a rare presentation that exhibits a challenging diagnosis. We describe the case of a 47 year old diabetic man with complains of left zygomatic arch swelling of 3 months evolution. He had received previous antibiotic treatment without improvement. Biopsy of maxillary sinus revealed the presence of non-septated, 90° angle branched hyphae compatible with zygomicetes. The patient was treated with surgical debridement and amphotericin B until there was no evidence of fungi in the tissue by biopsy. We reviewed chronic rhino-orbito-cerebral mucormycosis from 1964–2014 and 22 cases were found, being this the second case of chronic mucormycosis reported in Mexico. A quarter of the cases were seen in immunocompetent hosts. As only 20% of the causal agent can be isolated by culture, the diagnosis is mainly made by biopsy. Besides treatment with amphotericin B, posaconazole as alternative, and control of the underlying comorbidities, surgical debridement represents the corner stone therapy. We recommend at least 36 month follow-up, due to the 13% risk of recurrence. A chronic presentation has a general survival rate of approximately 83%. We describe the case of a chronic rhino-orbito-cerebral mucormycosis. Chronic mucormycosis has low rate of frequency and is difficult to diagnose. A quarter of chronic rhino-orbito-cerebral mucormycosis cases are in immunocompetents. Surgical debridement is the corner stone of mucormycosis treatment. Survival rate in chronic mucormycosis cases (83%) is higher than acute cases (10–35%).
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Affiliation(s)
- Eva M Gutiérrez-Delgado
- Infectious Diseases Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
| | - José Luis Treviño-González
- Otolaryngology-Head and Neck Surgery Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP, 64460, NL, Mexico
| | - Adolfo Montemayor-Alatorre
- Otolaryngology-Head and Neck Surgery Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP, 64460, NL, Mexico
| | - Luis Angel Ceceñas-Falcón
- Pathology Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
| | - Eduardo Ruiz-Holguín
- Pathology Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
| | - Catalina Janette Andrade-Vázquez
- Internal Medicine Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
| | - Reynaldo Lara-Medrano
- Infectious Diseases Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
| | - Javier Ramos-Jiménez
- Infectious Diseases Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" of the Autonomous University of Nuevo León, Gonzalitos Y Madero SN, Mitras Centro, Monterrey, CP 64460, NL, Mexico
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