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Jain AK, Gupta Y, Verma J, Godha S, Prajapati IP. Minimizing the Recurrence Rate in Covid Associated Mucormycosis: Our Experience in 500 Patients. Indian J Otolaryngol Head Neck Surg 2024; 76:1898-1902. [PMID: 38566733 PMCID: PMC10982205 DOI: 10.1007/s12070-023-04442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/08/2023] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is an aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. The main aim of this article is to emphasize over the knowledge of different diagnostic methods (diagnostic nasal endoscopy, ct/ contrast mri pns + orbit + brain, Wet KOH mount), the importance of practising an aggressive surgical resection, medical treatments (liposomal amphotericin B, amphotericin gel, tablet posaconazole, nasal douching, retrorbital amphotericin injection), suction cleaning and regular follow up of the patient after surgical management. This can greatly help in minimizing the recurrence of mucormycosis even in immunocompromised patients in a population. The study performed was a prospective study conducted from April 2021 to July 2021 in which we included 500 patients who presented to the OPD & Department of ENT or Emergency Department of Maharaja Yashwantrao Hospital with complaints suggestive of mucormycosis. The patients who were surgically fit were operated. Out of the 500 patients who were diagnosed with Mucormycosis, from April 2021 to July 2021 complete cure was achieved in 456 patients( 91.2%) and only 44 patients (8.8%) have shown recurrence due to various causes (specially those who did not came for regular follow up). Rhinorbital was the most common site to be involved. In the study it was found that most of the patients which showed recurrence were male, post covid and immunocompromised. Diabetes mellitus was found to be most common among immunocompromised patients. The recurrence in patients with mucormycosis can be minimise by educating the masses regarding importance of public and personal hygiene, and multidisciplinary management with regular follow up offers a better approach to treat this life-threatening condition. The study shows the importance of clinical diagnosis, concurrent surgical treatment, medical treatment, post op care, suction cleaning and regular follow up advice. It is necessary us to take the step forward in this regard, so that in the future we will be better prepared for such type of epidemic.
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Affiliation(s)
- Anchal Kumar Jain
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
- Indore, India
| | - Yamini Gupta
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Jagram Verma
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Surbhi Godha
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Indra Prakash Prajapati
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
- Indore, India
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Mora-Martínez A, Murcia L, Rodríguez-Lozano FJ. Oral Manifestations of Mucormycosis: A Systematic Review. J Fungi (Basel) 2023; 9:935. [PMID: 37755045 PMCID: PMC10533187 DOI: 10.3390/jof9090935] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Mucormycosis is a rare, opportunistic, and emerging fungal infection that can rapidly develop into a severe, highly fatal clinical picture. In most cases, it is caused by fungi of the order Mucorales, which are usually avirulent but become pathogenic when the host's immune system is compromised. This systematic review was conducted according to PRISMA guidelines. The databases searched included PubMed, Scopus, and Web of Science. We chose articles that analyzed the oral manifestations of patients with mucormycosis, were published between 2018 and 2023, and met our search terms. The risk of bias in the articles was assessed using the CARE guideline for case reports and STROBE for a cross-sectional study. After the selection process, 20 articles were included in this review, all containing information about the different oral manifestations presented by people with mucormycosis. The most common oral manifestations are mainly bone exposures and oral ulcers, halitosis, pus discharge, gingival thickening, and periodontitis. However, despite the importance of recognizing these oral manifestations in the early stages of mucormycotic infection, providing early treatment, and reducing the high mortality rate of the infection, more studies are needed.
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Affiliation(s)
- Alejandro Mora-Martínez
- Department of Special Care in Dentistry, Hospital Morales Meseguer, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain; (A.M.-M.); (F.J.R.-L.)
| | - Laura Murcia
- Department of Health Sciences, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
| | - Francisco Javier Rodríguez-Lozano
- Department of Special Care in Dentistry, Hospital Morales Meseguer, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain; (A.M.-M.); (F.J.R.-L.)
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Fathima SD, Gururaj N, Sivapathasundharam B, Vennila AA, Keerthik Lavanya MK, Sarayushivani U. Histopathological significance of necrosis in oral lesions: A review. J Oral Maxillofac Pathol 2023; 27:340-347. [PMID: 37854904 PMCID: PMC10581306 DOI: 10.4103/jomfp.jomfp_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 10/20/2023] Open
Abstract
Necrosis is a localized area of tissue death followed by degradation of tissue by hydrolytic enzymes released from the dead cells, resulting in swelling of organelles, rupture of the plasma membrane, eventual cell lysis, and leakage of intracellular contents into the surrounding tissue. It is always accompanied by an inflammatory reaction. Necrosis is caused by various factors such as hypoxia, physical factors, chemical agents, immunological agents, and microbial agents. Still now, there is no literature review regarding the necrotic lesions of the oral cavity. In this paper, the oral lesions associated with necrosis are categorized under the headings such as odontogenic cysts, odontogenic tumors, salivary gland pathology, and epithelial malignancies. In addition, the histopathological significance of necrosis in oral lesions has been discussed. By suggesting that spotting necrosis in the histopathology aids in determining the diagnosis, tumor behavior, and prognosis of oral lesions.
