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CT scanning in rhinocerebral mucormycosis and aspergillosis.

Patients with rhinocerebral mucormycosis and rhinocerebral aspergillosis had computed tomography (CT) as well as other studies. Characteristic sinus involvement was demonstrated by CT and conventional tomography, but the latter produced a better image of bone destruction. CT was clearly superior in demonstrating orbital involvement, the most common of which included lateral displacement of a thickened medial rectus muscle, increased density of the orbital apex, and often enlargement of the optic nerve. Orbital venography and carotid arteriography were diagnostically helpful. Recognition of the characteristic pattern of sinus and orbital involvement should be helpful in leading to early biopsy and treatment.

Adolescent↗

Rhinoorbital mucormycosis: surgical aspects.

The authors present a case of a young woman with a diabetic ketoacidosis and rhinoorbital mucormycosis, successfully treated by resection of necrotic areas without orbital exenteration. The favorable outcome was attributed to early diagnosis and immediate commencement of the adequate therapy, which included correction of diabetic ketoacidosis, debridement of devitalized tissue, daily irrigation of the involved areas with amphotericin B solution and application of intravenous amphotericin B.

Adult↗

Acute rhino-orbito-cerebral mucormycosis.

Report of the typical clinical course and pathological findings in acute rhino-orbito-cerebral mucormycosis following diabetic coma. Invasion of orbital nerves by the fungus with neural and perineural changes may contribute to the neuroophthalmological symptoms in this disease besides the predilection for blood vessels with consequent thrombosis.

Acute Disease↗

Mucormycosis of the temporal bone.

Mucormycosis of the temporal bone is described in a 60-year-old female with uncontrolled diabetes mellitus whose symptoms related to cranial nerve palsies and hearing loss, following spread of infection from the nasopharynx. The infection spread along the eustachian tube and tensor tympani muscle to the base of the skull, involving the internal carotid artery with mycotic thrombosis and rupture. Subsequent spread occurred from this area predominantly along nerve pathways and as mycotic emboli in blood vessels of the labyrinth and middle ear. Infection also spread from the anterior middle ear wall through the oval window into the vestibule. The temporal bone changes were those of granulomatous inflammation with necrosis and ischemic infarction.

Ear, Middle↗

Post-traumatic cutaneous mucormycosis in diabetes mellitus. Short-term antifungal therapy.

Mucormycosis is infrequently encountered in the pediatric population in any of its forms (nasopharyngeal, disseminated, pulmonary, or cutaneous) and generally is associated with the immunocompromised host. We present an adolescent with poorly controlled diabetes mellitus who developed a progressive skin lesion 3 weeks after a motor vehicle accident. Rhizopus species was isolated from the lesion, and the biopsy revealed a fungal vasculopathy. Control of her diabetes, aggressive surgical intervention and a 10-day course of antifungal therapy (amphotericin B) resulted in a favorable outcome. This article illustrates the importance of considering cutaneous fungal infections, especially those in the class zygomycetes, in the diabetic patient with unusual, severe or persistent skin lesions. Early recognition is essential in order to avoid morbidity and mortality from this unusual opportunistic infection.

Accidents, Traffic↗

Breast cancer, chronic lymphocytic leukaemia and mucormycosis.

Prolonged survival following diagnosis of lipid-rich carcinoma of breast is unusual. We report on a patient in whom lipid-rich carcinoma of one breast, invasive ductal carcinoma of the other breast and chronic lymphocytic leukaemia were diagnosed simultaneously; she survived 14 years without breast tumour recurrence and died with atypical mucormycosis.

Aged↗

Rhino-orbital-cerebral mucormycosis--a clinico-pathological report of two cases.

Rhino-orbital-cerebral mucormycosis is an acute fungal infection of the oropharynx, paranasal sinuses, orbit and intracranial structures. It is rare, occurring mainly in diabetics in ketoacidosis. The clinical presentation is highly suggestive of the diagnosis. Current treatment has resulted in a greatly improved prognosis for survival and clinical awareness of this disease is important for early initiation of treatment with optimal effect. A clinico-pathological report of two cases is presented.

Adult↗

Mucormycosis.

Three cases of mucormycosis are presented; two with unusual aspects: one with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis. Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

Aged↗

Patient survival factors in paranasal sinus mucormycosis.

