A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis—has anything changed in the past 20 years?

Vaughan, Casey; Bartolo, Amanda; Vallabh, Nimisha; Leong, Samuel

doi:10.1111/coa.13175

Cited by 104 publications

(126 citation statements)

References 135 publications

(133 reference statements)

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“…In contrast, similar mortality rates 5,6 or even better survival of non‐diabetic ROCM 10 have been reported in other studies. Based on recent meta‐analysis, survival rates in non‐diabetics had improved to 50% especially in patients with renal failure and leukaemia 5 . Introduction of less toxic antifungal agents such as liposomal amphotericin B into routine clinical practice and improved diagnostic tests and therapies of malignancies were possible causes 5 .…”

Section: Discussionsupporting

confidence: 80%

“…Some studies 7,9,20 have reported a higher mortality rate in non‐diabetics which could be because of more debilitated nature of the patients as well as the reversibility of the diabetic immune dysfunction 7,9,20 . In contrast, similar mortality rates 5,6 or even better survival of non‐diabetic ROCM 10 have been reported in other studies. Based on recent meta‐analysis, survival rates in non‐diabetics had improved to 50% especially in patients with renal failure and leukaemia 5 .…”

Section: Discussionmentioning

confidence: 81%

“…Common presenting signs and symptoms in mucormycosis were fever, facial pain, periorbital cellulitis, proptosis, ptosis, palatal eschar and nasal mucosal involvement 5,9 . Nasal and sinus signs and symptoms are not usually picked up, and patients especially diabetics are presenting with orbital signs and symptoms 3,16,17 .…”

Section: Discussionmentioning

confidence: 99%

“…The survival rate of ROCM has remained largely unchanged over the last 20 years 5 . It has been nearly 60% 5,6,12 . The literature does not have consensus on the mortality rate of diabetics and non‐diabetics.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, some series specifically evaluated the clinical pictures and outcomes of diabetic ROCM 3,4 . Nearly half of the patients with mucormycosis die 2,5,6 . Some reported better 7,8 and some worse 9‐11 outcomes for diabetic ROCM as compared with the other immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

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Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

Abdolalizadeh

Kashkouli

Khademi

et al. 2020

Mycoses

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| INTRODUC TI ONRhino-orbito-cerebral mucormycosis (ROCM) is the most common presentation of mucormycosis that defined as paranasal sinuses infection spreading to contiguous structures like orbit, nose or brain.Diabetes is the most common predisposing factor for mucormycosis. 1 The role of the diabetes is more prominent in ROCM than other types. 2 Therefore, some series specifically evaluated the clinical pictures and outcomes of diabetic ROCM. 3,4 Nearly half of the patients with mucormycosis die. 2,5,6 Some reported better 7,8 and some worse 9-11 outcomes for diabetic ROCM as compared with the other immunocompromised patients. On the other hand, no study has previously compared diabetic and non-diabetic ROCM with regard to the presenting symptom, exenteration rate and visual outcome.We recently reported the outcomes of 63 patients with ROCM in whom patients', globe and vision survivals were 57%, 43% and 25%. 12 This is the second part of a research project on patients with ROCM in which the aim is to compare characteristics and the outcomes between the diabetic versus non-diabetic ROCM. | ME THODSMedical records of patients with ophthalmic manifestations of ROCM who were referred to a university-based hospital (Rassoul Summary Objective: To compare the characteristics and outcomes of rhino-orbito-cerebral mucormycosis (ROCM) in diabetic versus non-diabetic patients. Method:It is a retrospective comparative case series on consecutive patients with biopsy-proven ROCM. Systemic and ophthalmic manifestations, imaging, management and final outcomes were compared between diabetic versus non-diabetic ROCMs referred the eye clinic of a university-based hospital (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Results: Forty-three diabetics (55 eyes) with mean age of 54.6 (SD:12.5) years and 20 nondiabetics (24 eyes) with mean age of 57.5 (SD:13.8) years were enrolled. Patients' survival was observed in 51% of diabetics and 70% of non-diabetics (P = .1). The mortality rate was 7.4 times (CI95%: 1.85-29.96) higher in diabetic ROCM treated with non-liposomal amphotericin (P = .01). Exenteration did not significantly change the mortality rate in either group. Globe survival was 40% and 50% in diabetics and non-diabetics (P = 1), respectively. Vision survival was observed in 20% of diabetics and 37% of non-diabetics (P = .2). Conclusion:Patients', globe and vision survivals were not different between diabetic and non-diabetic patients with ROCM. They were 51%, 40% and 20% in diabetic and 70%, 50% and 37% in non-diabetic ROCM.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

Abdolalizadeh

Kashkouli

Khademi

et al. 2020

Mycoses

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International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

518

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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BackgroundAcute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.MethodsThe PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non‐sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.ResultsA review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.ConclusionBased on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.

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A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis—has anything changed in the past 20 years?

Cited by 104 publications

References 135 publications

Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

Diabetic versus non‐diabetic rhino‐orbito‐cerebral mucormycosis

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

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