Rhinocerebral Mucormycosis: Consideration of prognostic factors and treatment modality

Jung, Su Woong; Kim, Sung Won; Park, Chan Soon; Song, Chang Eun; Cho, Jin Hee; Lee, Joohyung; Kim, Nam Sik; Kang, Jun Myung

doi:10.1016/j.anl.2008.07.003

Cited by 66 publications

(72 citation statements)

References 9 publications

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“…A delay in diagnosis and treatment, brain involvement, hemiparesis, bilateral sinus involvement, and facial necrosis are all associated with poor survival (Scheckenbach et al, 2010). The overall mortality rate has been reported to be between 33.3% (Jung et al, 2009) and 80% (Scheckenbach et al, 2010), and in cases of disseminated infections mortality rates can be up to 100% (Uçkay et al, 2007). Jung et al (2009) in a retrospective study of 12 patients with rhinocerebral mucormycosis reported a mortality rate of 50% with medical management alone, while the patients who were treated with combined medical and surgical management had a mortality rate of 30%.…”

Section: Discussionmentioning

confidence: 99%

“…The overall mortality rate has been reported to be between 33.3% (Jung et al, 2009) and 80% (Scheckenbach et al, 2010), and in cases of disseminated infections mortality rates can be up to 100% (Uçkay et al, 2007). Jung et al (2009) in a retrospective study of 12 patients with rhinocerebral mucormycosis reported a mortality rate of 50% with medical management alone, while the patients who were treated with combined medical and surgical management had a mortality rate of 30%. These results demonstrate that a surgical approach of the infected tissue in combination with systemic antifungal therapy are important for correct management and should start immediately when there is clinical suspicion of mucormycosis.…”

Section: Discussionmentioning

confidence: 99%

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Mucormycosis of the head and neck: Report of five cases with different presentations

Ballester

González-García

García

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mucormycosis of the head and neck: Report of five cases with different presentations

Ballester

González-García

García

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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“…20 Due to the possibility of contamination, the diagnosis should be verified histologically rather than by positive microbial cultures. 8,21 Waiting for cultures may also delay the initiation of treatment. If a clinical picture of mucormycosis exists, positive direct smears may be sufficient to justify treatment.…”

Section: Discussionmentioning

confidence: 99%

Rhinocerebral mucormycosis: experience in 14 patients

et al. 2011

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“…The most important predisposing factors are haematological disorders and poorly controlled DM particularly if associated with KA 3 . Jung et al 9 in their case series reported 100% mortality with diabetic KA (DKA) and hence proved it to be the single detrimental factor. Acidosis decreases neutrophil chemotaxis and phagocytosis, inhibits iron binding of the transferrin resulting in an increased proportion of unbound iron, which promotes the fungal growth 10 .…”

Section: Discussionmentioning

confidence: 98%

Rhinocerebral mucormycosis with therapeutic challenges encountered in a rural resource constrained setting

Sangwan¹,

Juyal²,

Negi³

et al. 2013

OA Case Reports

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. Common genera involved are Rhizopus, Mucor and Absidia which are ubiquitous fungi surviving on decaying vegetation and diverse organic matter. The major predisposing factors for acquisition of mucormycosis are uncontrolled diabetes mellitus (DM), metabolic acidosis, haematological malignancies and immunosuppression 2,3 . Depending on the patient's immunological status disease may manifest as rhinocerebral, pulmonary, cutaneous, gastrointestinal or haematogenous form 4 . Rhinocerebral mucormycosis (RCM) is the most serious, rapidly progressive, fatal form of the disease with a mortality rate of 70%-100% if not treated adequately 5,6 and most commonly manifests itself in the setting of poorly controlled DM especially with ketoacidosis (KA). Rapid progression and high mortality necessitate prompt recognition and aggressive treatment to increase survival rate.We present a case of rapidly progressive RCM in a 17-year-old girl with ketoacidotic type 1 DM. The case exemplifies the therapeutic challenges encountered in a rural resource constrained setting. Case reportA 17-year-old girl was brought to the emergency department of our hospital with the complaint of breathing difficulty for the last three days. The patient's medical history included type 1 DM, with poor drug compliance. Her parents gave a history of odontalgia which she developed after using a match stick as a tooth pick. She took prescription from Vaidh (unauthorised medical practitioner in the village) and used clove oil and some local herbs for the treatment. After two to three days she developed low-grade fever, lethargy, purulent blood tinge nasal discharge from the left nostril.On admission, she was febrile (39.1°C), had facial puffiness, marked left-sided hemifacial oedema, periorbital oedema, unilateral mucopurulent rhinorrhea, had acidotic breath and difficulty in breathing. On physical examination, the nasal wall and the upper lip showed necrotic lesions (more so) on the left side (Figure 1), also necrotic mucosal lesions in the Abstract IntroductionRhinocerebral mucormycosis is the most serious, rapidly progressive, fatal form of the disease with a mortality rate of 70%-100% if not treated adequately and most commonly manifests itself in the setting of poorly controlled diabetes mellitus especially with ketoacidosis. Rapid progression and high mortality necessitate prompt recognition and aggressive treatment to increase survival rate.We present a case of rapidly progressive rhinocerebral mucormycosis in a 17-year-old girl with ketoacidotic type 1 diabetes mellitus. The case exemplifies the therapeutic challenges encountered in a rural resource constrained setting. Case report A 17-year-old girl was brought to the emergency department of our hospital with the complaint of breathing difficulty for the last three days. On admission she was febrile (39.1°C), had facial puffiness, marked leftsided hemifacial oedema, periorbital oedema, unilateral mucopurulent rhinorrhea, had acidotic breath and difficulty in breathing. On physical examination, nasal...

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Rhinocerebral Mucormycosis: Consideration of prognostic factors and treatment modality

Cited by 66 publications

References 9 publications

Mucormycosis of the head and neck: Report of five cases with different presentations

Mucormycosis of the head and neck: Report of five cases with different presentations

Rhinocerebral mucormycosis: experience in 14 patients

Rhinocerebral mucormycosis with therapeutic challenges encountered in a rural resource constrained setting

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