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Rhinocerebral mucormycosis: experience in 14 patients

Published online by Cambridge University Press:  13 May 2011

İ Ketenci ,
Y Ünlü ,
H Kaya ,
M A Somdaş ,
O Kontaş ,
M Öztürk  and
A Vural
İ Ketenci*
Affiliation:
Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey
Y Ünlü
Affiliation:
Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey
H Kaya
Affiliation:
Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey
M A Somdaş
Affiliation:
Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey
O Kontaş
Affiliation:
Department of Pathology, Erciyes University, Kayseri, Turkey
M Öztürk
Affiliation:
Department of Radiology, Erciyes University, Kayseri, Turkey
A Vural
Affiliation:
Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey
*
Address for correspondence: Dr İbrahim Ketenci, Alpaslan Mah Bahar Cad, Şişli Sitesi A Blok 20/26, 38040 Kayseri, Turkey Fax: +90 352 4379164 E-mail: ketenci@erciyes.edu.tr
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Abstract

Objective:

Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.

Patients and methods:

A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.

Results:

Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.

Conclusion:

Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.

Keywords

MucormycosisFungal Infections, Central Nervous SystemDiabetes MellitusZygomycosis

Information

Type
Online Only Main Article
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 8 , August 2011 , e3
Copyright
Copyright © JLO (1984) Limited 2011