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Affiliation(s)
- S Deenul Fathima
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - N Gururaj
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - B Sivapathasundharam
- Department of Oral and Maxillofacial Pathology, Priyadharshini Dental College and Hospital, Pandur, Tamil Nadu, India
| | - A Alagu Vennila
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - M. K. Keerthik Lavanya
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
| | - U Sarayushivani
- Department of Oral and Maxillofacial Pathology, CSI College of Dental Science and Research, Madurai, Tamil Nadu, India
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Aswal GS, Rawat R, Dwivedi D, Prabhakar N, Kumar KRV. Diagnosis and management of mucormycosis in the dental clinic: A guide for oral health professionals in India. J Family Med Prim Care 2022; 11:4293-4298. [PMID: 36353040 PMCID: PMC9638618 DOI: 10.4103/jfmpc.jfmpc_1373_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 12/03/2022] Open
Abstract
With the current pandemic raging over the world, science and medicine is faced with hereto with unfought enemies or less fought opponent in the form of viruses and consequently, other biotic entities. While researchers are striving to identify and conquer the variants of COVID-19, other innocuous organisms are raising their ugly heads in the form of opportunistic fungal infections. Mucormycosis/Black Fungus is an invasive opportunistic fungal infection caused by mucorale species. It spreads through blood vessels causing thrombosis, ischemia, and necrosis. Population with pre-existing immunocompromised conditions such as Diabetes Mellitus, Malignancy, Long-term immunosuppressant therapy are more susceptible. Mucormycosis associated with Corona Virus Disease-2019 (COVID-19) proved to be catastrophic due to its high mortality rates. Rhino orbital Mucormycosis is the most common form. The primary care physician, being the first and often, (more so in developing countries) and being the only point of contact with a healthcare professional, plays a pivotal role in the diagnosis and management of this condition. The keystone to decreasing mortality is early detection and diagnosis followed by preventive measures to control progression to the brain. A multidisciplinary approach by various specialties is a prerequisite for effective diagnosis and management. Antifungal therapy, surgical debridement, and resection of the affected areas are protocols to be followed. Post-operative defects cause impairment of function, phonetics, and esthetics. Prosthetic rehabilitation of these defects has shown favorable results, especially in the aged and immunocompromised individuals.
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Affiliation(s)
- Gunjan S. Aswal
- School of Dentistry, Faculty of Medical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
| | - Renu Rawat
- Private Practitioner, Bangalore, Karnataka, India
| | - Dhara Dwivedi
- Department of Dental Medicine, Hawassa University, Hawassa, Ethiopia
| | - Nitin Prabhakar
- Department of Oral and Maxillofacial Surgery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Swain S. Sinonasal mucormycosis with an unusual involvement of palate. APOLLO MEDICINE 2022. [DOI: 10.4103/am.am_130_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Devaraja K, Krishnan NV, Bhat VK, Pujary K, Venkatagiri AM, Vijayasekharan K. Palatal mucormycosis in neutropenic children: A Case Report with Review of Literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1739188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractPalatal involvement in mucormycosis is mostly secondary to rhino-orbito-cerebral disease, but rarely can be a primary disease of the oral mucosa. This report presents two rare cases of the isolated palatal mucormycosis in neutropenic children and highlights some of the peculiar features of the primary palatal disease and management-related issues in children. A 12-year-old child, who had completed the dexamethasone-based induction phase of chemotherapy for Near Early T cell precursor acute lymphoblastic leukemia, and a 9-year-old boy with a Late Isolated Medullary relapse of B cell acute lymphoblastic leukemia, who was to receive salvage induction chemotherapy, developed palatal discoloration without any other major complaints. Both had neutropenia and were on antifungal prophylaxis. In vitro staining of the discolored mucosa suggested mucormycosis, which was confirmed by pathological examination of the debrided tissue. Computed tomography, done before debridement, showed no significant sinonasal disease enabling us to proceed with the transoral approach. With the help of adjuvant antifungal therapy, the infection could be contained in both cases. This report, along with the reviewed literature, shows that limited palatal mucormycosis can be effectively treated by early diagnosis and debridement and appropriate antifungal therapy. Also, the role of antifungal prophylaxis amongst neutropenic patients has been briefly discussed here.
