Rhinocerebral zygomycosis in a diabetic patient

Cunha, Mirella Alves; Nery, Andréia Ferreira; Lima, Francisco Pignataro; Neto, José Xavier; Calado, Nicácia Barbosa; Luz, Kléber Giovanni; Milan, Eveline Pı́polo

doi:10.1590/s0037-86822011000200027

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…In agreement with our findings, there are several reports on the most common manifestations of mucormycosis in ROCM patients indicating ptosis, proptosis, periorbital swelling, facial swelling, and dysesthesia on the involved side and black necrotic area in the turbinate, palate, and other involved sites [ 1 – 4 , 6 , 7 , 9 , 12 , 30 , 32 ,].…”

Section: Discussionsupporting

confidence: 93%

“…In line with our study, other studies also showed that diabetes mellitus is the main underlying condition of ROCM followed by hematological disorders and transplantation due to chemotherapy causing immune defects [ 1 , 3 , 5 , 9 , 26 – 29 ]. In a study of 98 cases of mucormycosis in Iran, Vaezi et al [ 29 ] reported that uncontrolled diabetes was the most common underlying condition.…”

Section: Discussionsupporting

confidence: 92%

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Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis: A retrospective analysis

et al. 2016

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Background and Purpose:Rhino-orbito-cerebral mucormycosis (ROCM) is a rare disease with acute and fulminant manifestation. This infection is associated with high morbidity and mortality rates. Herein, we reviewed the manifestations, underlying conditions, medical treatments, and surgical interventions in ROCM patients admitted to a tertiary referral center in northern Iran over a seven-year period.Materials and Methods:In a retrospective analysis, 15 cases of ROCM were identified from 2007 to 2013 in Bu Ali Sina Hospital, Sari, Iran. All the ROCM cases were clinically diagnosed and confirmed by histopathological and/or mycological examination. The relevant demographic data, clinical, ophthalmic, and neurologic manifestations, underlying conditions, medical treatments, and surgical interventions were recorded and analyzed.Results:The mean age of the patients was 54±11 years (age range: 28–70 years); 26.7% of the patients were male and 73.3% female (male: female ratio of 1: 2.7). Uncontrolled diabetes was noted in at least 86.7% (13/15) of the cases. The maxillary sinuses were the most frequently involved sites (66.7% of the cases) followed by the ethmoid sinus. Amphotericin B in combination with surgical debridement was used in the treatment of 80% of the cases. Furthermore, 73.3% of the patients who were diagnosed early and underwent medical and extensive surgical debridement of the infected tissues survived.Conclusion:Uncontrolled diabetes mellitus is considered to be the main predisposing factor for ROCM. To prevent and reduce mortality rate of this acute disease, early diagnosis based on clinical findings and biopsy is recommended.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis: A retrospective analysis

et al. 2016

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“…In line with the study by Sujatha et al in 2015, there is a change in trend towards diabetes mellitus as it is the most important factor. 11,12,13,14 Mucormycosis as the first manifestation of an undiagnosed Diabetes Mellitus 15 was the feature in 4 patients in our study as quoted byBhansali et al in her study. Also, the recent control of diabetes and diabetic ketoacidosis 11,12 was more commonly associated rather than the duration of diabetes.…”

Section: Discussionsupporting

confidence: 76%

“…11,12,13,14 Mucormycosis as the first manifestation of an undiagnosed Diabetes Mellitus 15 was the feature in 4 patients in our study as quoted byBhansali et al in her study. Also, the recent control of diabetes and diabetic ketoacidosis 11,12 was more commonly associated rather than the duration of diabetes. Recent history of admission(nosocomial infection) 16 was present in 20/37 patients which correlates with Chakrabarti et al which states that mucormycosis trend is changing towards nosocomial rather than community acquired infection.…”

Section: Discussionsupporting

confidence: 76%

“…10 The risk factors for mucormycosis includes diabetes mellitus, haematological malignancy, solid organ transplantation, prolonged corticosteroid therapy, iron overload, desferroxamine therapy, neutropenia, trauma, burns etc. 11,12 In our study, only 2 out of 37 patients had history of prolonged corticosteroid treatment. 83.7% (31 out of 37 patients) had Diabetes Mellitus.…”

Section: Discussionmentioning

confidence: 69%

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A Study on Management of Mucormycosis - Comparative Study Between Multiple Staged Surgical Procedures and Single Surgical Procedure in a Tertiary Care Centre

2017

CHCMJ

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Background Mucormycosis is an invasive fungal infection most commonly affecting immuno-compromised individuals. It is a rapidly progressive, life threatening infection. Objective To study the various treatment modalities and their outcome Method In this study we retrospectively and prospectively investigate 37 patients of rhino-maxillary/ rhino-orbital/ rhino-cerebral mucormycosis between January 2016 and September 2017. We analysed the risk factors, clinical features, histopathological reports, radiological investigation and treatment (medical and surgical-Multiple staged surgical procedures and Single stage procedure) along with the outcome. We compared multiple staged surgeries with single debridement and followed up the patient till October 2017. Results Diabetes was the single most important risk factor (31 patients)-of which the recent status of glycemic control was the most contributing factor. Other risk factors included-electrolyte imbalance, anaemia and deranged renal parameters. Out of 23 patients treated with multiple staged surgeries, 29 were free of disease, 2 lost to follow up and 1 died. Out of 11 patients treated with single surgical procedure, 5 were cured, 3 lost to follow up and 3 were dead (2 due to other reasons). The 3 patients who weren't operated died within 2 weeks. Conclusion Multiple staged surgical procedures proved to have a much better prognosis compared to a single staged procedure.

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Evaluation of disinfectants for elimination of fungal contamination of patient beds in a reference hospital in Piauí, Brazil

Aquino

Porto

Silva

et al. 2016

Environ Monit Assess

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This quantitative and qualitative study aimed to identify fungi isolated from patient beds at a reference hospital in Teresina, Piauí, Brazil, and evaluate the efficacy of 70 % ethanol and 1 % hypochlorite for removing the contamination. Thirty-eight beds were chosen at random and the collection was carried out in three situations: before and after disinfection with 70 % alcohol or hypochlorite 1 %. Each sample was inoculated onto Sabouraud dextrose agar containing chloramphenicol and incubated at room temperature to allow fungal growth. We identified 13 species belonging to the genera Aspergillus, Cladosporium, Alternaria, Rhizopus, Penicillium, and Candida. All of these species are pathogenic and can worsen the clinical condition of patients. The 1 % hypochlorite solution proved to be an efficient disinfectant against the fungi, but the same was not observed using 70 % ethanol. Based on these findings, we recommended that the use of 1 % hypochlorite during bed disinfection be added to the hospital biosafety protocol to reduce cross contamination and contribute to patient recovery.

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Rhinocerebral zygomycosis in a diabetic patient

Cited by 9 publications

References 6 publications

Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis: A retrospective analysis

Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis: A retrospective analysis

A Study on Management of Mucormycosis - Comparative Study Between Multiple Staged Surgical Procedures and Single Surgical Procedure in a Tertiary Care Centre

Evaluation of disinfectants for elimination of fungal contamination of patient beds in a reference hospital in Piauí, Brazil

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