11/60. Rhinocerebral mucormycosis in an 11-year-old boy.A patient with diabetic ketoacidosis admitted for treatment developed features characteristic of rhinocerebral mucormycosis, confirmed by histopathologic examination, is presented. The patient had been experiencing symptoms of diabetes for one month before presentation to the hospital in state of diabetic ketoacidosis. Within a few days of admission he developed mucormycosis of the nasal cavity and the orbit which extended to the brain very fast and resulted in death. High index of suspicion form the clinical presentation in an immunocompromised patient, especially, one with diabetic ketoacidosis, is suggested to effect early intervention.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
12/60. 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.- - - - - - - - - - ranking = 0.83333333333333keywords = mucormycosis (Clic here for more details about this article) |
13/60. Rhinocerebral mucormycosis: case report.Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.- - - - - - - - - - ranking = 1.3333333333333keywords = mucormycosis (Clic here for more details about this article) |
14/60. Improving outcomes in rhinocerebral mucormycosis--early diagnostic pointers and prognostic factors.Rhinocerebral mucormycosis is an uncommon, rapidly progressive, highly fatal sinus infection, usually occurring in immunocompromised hosts. We describe our clinical experience with nine such consecutive cases managed at our centre, with emphasis on identifying early diagnostic and prognostic features. Perinasal cellulitis/paraesthesia was the most frequent early clinical sign of disease, being evident in at least six cases. Periorbital oedema, mucopurulent rhinorrhoea and nasal crusting were the other early manifestations. Concurrent computed tomography (CT) scan at this initial stage however revealed only minimal mucosal thickening of the sinuses in all four cases wherein it was done. Intracranial extension as evident on CT was the only adverse prognostic sign (p<0.05). The present report highlights the importance of early diagnosis and prompt institution of antifungal chemotherapy in ensuring a favourable outcome in rhinocerebral mucormycosis. However, initial CT is frequently near-normal and biopsy time-consuming and often not feasible. To optimize early diagnosis therefore, the clinician should be highly alert to certain subtle clinical signs, in the appropriate setting of an immunocompromised patient.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
15/60. Rhinocerebral mucormycosis: an unusual case presentation.Rhinocerebral mucormycosis is a rapidly fatal fungal disease which involves the nose, paranasal sinuses, orbit and central nervous system. The fungal infection is usually secondary to immunosuppression, diabetic acidosis, or antibiotic, steroid or cytotoxic therapy. It can also occur in patients suffering from burns, malignancy and haematological disorders. Current treatment consists of correction of the underlying disorder, repeated debridement of the wound in combination with intravenous amphotericin b. This paper describes our experience with a case of rhinocerebral mucormycosis. This is an unusual case in which mucormycosis was seen in a young female where no underlying cause was found. She responded to surgical debridement in combination with intravenous amphotericin b.- - - - - - - - - - ranking = 1.1666666666667keywords = mucormycosis (Clic here for more details about this article) |
16/60. MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation.Three cases of mucormycosis, two in diabetics and one in an intravenous drug abuse patient, are presented. magnetic resonance imaging proved to be useful in all cases, as was computed tomography. In one case, extremely low signal was detected from the fungal mass. It is surmised that this appearance was a result of high concentrations of iron and manganese. The low-signal area simulated air in paranasal sinuses; however, CT displayed a mildly enhancing soft tissue mass and allowed the correct diagnosis to be made. In another patient, pontine infarction was demonstrated by MR. In the third case the MR findings of mucormycosis involving the basal ganglia are shown and correlated with CT. Subsequent imaging studies demonstrated reduction of the mass, corresponding to clinical improvement.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
17/60. Rhinoorbital mucormycosis secondary to rhizopus oryzae: a case report and literature review.mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order mucorales, and it is considered to be the most fatal fungal infection known to man because it is rapidly disseminated by the blood vessels. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome, and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbital mucormycosis, a subtype of the rhinocerebral variety, secondary to rhizopus oryzae that developed in a patient with lymphoma. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and outcome of the disease.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
18/60. Ocular invasion in mucormycosis.The histopathologic findings in a case of ocular invasion in rhinocerebral mucormycosis are described. The findings of hyphae in the inner sclera and marked involvement of the posterior ciliary arteries suggested an arterial route of ocular invasion by fungus. Only five other cases of rhinocerebral mucormycosis with ocular fungal invasion have been reported to our knowledge. All six patients died from the infection. As a group, these cases suggest that the presence of ocular infiltration by fungus may indicate poor prognosis in rhinocerebral mucormycosis.- - - - - - - - - - ranking = 1.1666666666667keywords = mucormycosis (Clic here for more details about this article) |
19/60. Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus.AIM: To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1DM). methods: The medical records of six patients of T1DM with ROCM admitted between October 2001 to January 2004 were analysed. RESULTS: The mean ( /- SD) age and duration of DM of these patients were 16.1 /-3.0 years and 26.3 /- 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin b and had appropriate surgery except one. Four patients survived. patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome. CONCLUSION: High index of suspicion of ROCM in T1DM and combined approach with amphotericin b and appropriate surgery is rewarding.- - - - - - - - - - ranking = 0.83333333333333keywords = mucormycosis (Clic here for more details about this article) |
20/60. Rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans.Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin b and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin b. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.- - - - - - - - - - ranking = 0.83333333333333keywords = mucormycosis (Clic here for more details about this article) |
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