Abstract:Rhino-orbital-cerebral zygomycosis afflicts primarily diabetics and immunocompromised individual, but can also occur in normal hosts rarely. We here presented an interesting case of facial nerve palsy and multiple cold abscesses of neck due to rhino-orbital-cerebral zygomycosis in an otherwise healthy man. Although some reports of facial nerve paralysis in conjunction with rhino-orbital-cerebral zygomycosis exist, no case of bilateral complete facial paralysis has been reported in the literature to date.
“…14,15 Another theory concerns the spread of mucormycosis to the middle ear via the Eustachian tube that therefore involves the facial nerve. 16 This latter theory is not supported by our study, as none of the patients had an abnormality around the Eustachian tube on diagnostic nasal endoscopy. During the second coronavirus wave in India, many patients attended ENT with rhino-orbital-cerebral mucormycosis symptomsThis retrospective study of 400 patients reports on those with coronavirus-associated mucormycosisUnusual rhino-orbital-cerebral mucormycosis presentations included facial palsy, cheek abscess, gum ulcers and nasal myiasisMost mucormycosis patients had a history of coronavirus; the unusual presentations raise concerns amid the ongoing pandemicAll patients with such symptoms following coronavirus infection should be evaluated for rhino-orbito-cerebral mucormycosis…”
Section: Discussioncontrasting
confidence: 64%
“…14,15 Another theory concerns the spread of mucormycosis to the middle ear via the Eustachian tube that therefore involves the facial nerve. 16 This latter theory is not supported by our study, as none of the patients had an abnormality around the Eustachian tube on diagnostic nasal endoscopy. Myiasis, an infection of tissues or organs caused by fly larvae, was found in two patients with extensively disseminated rhino-orbito-cerebral mucormycosis.…”
Objective
To study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases.
Method
The data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples.
Results
Out of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct.
Conclusion
Mucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations.
“…14,15 Another theory concerns the spread of mucormycosis to the middle ear via the Eustachian tube that therefore involves the facial nerve. 16 This latter theory is not supported by our study, as none of the patients had an abnormality around the Eustachian tube on diagnostic nasal endoscopy. During the second coronavirus wave in India, many patients attended ENT with rhino-orbital-cerebral mucormycosis symptomsThis retrospective study of 400 patients reports on those with coronavirus-associated mucormycosisUnusual rhino-orbital-cerebral mucormycosis presentations included facial palsy, cheek abscess, gum ulcers and nasal myiasisMost mucormycosis patients had a history of coronavirus; the unusual presentations raise concerns amid the ongoing pandemicAll patients with such symptoms following coronavirus infection should be evaluated for rhino-orbito-cerebral mucormycosis…”
Section: Discussioncontrasting
confidence: 64%
“…14,15 Another theory concerns the spread of mucormycosis to the middle ear via the Eustachian tube that therefore involves the facial nerve. 16 This latter theory is not supported by our study, as none of the patients had an abnormality around the Eustachian tube on diagnostic nasal endoscopy. Myiasis, an infection of tissues or organs caused by fly larvae, was found in two patients with extensively disseminated rhino-orbito-cerebral mucormycosis.…”
Objective
To study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases.
Method
The data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples.
Results
Out of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct.
Conclusion
Mucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations.
“…However, this was not observed in our case series as only two cases had ear (opposite side of facial palsy) discharge (mucosal COM) for so many years. Involvement of the floor of sphenoid sinus via the Vidian nerve, which is a continuation of the greater superficial petrosal nerve (GSPN) is also a viable alternative [ 10 ].…”
Sinonasal mucormycosis is a deadly fungal illness that primarily affects diabetics who are uncontrolled. Numerous cranial nerves can be involved; however, facial nerve palsy has only been observed in a few cases. The main objective of this research is to highlight facial nerve involvement as a clinical sign of sinonasal mucormycosis. Nasal stuffiness, headaches, eye pain, orbital edema, ophthalmoplegia, and vision loss are common symptoms in these mucormycosis patients. The study was done in the Department of Otolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences (AIIMS), Raipur, India. Nevertheless, 17 patients with facial nerve palsy (lower motor nerve palsy) and sinonasal mucormycosis arrived at our department. All patients were diabetic, and a majority of patients got Schirmer's test positive with severe stage. In the case of mucormycosis, facial nerve palsy is an unusual but noteworthy symptom. This could be misinterpreted as a cerebrovascular accident (CVA), causing the therapy to be delayed. This is critical as early identification, surgical debridement, and adequate therapy of the underlying metabolic imbalance, as well as amphotericin B, are critical for a successful treatment outcome in mucormycosis.
Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.
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