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References

1Ribes, JA, Vanover-Sams, CL, Baker, DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13:236–301CrossRefGoogle ScholarPubMed
2Yohai, RA, Bullock, JD, Aziz, AA, Markert, RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 1994;39:3–22CrossRefGoogle ScholarPubMed
3Mohindra, S, Gupta, R, Bakshi, J, Gupta, SK. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses 2007;50:290–6CrossRefGoogle ScholarPubMed
4Sundaram, C, Mahadevan, A, Laxmi, V, Yasha, TC, Santosh, V, Murthy, JM et al. Cerebral zygomycosis. Mycoses 2005;48:396–407Google Scholar
5Yeung, CK, Cheng, VC, Lie, AK, Yuen, KY. Invasive disease due to mucorales: a case report and review of the literature. Hong Kong Med J 2001;7:180–8Google Scholar
6Luna, JD, Ponssa, XS, Rodriguez, SD, Luna, NC, Juarez, CP. Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis. Ophthalmic Surg Lasers 1996;27:706–8CrossRefGoogle ScholarPubMed
7Blitzer, A, Lawson, W, Meyers, BR, Biller, HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope 1980;90:635–48Google Scholar
8Peterson, KL, Wang, M, Canalis, RF, Abemayor, E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 1997;107:855–62CrossRefGoogle ScholarPubMed
9Sims, CR, Zeichner, LO. Contemporary treatment and outcomes of zygomycosis in a non-oncologic tertiary care center. Arch Med Res 2007;38:90–3Google Scholar
10Gillespie, MB, O'Malley, BW, Francis, HW. An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg 1998;124:520–6CrossRefGoogle ScholarPubMed
11Hargrove, RN, Wesley, RE, Klippenstein, KA, Fleming, JC, Haik, BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg 2006;22:286–91CrossRefGoogle ScholarPubMed
12Turunc, T, Demiroglu, YZ, Aliskan, H, Colakoglu, S, Arslan, H. Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients. Diabetes Res Clin Pract 2008;82:203–8CrossRefGoogle ScholarPubMed
13Kennedy, CA, Adams, GL, Neglia, JP, Giebink, GS. Impact of surgical treatment on paranasal fungal infections in bone marrow transplant patients. Otolaryngol Head Neck Surg 1997;116:610–16CrossRefGoogle ScholarPubMed
14Pillsbury, HC, Fischer, ND. Rhinocerebral mucormycosis. Arch Otolaryngol 1977;103:600–4CrossRefGoogle ScholarPubMed
15Bodenstein, NP, McIntosh, WA, Vlantis, AC, Urquhart, AC. Clinical signs of orbital ischemia in rhino-orbitocerebral mucormycosis. Laryngoscope 1993;103:1357–61Google Scholar
16Talmi, YP, Goldschmied-Reouven, A, Bakon, M, Barshack, I, Wolf, M, Horowitz, Z et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002;127:22–31Google Scholar
17Gillespie, MB, O'Malley, BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin North Am 2000;33:323–34Google Scholar
18Gravesen, S. Fungi as a cause of allergic disease. Allergy 1979;34:135–54CrossRefGoogle ScholarPubMed
19Alleyne, CH, Vishteh, AG, Spetzler, RF, Detwiler, PW. Long term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: case report. Neurosurgery 1999;45:1461–4CrossRefGoogle ScholarPubMed
20Ferguson, BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349–65Google Scholar
21Jung, SH, Kim, SW, Park, CS, Song, CE, Cho, JH, Lee, JH et al. Rhinocerebral mucormycosis: consideration of prognostic factors and treatment modality. Auris Nasus Larynx 2009;36:274–9Google Scholar
22Spellberg, B, Edwards, J, Ibrahim, A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev 2005;18:556–69CrossRefGoogle Scholar
23Centeno, RS, Bentson, JR, Mancuso, AA. CT scanning in rhinocerebral mucormycosis and aspergillosis. Radiology 1981;140:383–9CrossRefGoogle ScholarPubMed
24Terk, MR, Underwood, DJ, Zee, CS, Colletti, PM. MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation. Magn Reson Imaging 1992;10:81–7Google Scholar
25Weir, NW, Golding-Wood, DG. Infective rhinitis and sinusitis. In: Kerr, GA, MacKay, IS, Bull, TR, eds. Scott-Brown's Otolaryngology, 6th edn.Oxford: Butterworth-Heinemann, 1997;4/8/1–4Google Scholar
26Avet, PP, Kline, LB, Sillers, MJ. Endoscopic sinus surgery in the management of mucormycosis. J Neuroophthalmol 1999;19:56–61CrossRefGoogle ScholarPubMed
27Roden, MM, Zaoutis, TE, Buchanan, WL, Knudsen, TA, Sarkisova, TA, Schaufele, RL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41:634–53Google Scholar
28Zaoutis, TE, Roilides, E, Chiou, CC, Buchanan, WL, Knudsen, TA, Sarkisova, TA et al. Zygomycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis J 2007;26:723–7Google Scholar
29Pagano, L, Ricci, P, Tonso, A, Nosari, A, Cudillo, L, Montillo, M et al. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA infection program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). Br J Haematol 1997;99:331–6Google Scholar
30Eucker, J, Sezer, O, Graf, B, Possinger, K. Mucormycoses. Mycoses 2001;44:253–60Google Scholar
31Greenberg, RN, Scott, LJ, Vaughn, HH, Ribes, JA. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis 2004;17:517–25CrossRefGoogle ScholarPubMed
32Kontoyiannis, DP, Lewis, RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006;20:581–607CrossRefGoogle Scholar
33Rosenberg, SW, Lepley, JB. Mucormycosis in leukemia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1982;54:26–32CrossRefGoogle ScholarPubMed
34Bullock, JD, Jampol, LM, Fezza, AJ. Two cases of orbital phycomycosis with recovery. Am J Ophthalmol 1974;78:811–15CrossRefGoogle ScholarPubMed
35Hejny, C, Kerrison, JB, Newman, NJ, Stone, CM. Rhino-orbital mucormycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia. Am J Ophthalmol 2001;132:111–12CrossRefGoogle Scholar
36Lueg, EA, Ballagh, RH, Forte, V. Analysis of the recent cluster of invasive fungal sinusitis at the Toronto Hospital for Sick Children. J Otolaryngol 1996;25:366–70Google ScholarPubMed
37Sahin, B, Paydas, S, Cosar, E, Bicakci, K, Hazar, B. Role of granulocyte colony-stimulating factor in the treatment of mucormycosis. Eur J Clin Microbiol Infect Dis 1996;15:866–9Google Scholar
38Bonifaz, A, Macias, B, Paredes-Farrera, F, Arias, P, Ponce, RM, Araiza, J. Palatal zygomycosis: experience of 21 cases. Oral Dis 2008;14:569–74CrossRefGoogle ScholarPubMed
39Scheckenbach, K, Cornely, O, Hoffmann, TK, Engers, R, Bier, H, Chaker, A et al. Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis. Auris Nasus Larynx 2010;37:322–8Google Scholar
40John, BV, Chamilos, G, Kontoyiannis, DP. Hyperbaric oxygen as an adjunctive treatment for zygomycosis. Clin Microbiol Infect 2005;11:515–17CrossRefGoogle ScholarPubMed
41Simmons, JH, Zeitler, PS, Fenton, LZ, Abzug, MJ, Fiallo-Scharer, RV, Klingensmith, GJ. Rhinocerebral mucormycosis complicated by internal carotid artery thrombosis in a pediatric patient with type 1 diabetes mellitus: a case report and review of the literature. Pediatr Diabetes 2005;6:234–8CrossRefGoogle Scholar
42Tarani, L, Costantino, F, Notheis, G, Wintergerst, U, Venditti, M, Di Biasi, C et al. Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatr Diabetes 2009;10:289–93CrossRefGoogle Scholar
43Kohn, R, Hepler, R. Management of limited rhino-orbital mucormycosis without exenteration. Ophtalmology 1985;92:1440–4Google Scholar
44Fingeroth, JD, Roth, RS, Talcott, JA, Rinaldi, MG. Zygomycosis due to Mucor circinelloides in a neutropenic patient receiving chemotherapy for acute myelogenous leukemia. Clin Infect Dis 1994;19:135–7CrossRefGoogle Scholar
45Anaissie, EJ, Shikhani, AH. Rhinocerebral mucormycosis with internal carotid occlusion: report of two cases and review of the literature. Laryngoscope 1985;95:1107–13Google Scholar