ABSTRACT
Mucormycosis is a serious, rapidly progressing, life-threatening, and sight threatening fungal infection frequently seen in diabetics and immunocompromised patients. We report a rare occurrence of rhino-orbital mucormycosis presenting as unilateral central retinal vein occlusion (CRVO) and no other ocular signs of infection in a 65-year-old diabetic male. The definitive diagnosis was made by nasal biopsy which confirmed broad branching aseptate fungal hyphae. The patient was treated with amphotericin B for mucormycosis and intravitreal anti-vascular growth factor (anti-VEGF) drug for macular edema. To conclude, although ophthalmoplegia is the most common ocular presentation and retinal artery occlusion is the most common cause of visual loss in mucormycosis, it may have many varied presentations including CRVO. A high index of suspicion must be kept in diabetics and immunocompromised patients
ABSTRACT
Purpose: An unprecedented surge has been noted in rhino?orbital?Cerebral mucormycosis (ROCM) in times of current COVID?19 pandemic. The present prospective study aims to evaluate clinico?epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino?nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID?19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino?nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino?orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.
ABSTRACT
The storm of COVID?19?associated mucormycosis (CAM) has not yet settled, and it has proven itself a disfiguring and potentially life?threatening disease, complicating the course of COVID?19 infection. Mucormycosis is a rare but devastating fungal infection caused by filamentous fungi of the family Mucoraceae. We report a rare case of a 37?year?old diabetic male with bilateral rhino?orbital?cerebral mucormycosis (ROCM) where it leads to bilateral central retinal artery occlusion (CRAO) as manifestation of the disease. Bilateral CRAO secondary to ROCM is extremely rare. A strong suspicion of CAM in uncontrolled diabetics can result in early diagnosis and management.
ABSTRACT
Purpose: Rhino?orbital?cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune?compromised patients such as those having uncontrolled diabetes, on long?term corticosteroid or immunosuppressive therapy, with COVID?19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID?19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID?19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino?orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID?19 still lurking, a fatal fungal infection should be kept in mind in COVID?19 active as well as recovered patients, especially those who have co?morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.
ABSTRACT
Introducción: se presenta el caso clínico de un paciente con mucormicosis orbitorrinocerebral y revisión de la literatura. Caso clínico: se trata de hombre de 45 años que consultó por síntomas nasosinusales manejado ambulatoriamente con múltiples antibióticos sin mejoría, por lo cual se realizó manejo quirúrgico con toma de muestras que revelaron hifas compatibles con mucormicosis. Cuando acudió a la institución presentaba extensión de la infección a todas las cavidades nasales y parte de la base del cráneo. En la búsqueda de la inmunosupresión, se encontró una diabetes de novo de difícil control. Discusión: la mucormicosis orbitorrinocerebral es una enfermedad altamente invasiva que requiere un manejo multidisciplinario, cirugías seriadas y extendidas, antimicóticos tópicos y sistémicos. El pronóstico mejora y la evolución puede ser favorable cuando se logra controlar la causa de la inmunosupresión, en este caso la diabetes. Conclusiones: es requisito fundamental realizar un tratamiento multidisciplinario en el abordaje de estos pacientes, tanto en la especialidad clínica como en la quirúrgica, psicosocial, nutricional y de rehabilitación.
Introduction: It is the clinical case of a patient with rhino-orbital-cerebral mucormycosis and the review of the literature. Clinical case: We present the case of a previously healthy young man who started with sinonasal symptoms and hyphae compatible with mucormycosis were found in the initial samples of outpatient care. When he came to the institution, the infection had spread to all the nasal cavities and part of the skull base. Discussion: Searching for baseline immunosuppression, only difficult-to-control diabetes and de novo diagnosis were found. It required multidisciplinary management, serial and extended surgeries, topical, venous and oral antifungals. The prognosis improved and the evolution became favorable when glycemic control was achieved. Conclusion: It is a fundamental requirement to carry out a multidisciplinary work for the approach to these patients, both in the clinical, surgical, psychosocial, nutritional and rehabilitation specialties.
Subject(s)
Humans , Mucormycosis , Immunosuppression TherapyABSTRACT
Acute sinusitis secondary to virulent organisms can initially be subtle, or might be misdiagnosed as viral sinusitis. It is one of the most common diagnoses we face in clinical practice. Among all the variable etiologies, fungal sinusitis is the most obscure with devastating consequences. The purpose of this case report is to increase the awareness of health care professionals about invasive fungal sinusitis as an under-diagnosed disease, and emphasize that excellent outcome can be achieved by early employment of different therapeutic modalities. In this case report, we review an older adult male, with significant cardiac and diabetes history, who presented with acute rhino-orbital mucormycosis, and was successfully treated with prompt endoscopic surgical debridement, dual IV antifungals, local amphotericin B nasal washing, and hyperbaric oxygen therapy. All of the above led to extremely favorable outcome for such an aggressive infection.
ABSTRACT
Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.
Subject(s)
Humans , Aneurysm, Infected , Carotid Artery, Internal , Coma , Fungi , Mucorales , Mucormycosis , Necrosis , Ophthalmoplegia , Opportunistic Infections , Orbit , Paresis , Rupture , Subarachnoid Hemorrhage , Thrombosis , TropismABSTRACT
Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.
Subject(s)
Humans , Aneurysm, Infected , Carotid Artery, Internal , Coma , Fungi , Mucorales , Mucormycosis , Necrosis , Ophthalmoplegia , Opportunistic Infections , Orbit , Paresis , Rupture , Subarachnoid Hemorrhage , Thrombosis , TropismABSTRACT
PURPOSE: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. METHODS: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. RESULTS: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. CONCLUSIONS: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.
Subject(s)
Humans , Blepharoptosis , Diagnosis , Mucormycosis , Ophthalmoplegia , Orbital Cellulitis , Visual FieldsABSTRACT
Rhino-orbital-cerebral mucormycosis is a very rare, but mostly fatal infection and is usually found in diabetic or immunocompromised hosts. It has a characteristic rapid progression, so we pay close attention to patients who have symptoms associated with rhino-orbital-cerebral mucormycosis. The symptoms due to rhino-orbital-cerebral mucormycosis are fever, ulceration or necrosis in nasal cavity, edema of the periorbital area or face, decreased visual acuity, headache, decreased mentality, etc. Because of the rapid progression and high mortality rate, close attention is needed in patients who complained such symptoms and signs. We experienced two cases of rhino-orbital-cerebral mucormycosis which had a poor prognosis, and we report them here.