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Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neethu V. Krishnan
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva K. Bhat
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Archana M. Venkatagiri
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kalasekhar Vijayasekharan
- Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Deshpande P, Patil K, Guledgud MV, Prashanthi NM. Diagnosis of the misdiagnosed: Mucormycosis depicting periodontitis. J Indian Soc Periodontol 2021; 25:443-447. [PMID: 34667390 PMCID: PMC8452173 DOI: 10.4103/jisp.jisp_720_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/05/2022] Open
Abstract
Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.
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Affiliation(s)
- Prasannasrinivas Deshpande
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Karthikeya Patil
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Mahima V Guledgud
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - N Mounika Prashanthi
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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R R, Thanthoni M, Warrier AS. COVID-19 Coinfection With Mucormycosis in a Diabetic Patient. Cureus 2021; 13:e15820. [PMID: 34306884 PMCID: PMC8295568 DOI: 10.7759/cureus.15820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a form of β-Coronavirus of the Coronaviridae family, has been causing infection among humans worldwide leading to a pandemic emergency. New strains of SARS-CoV-2 have been evolving unceasingly, presenting with various systemic and oral manifestations. There has been an increase in the incidence of secondary infection in the coronavirus infected individual either due to pre-existing factors or the virus by itself is causing such infection, which is still unclear. As it is already known, immunocompromised and uncontrolled diabetic patients have an increased chance of developing mucormycosis. Herein, we report a case who presented with a swelling in the left cheek, eye, and avascular necrosis intraorally, post COVID-19 infection.
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Affiliation(s)
- Roopa R
- Oral Medicine and Radiology, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Malarkodi Thanthoni
- Oral Medicine and Radiology, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Aravind S Warrier
- Oral Medicine and Radiology, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Panneerselvam K, Kumar MS, Karthikeyan, Mohan AM. Recurrent mucormycosis - Better understanding of treatment and management. J Family Med Prim Care 2020; 9:6279-6281. [PMID: 33681078 PMCID: PMC7928079 DOI: 10.4103/jfmpc.jfmpc_1220_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/08/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Mucormycosis is a rare opportunistic, aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. It is spread on inhalation, inoculation and wound contamination and is more common in diabetic and other immunocompromised individuals in a population. The clinical and radiological features of Mucormycosis can overlap with other conditions for which a thorough diagnosis should be made. The rate of recurrence in Mucormycosis cases is high. This article reports one such case in which recurrence occurred twice and was controlled only with resection. The main aim of this article is to emphasize the importance of practicing aggressive resection and also on regular follow up of the patient after surgical management. Knowledge on different diagnostic and treatment methods, availability of newer drugs and regular follow up can greatly help in the management and recurrence of Mucormycosis even in immunocompromised patients in a population where diabetes is more common and mortality of rhino cerebral form is high.
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Affiliation(s)
- Karthika Panneerselvam
- Department of Oral Pathology and Microbiology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - M Sathish Kumar
- Department of Oral Pathology and Microbiology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - Karthikeyan
- Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - A Mathan Mohan
- Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
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Srivastava A, Mohpatra M, Mahapatra A. Maxillary Fungal Osteomyelitis: A Review of Literature and Report of a Rare Case. Ann Maxillofac Surg 2019; 9:168-173. [PMID: 31293947 PMCID: PMC6585207 DOI: 10.4103/ams.ams_218_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fungal osteomyelitis is a life-threatening and seldom seen opportunistic infection. It is commonly an affectation of the nose and paranasal sinuses within the orofacial region. It is an aggressive infection that needs to be addressed promptly to prevent fatal consequences. Here, we present a case of a 62-year-old female who presented with complaints of pain and pus discharge from the extraction socket of the left maxillary 23, 24, 25, 26 teeth. She had a history of uncontrolled diabetes mellitus. On further investigation, using diagnostic and Interventional aids, a final diagnosis of maxillary fungal osteomyelitis was made. The infective fungal agents were a mixture of Mucorales and Aspergillus species. A review of all literatures on the subject in the past 13 years using different search engines showed that craniofacial fungal infections with primary maxillary involvement are a rare phenomenon. The primary aim of reporting this case, therefore, is to highlight its rarity, presentation, management and most importantly the outcome of management.
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Affiliation(s)
- Ankita Srivastava
- Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mounabati Mohpatra
- Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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