Institutional experience of mucormycosis over a period of 10 years - retrospective case series
Keywords:Mucormycosis, Orbital cellulitis, Amphotericin, Diabetes mellitus
Background: Mucormycosis is an invasive fungal infection seen in immunocompromised patients. Most common presentation is face or orbital pain, headache, lethargy, visual loss, proptosis, or palatal ulcer. Because of its angioinvasive properties, it can rapidly spread to intracranial tissues and orbit. It can lead to fatal complications such as blindness, intracranial infections, convulsions and even death. Aim of current study was to diagnose this condition; a high index of suspicion is required. Blackish crusts are characteristically seen and Potassium hydroxide (KOH) staining of these crusts can give a rapid diagnosis.
Methods: Study Design was retrospective review of the charts. We reviewed the charts between January 2001 and December 2010 and compiled together 60 cases of mucormycosis.
Results: The most common presentation was orbital cellulitis. Some patients presented with features of acute sinusitis. The most common cause of immunosuppression was diabetes mellitus. Patients were started on amphotericin. The prognosis was bad in 7 patients who lost vision and 8 patients died.
Conclusion: Diagnosis in the early stage needs a high degree of suspicion. The underlying illness, the time between the onset of the disease and the establishment of treatment, and the occurrence of cerebral ischemic events play a role in worse survival rates.
Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012 Feb;54(Suppl 1):S23-34.
Yao-Chung Chuang, Yeh-Lin Kuo, Chun-Chung Lui, Hung-Wen Kuo, Shang-Der Chen. Facial nerve paralysis resulting from parotid involvement with mucormycosis. Infect Dis Clin Practice. 1999;9(1):36-8.
Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. Lancet Infect Dis. 2011 Apr;11(4):301-11.
Clóvis Klock, Ivan Tadeu Rebouças, Ane Cristine Zenella Monteiro. Rhino-cerebral zygomycosis in a diabetes mellitus patient. Case report. Congreso de Anatomía Patológica. 2005 Oct;18:1-3.
Brad Spellberg, John Edwards Jr, Ashraf Ibrahim. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005 July;18(3):556-69.
Santos Gorjón P, Blanco Pérez P, Batuecas Caletrío A, Muñoz Herrera AM, Sánchez González F, de la Fuente Cañibano R. Rhino-orbito-cerebral mucormycosis: a retrospective study of 7 cases. Acta Otorrinolaringol Esp. 2010 Jan-Feb;61(1):48-53.
Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope. 1997 Jul;107(7):855-62.