Case Of Rhinocerebral Mucormycosis Research Articles

Mucormicosis rinoorbitocerebral, un estudio retrospectivo de 7 casos

Mucormycosis is an opportunistic fungal infection caused by fungi of the Mucorales order. It has a low incidence and is a potentially lethal infection which generally affects patients who are immunocompromised due to systemic disease. We report 7 cases of rhinocerebral mucormycosis in a retrospective study of 8 years (2000–2008) in hematologyc patients. An early diagnosis is essential, and therefore there must be a high level of clinical suspicion in patients with predisposing factors. Certainty diagnosis requires fungal cultures or biopsies of the affected areas which prove an invasion of the tissues by the characteristic hyphae. The key to treatment is early and aggressive surgical treatment, together with high intravenous doses of B amphotericyn. Despite this, prognosis is poor and mortality is about 70–80%.

Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis

Five cases of rhinocerebral mucormycosis (RCM) with different courses of illness and outcomes also due to different therapeutical strategies including Posaconazole as a new therapeutic option are described. Predisposing conditions for RCM are diabetes mellitus and immunosuppression. Diagnosis is often delayed because patients complain about nonspecific symptoms of acute rhinosinusitis, and initial CT imaging is unimpressive. Progressive disease, however, leads to early orbital and cerebral invasion. Due to the lack of typical clinical signs, diagnosis relies on histopathology. Therapy consists of the management of predisposing factors, radical surgical intervention and systemic antifungal therapy. We describe five cases of RCM with different comorbidities and outcomes. RCM remains a diagnostic and therapeutic challenge because it begins with nonspecific symptoms and ends as fulminant disease with high mortality. Here, systemic treatment with Posaconazole appears to be a more effective alternative to amphotericin. If a patient is suspected having RCM, improvement of predisposing diseases, radical surgical debridement and effective systemic antifungal therapy must be instituted immediately.

P240 Report of four cases of rhinocerebral mucormycosis in Loghman Hospital, Tehran, Iran

P240 Report of four cases of rhinocerebral mucormycosis in Loghman Hospital, Tehran, Iran

La mucormycose rhinocérébrale chez le diabétique: À propos de quatre observations

Mucormycosis is caused by a zygomycetes fungus in a vascular location. This fungus is a saprophytic organism which can become pathogenic in specific conditions, particularly in patients with diabetes mellitus. A rhinocerebral localization is common, leading to often fatal devastating sinusitis. Positive diagnosis requires histological proof with characteristic hyphal tissue invasion. Frozen section is essential for diagnosis and management of rhinocerebral mucormycosis. Material and methods We report four cases of rhinocerebral mucormycosis in diabetic patients, two men and two women, mean age 51 years. Results Histological examination showed characteristic hyphae in a vascular localization. Treatment was systemic antifungal therapy with amphotericin B and debridement of necrotic tissue. Three patients recovered completely. One died. Conclusion Rhinocerebral mucormycosis is a rare fungal infection with very poor prognosis. The aim of this study was to report the clinical and pathological features of rhinocerebral mucormycosis and to evaluate the contribution of frozen section for diagnosis and management. (J Mal Vasc 2006; 31: 85-87).

健康成人に発症した鼻脳型ムコール症の1例

健康成人に発症した鼻脳型ムコール症の1例

Molecular cloning of an extracellular aspartic proteinase from Rhizopus microsporus and evidence for its expression during infection.

An extracellular aspartic proteinase (Rmap) from Rhizopus microsporus var. rhizopodiformis was detected in the culture supernatant of a fungal isolate from a case of rhinocerebral mucormycosis (case HA). The proteinase was purified to near homogeneity by ion exchange and affinity chromatography on pepstatin agarose. Based on its N-terminus the RMAP gene was cloned and found to code for 388 amino acids. The preproenzyme has an aminoterminal leader sequence of 65 amino acids, whereas the mature enzyme consists of 323 amino acids. The deduced amino-acid sequence of the preproenzyme was 82% homologous to an extracellular aspartic proteinase of Rhizopus niveus. Low stringency Southern blot analysis of R. microsporus DNA suggested the presence of other homologous genes. Expression of Rmap in Pichia pastoris was achieved, and the recombinant enzyme was active in the yeast culture supernatant. Both enzyme preparations exhibited a similar optimum of activity in the pH 2.5 region. Furthermore, Rmap was shown to activate bovine blood coagulation factor X at slightly acidic pH in vitro. Expression of the proteinase during mycosis was proven by a specific immune response of patient HA.

Rhinocerebral mucormycosis diagnosis by aspiration cytology

Rhinocerebral mucormycosis is a rapidly progressing, often fatal fungal infection that occurs commonly in diabetics and immunocompromised individuals. We present 2 cases of rhinocerebral mucormycosis with a paranasal mass. One patient had an intracranial extension. Nasal scrapings and fine-needle aspiration cytology (FNAC) of the paranasal masses showed fungal hyphae morphologically resembling Mucor. Surgical material showed features of mucormycosis. FNAC and scrape smears can give a conclusive diagnosis of mucormycosis, and the patient can be treated with appropriate antifungal therapy and surgical debridement. Preoperative cytology is an effective technique to establish a diagnosis of mucormycosis and obviates the need for a preoperative biopsy. Diagn. Cytopathol. 23:97–100, 2000. © 2000 Wiley-Liss, Inc.

A Case of Rhinocerebral Mucormycosis in a Diabetic Woman

A Case of Rhinocerebral Mucormycosis in a Diabetic Woman

Rhinozerebrale Mucormykose durch Absidia corymbifera

We report two cases of rhinocerebral mucormycosis due toAbsidia corymbifera, an extremely uncommon causal agent. Both occurred in patients with haematological disorders and both had a fatal outcome, despite antemortem diagnosis and aggressive treatment. We discuss the factors which generally contribute to the poor prognosis in this group of patients and suggest another possible mechanism which may contribute to the high mortality.

Rhinocerebral mucormycosis with ct scan findings: A case report

A case of rhinocerebral mucormycosis in a diabetic patient is presented. The radiologic findings of the disease with differential diagnosis are reviewed. Almost complete cure with surgical excision and Amphotericin B was accomplished.

Rhinocerebral mucormycosis

Two cases of rhinocerebral mucormycosis are reported to draw attention to this fulminating fungal disease. Both patients had diabetes, and presented with a rapidly progressive orbital apex syndrome.

Rhinocerebral mucormycosis.

Nine cases of rhinocerebral mucormycosis are reviewed. Eight patients had diabetes and 7 had symptoms related to the orbit. Roentgen analysis of focal bone destruction and uniform mucosal thickening will frequently suggest the diagnosis. Mucormycosis should be suspected in the diabetic patient with destruction of the walls of the bony sinuses, especially when multiple sinus involvement suggests an etiology other than neoplasm.

Histopathological and mycological features of a case of rhinocerebral mucormycosis (phycomycosis) in Britain.

The histopathological and mycological findings in a case of rhinocerebral mucormycosis (phycomycosis) are described. The infective process involved especially the nasal area, but the palate, orbit, olfactory nerves, left temporal lobe and pons were also affected. In the sites most extensively affected the blood vessels were thrombosed and invaded by the fungus. The tissue reaction was both suppurative and granulomatous. The mucoraceous mould, which was identifiable as Rhizopus oryzae Went et Princen Geerlings, was present in abundance, especially in the nasal area where, besides mycelium, there were numerous sporangia and chlamydospores.