2016, Number 6
Rhino-Orbital Mucormycosis. Cohort study of its treatment according disease extent and reversion of its pathophysiology
PDF size: 208.26 Kb.
ABSTRACTMucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.
Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634-53.
Saegeman V, Maertens J, Ectors N, et al. Epidemiology of mucormycosis: review of 18 cases in a tertiary care hospital. Med Mycol. 2010;48: 245-54.
Ibrahima A, Kontoyiannis D. Update on mucormycosis pathogenesis. Curr Opin Infect Dis. 2013;26:508-15.
Mousa S, Peyman B. Rhinocerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngol. 2005;262:932-8.
Talmi YP, Goldschmied-Reouven A, Bakon M, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg. 2002; 127:22-31.
Skiada A, Lanternier F, Groll A, et al. Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia. Haematologica. 2013;98(4):492-504.
Muszewska A, Pawlowska J, Krzys ´ciak P. Biology, systematics, and clinical manifestations of Zygomycota infections. Eur J ClinMicrobiol Infect Dis. 2014;33:1273-87.
Piromchai P, Thanaviratananich S. Acute versus chronic invasive fungal rhinosinusitis: a case control study. Infect Dis: Research and Treatment. 2012;5:43-8.
Meas T, Mouly S, Kania R, et al. Zygomycosis: an uncommon cause for peripheral facial palsy in diabetes. Diabetes Metab. 2007;33:227-9.
Saedi B, Sadeghi M, Seilani P. Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B. J Laryngol Otol. 2011;125:807-10.
Hargrove R, Wesley R, Klippenstein K, Fleming JC, Haik BG. Indications for orbital exenteration in mucormycosis. Opthal Plast Reconstr Surg. 2006;22:286-91.
Songu M, Unlu HH, Gunhan K, Iker SS, Nese N. Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome. Am J Rhinol. 2008;22:98-103.
Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;15:48(12):1743-51.
Chamilos G, Lewis RE, Konoyiannis DP. Delaying amphotericin B- based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomicosis. Clin Infet Dis. 2008; 47:503-9.
Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Opthal Plast Reconstr Surg. 1999;15:28-31.
Reed C, Bryant R, Ibrahim AS, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. 2008;47(3):364-71.
Bhansali A , Bhadada S, Sharma A, et al. Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J. 2004;80(949):670-4.
Rangel R, Martínez H, Sáenz C, Bosques F, Estrada I. Rhinocerebral and systemic mucormycosis. Clinical experience with 36 cases. J Neurol Sci. 1996;143(1-2):19-30.
Süslü A, Öfretmenoflu O, Süslü N, Yücel O, ÖnerciT. Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol. 2009;266:77-82.
Bala K, Chander J, Handa U, Punia R, Attri A. A prospective study of mucormycosis in north India: Experience from a tertiary care hospital. Med Mycol. 2015;53:248-57.
Nithyanandam S, Jacob M, Battu R, et al. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. 2003;51(3):231-6.
Abedi E, Sismanis A, Choi K, Pastore P. Twenty-five years’ experience treating cerebro-rhino-orbital mucormycosis. Laryngoscope. 1984;94(8): 1060-2.
Sun H, Forrest G, Gupta K, et al. Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. Transplantation. 2010;90:85-92.
Pagano L, Ricci P, Tonso A, et al. Mucormycosis in patientes with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto). Br J Haematol. 1997;99:331-6.
Shpitzer T, Stern Y, Anavi Y, et al. Mucormycosis: experience with 10 patients. Clin Otolaryngol. 1995;20:374-9.
Guevara N, Roy D, Dutruc-Rosset C, et al. Mucormycosis -early diagnosis and treatment. Rev Laryngol Otol Rhinol (Bord). 2004;125(2): 127-31.
Ghafur A, Shareek P, Senthur N, et al. Mucormycosis in Patients without Cancer: A Case Series from A Tertiary Care Hospital in South India. J Assoc Physicians India. 2013;61:305-8.
Kohn R, Hepler R. Management of limited rhino-orbital mucormycosis without exenteration. Ophthalmology. 1985;92(10):1440-4.
Talmi Y, Goldschmied-Reouven A, Bakon M, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg. 2002; 127:22-31.
Santos Gorjón P, Blanco Pérez P, Batuecas Caletrío Á, et al. Rhino-orbito- cerebral mucormycosis, a retrospective study of 7 cases. Acta Otorrinolaringol Esp. 2010;61(1):48-53.
Charfi S, Ayadi L, Makni S, et al. Rhinocerebral mucormycosis: Anatomoclinical study of seventh cases. Journal de Mycologie Médicale. 2008;18:46-52.
Bhadada S, Bhansali A, Reddy K, Bhat R, Khandelwal N, Gupta A. Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus. Indian J Pediatr. 2005;72(8):671-4.
Sachdeva K. Rhino-oculo Cerebral Mucormycosis with Multiple Cranial Nerve Palsy in Diabetic Patient: Review of Six Cases. Indian J Otolaryngol Head Neck Surg. 2013;65(4):375-9.
Arda B, Erdem A, Sipahi O, et al. Mucormycosis: retrospective evaluation of 12 cases. Mikrobiyol Bul. 2011;45(3):504-11.
Alobid I, Bernal M, Menéndez L, et al. Cirugía Endoscópica Nasosinusal en la Sinusitis Fúngica. Nuestra Experiencia. Acta Otorrinolaringol Esp. 2002;53:393-7.
Toumi A, Larbi Ammari F, Loussaief C, et al. Rhino-orbito-cerebral mucormycosis: five cases. Med Mal Infect. 2012;42(12):591-8.
González-Ramos M, Bertrán-Pasarell J, Guiot H, et al. Clinical experience with posaconazole in patients with invasive mucormycosis: a case series. P R Health Sci J. 2008;27:328-32.