Rhinosinusal mucormycosis: Literature review and some particular cases

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Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential.

Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke.

By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

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  • 1. Kwon-Chung KJ. Taxonomy of Fungi Causing Mucormycosis and Entomophthoramycosis (Zygomycosis ) and Nomenclature of the Disease: Molecular Mycologic Perspectives. Clin Infect Dis. 2012;54(Suppl 1):S8-S15. DOI: 10.1093/cid/cir864.

  • 2. Onyango J Kayima JK Owen WO. Rhinocerebral mucormycosis: case report. East African J. 2002;79(7):390-3.

  • 3. Sahota R Gambhir R Anand S Dixit A. Rhinocerebral Mucormycosis: Report of a Rare Case. Ethiop J Health Sci. 2017;27(1):85-90.

  • 4. Prakash H Chakrabarti A. Global epidemiology of mucormycosis. J Fungi. 2019;5(1):26. DOI: 10.3390/jof5010026.

  • 5. Spellberg B Edwards J Jr Ibrahim A. Novel perspectives on mucormycosis: pathophysiology presentation and management. Clin Microbiol Rev. 2005;18(3):556–69.

  • 6. Wali U Balkhair A Al-Mujaini A. Cerebro-rhino orbital mucormycosis: an update. J Infect Public Health. 2012;5(2):116–26. DOI: 10.1016/j.jiph.2012.01.003. Epub 2012 Mar 27.

  • 7. Alleyne CH Jr Vishteh AG Spetzler RF Detwiler PE. Long-terme survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular surgical and medical therapies: case report. Neurosurg. 1999;45(6):1461-3; discussion 1463-4.

  • 8. Ohtomo K Ueta T Nagahara M. Traumatic orbital apex syndrome. Can J Ophthalmol. 2015;50:e7–e8. DOI: 10.1016/j.jcjo.2014.10.012.

  • 9. Petrikkos G Skiada A Lortholary O Roilides E Walsh TJ Kontoyiannis DP. Epidemiology and Clinical Manifestations of Mucormycosis. Clin Infect Dis. 2012;54(Suppl 1):S23-34. DOI: 10.1093/cid/cir866.

  • 10. Silvernan CS Mancuso AA. Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings. AJNR Am J Neuroradiol. 1998;19(2):321–5.

  • 11. 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;48(12):1743-51. DOI: 10.1086/599105.

  • 12. Blyth CC Gomes L Sorrell TC da Cruz M Sud A Chen SC. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 2011;17(2):306-11. DOI: 10.1111/j.1469-0691.2010.03231.x.

  • 13. deShazo RD O’Brein M Chapin K Soto-Aguilar M Gardner L Swain R. A new classification and Diagnostic Criteria for Invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1997;123(11):1181-8.

  • 14. Alobid I Bernal M Calvo C Vilaseca I Berenguer J Alos L. Treatment of Rhinocerebral Mucormycosis by Combination of Endoscopic Sinus Debridement and Amphotericin B. Am J Rhinol. 2001;15(5):327-31.

  • 15. Spellberg B. Ibrahim A. Recent Advances in the Treatment of Mucormycosis. Curr Infect Dis Rep. 2010;12(6):423-9. DOI: 10.1007/s11908-010-0129-9.

  • 16. Katragkou A Walsh TJ Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014;20 Suppl 6:74-81. DOI: 10.1111/1469-0691.12466. Epub 2014 Jan 28.

  • 17. Adler DE Milhorat TH Miller JI. Treatment of rhinocerebral mucormycoosis with i.v. interstitial and cerebrospinal fluid administration of amphotericin B: case report. Neurosurgery. 1998;42(3):644-8; discussion 648-9.

  • 18. Ferry AP. Abedi S. Diagnosis and management of rhinoorbitocerebral and mucormycosis (phycomycosis): A report of 16 personally observed cases. Ophthalmology. 1983;90(9):1096-104.

  • 19. Songu M Unlu HH Gunhan K Ilker SS Nese N. Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome. Am J Rhinol. 2008;22(1):98-103. DOI: 10.2500/ajr.2008.22.3121.

  • 20. Kohn R Hepler R. Manage ment of Limited Rhino-or bital Mucormycosis without Exenteration. Ophthalmology. 1985;92(10):1440-4.

  • 21. Palejwala SK Zangeneh TT Goldstein SA Lemole GM. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis. Surg Neurol Int. 2016;7:61. DOI: 10.4103/2151-7806.182964. eCollection 2016.

  • 22. Yohai RA Bullock JD Aziz AA Markert RJ. Survival Factors in Rhino-Orbital-Cerebral mucormycois. Surv Opththalmol. 1994;39(1):3–22. DOI: 10.1016/S0039-6257(05)80041-4.

  • 23. Blitzer A Lawson W Meyers BR Biller HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope. 1980;90(4):635-48.

  • 24. Jayalakshmi S Reddy RG Borgohain R Subramanyam C Panigrahi M Sundaram C et al. Predictors of mortality in rhinocerebral mycosis. Neurol India. 2007;55(3):292–7.

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