Analysis of 170 cases of paranasal sinus mucormycosis collected from the literature and 9 cases of our own revealed a 50% mortality for this disease. When analyzed according to decade, survival has increased to 70% in the cases reported from 1970-1979. There were no significant differences between the survivors and the fatalities when evaluated according to age, sex, laterality, or radiographic findings. There was a markedly poorer prognosis for those patients with hemiplegia, facial necrosis, and nasal deformity. The underlying disease was an important determinant of survival: 75% of patients with no systemic disease, 60% of diabetics, and 20% of patients with other disorders survived. Surgical debridement or radical resection and the use of amphotericin B significantly increased survival. Their combination further enhanced survival, especially in the diabetic.

Adolescent↗

Gastric mucormycosis in a sika deer (Cervus nippon) associated with proliferation of Clostridium perfringens.

Seven sika deer (Cervus nippon) died in a park where 30 deer were kept. One adult female deer died suddenly was necropsied. Severe hemorrhages were noted beneath the serous membranes of the forestomach and abomasum. Hyphal proliferation with neutrophil infiltration was observed in the mucous membranes of the stomaches, and the hyphae showed characteristics of order Mucorales. Catarrhal enteritis with hemorrhages was also observed. A large number of Clostridium perfringens was isolated from the contents of the abomasum and small intestine. The case was diagnosed as gastric mucormycosis associated with proliferation of Clostridium perfringens. The incidence occurred during breeding season and incorrect management was considered to be a predisposing factor for the infection.

Abomasum↗

Pulmonary mucormycosis presenting as an endobronchial lesion.

A 56-year-old diabetic man presented with left upper lobe collapse and postobstructive pneumonitis. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left mainstem bronchus. The lesion resembled a bronchial adenoma; however, cytologic and histologic examination revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by endoscopic laser surgery that relieved the obstruction.

Adenoma↗

Successful treatment of prosthetic aortic valve mucormycosis.

Mucor endocarditis after cardiovascular surgery is rare and usually fatal. We report the first known case of prosthetic aortic valve mucormycosis in a patient without predisposing risk factors who was successfully treated using a combination of early antifungal drug therapy and surgical removal of infected material.

Aortic Valve↗

Rhinocerebral mucormycosis in the era of lipid-based amphotericin B: case report and literature review.

Rhinocerebral mucormycosis (RCM) is an invasive fungal infection that necessitates, in most cases, aggressive surgical debridement and high cumulative, often nephrotoxic doses of amphotericin B. A 50-year-old woman with RCM was treated successfully with amphotericin B lipid complex as primary therapy. The patient previously had displayed progressive intracranial involvement and rising serum creatinine levels while receiving the conventional (nonlipid) form of amphotericin B. A literature review identified only a few cases where systemic antifungal therapy was administered, with minimal or no surgery. Our case further supports that amphotericin B lipid complex can be used as primary therapy in selected patients with RCM, without the need for surgical exenteration.

Amphotericin B↗

Fluconazole therapy for pulmonary mucormycosis complicating acute leukemia.

A 29-year-old woman with acute myelogenous leukemia in relapse at the end of a nine-month period of remission was admitted to hospital where intensive antileukemic therapy was started. Antibiotics were given when she developed a fever and, when oral thrush appeared, intravenous amphotericin B was initiated. After 16 days, the amphotericin B (at a total dose of 295 mg) was discontinued because of side effects and 12 days later, when a lung biopsy had revealed mucormycotic hyphae in infarcted tissue in the left upper lobe, fluconazole (300 mg daily by intravenous infusion over a period of two hours) was substituted. This was continued for one month with clinical and radiologic improvement in the lung condition and no attributable adverse effect. At this juncture the patient died of intractable heart failure. We suggest that fluconazole may be an acceptable alternative to amphotericin B in the treatment of pulmonary mucormycosis.

Adult↗

Cerebral mucormycosis following open head trauma. Case report.

The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.

Amphotericin B↗

Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis.

Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy.

Absidia↗

Pulmonary mucormycosis without underlying systemic disease.

Mucormycosis (or zygomycosis) is an opportunistic fungal infection which usually is seen in patients who are immunosuppressed or who have diabetes. It is uncommon in healthy persons and also is uncommon in Australia. We report a case of a 45-year-old, otherwise-healthy man with an indolent lung infection that was caused by Absidia corymbifera, who was cured by a combination of surgical and medical therapy.

Antibodies, Fungal↗