Rhinoorbital mucormycosis in the immunocompetent: Experience with Isavuconazole

Ilharco, Marta; Pereira, Carla Maravilha; Moreira, Laura Magalhães; Proença, Ana Luísa; Fevereiro, Maria do Carmo; Lampreia, Fátima; Oliveira, Miguel Lopes; Rola, José

doi:10.1016/j.idcr.2019.e00591

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…Although inhalation is the main way of contamination, responsible for rhino-orbitosinus and pulmonary forms, in immunocompetent subjects the majority of reported cases of mucormycosis were localized to the skin following trauma [ 5 ]. The epithelium represents an active barrier against vascular and tissue invasion, the possibility of the development of mucormycosis in an immunocompetent subject can be explained by the presence of an epithelium previously weakened by chromic rhino sinusitis [ 4 , 6 ]. The spores can remain trapped at the level of the nasosinus mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…Both diagnosis and management of this disease are difficult. Several cases have been reported where rhino-orbital mucormycosis has been erroneously treated with antibiotics as being cellulitis [ 6 , 8 ], or by Voriconazol as being aspergillosis [ 8 , 9 ]. While infection spreads rapidly in immunocompromised hosts, it can be slow and chronic in immunocompetent ones.…”

Section: Discussionmentioning

confidence: 99%

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Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report

Razem

Dennai

Slimani

2021

International Journal of Surgery Case Reports

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Highlights Mucormycosis is an extremely rare infection. A very few cases of rhino-orbital mucormycosis in immunocompetent individuals have been reported. The course of this disease could be rapidly fatal if not or misdiagnosed. The chronical form of rhino-orbital localization is exceptional and misleading. The treatment has to be initiated once the infection is suspected without any delay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report

Razem

Dennai

Slimani

2021

International Journal of Surgery Case Reports

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“…Recently, the use of isavuconazole (a new antifungal drug) has been reported in cases of cutaneous and disseminated mucormycosis, rhino-orbital mucormycosis, and different Rhizopus species, as well as in A. elegans. The potent activity against these species shows that isavuconazole can be used as a primary or salvage treatment for mucormycosis [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Rhino-orbital mucormycosis due to Apophysomyces ossiformis in a patient with diabetes mellitus: a case report

et al. 2020

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Background: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. Case presentation: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. Conclusion: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.

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“…Several other case reports have subsequently shown isavuconazole to be effective as the salvage therapy for mucormycosis [ 41 , 42 , 43 ].…”

Section: Clinical Efficacymentioning

confidence: 99%

Isavuconazole: Mechanism of Action, Clinical Efficacy, and Resistance

Ellsworth

Ostrosky-Zeichner

2020

JoF

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Increasing incidence of invasive fungal infections combined with a growing population of immunocompromised hosts has created a rising need for antifungal agents. Isavuconazole, a second-generation broad-spectrum triazole with activity against yeasts, dimorphic fungi, and molds, has a favorable safety profile and predictable pharmacokinetics. Patients typically tolerate isavuconazole well with fewer drug–drug interactions. Clinical trials have found it to be noninferior to voriconazole for invasive aspergillosis, an alternative therapy for salvage treatment of mucormycosis, and suitable for stepdown therapy with invasive candidiasis. Cross-resistance with other triazoles is common. More studies are needed to determine the role of isavuconazole in anti-mold prophylaxis in high-risk patients.

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Rhinoorbital mucormycosis in the immunocompetent: Experience with Isavuconazole

Cited by 12 publications

References 15 publications

Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report

Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report

Rhino-orbital mucormycosis due to Apophysomyces ossiformis in a patient with diabetes mellitus: a case report

Isavuconazole: Mechanism of Action, Clinical Efficacy, and Resistance

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