Mucormycosis - An Adamant Parasitic Fungal Infection Requiring Multiple Surgeries

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Dr. Ishwar Singh
Dr. Ashish Gopal
Dr. Raman Sharma
Dr. Sakshi Negi
Dr. Shobhit Rastogi
Dr. Shramana Mandal
Dr. Raghav Singh
Dr. Rakesh Kumar

Abstract

Introduction - Mucormycosis is a life threatening invasive fungal infection that mostly occurs in immunocompromised patients. Aim of our study is to analyze the management of mucormycosis in rhinoorbital mucormycosis cases and dire requirement for more than one surgical intervention for their management. The limitations of first surgery, progressive nature of disease, and difficult anatomical regions were the areas to address in most of our patients in this series.


Methodology - Our case series consists of 34 confirmed cases of mucormycosis using standard staining and histopathological confirmation on biopsy. The study group being subjected to complete modern diagnostic, CT, MRI scrutinization. Detailed follow up with serial endoscopies, post-surgery. Re confirmation of residual on progressive mucormycosis disease condition being subjected to repeat of these investigative tools and confirmation with PET scan.


Results – Total of 34 patients were included in our study majority of them were diabetic. Only 3 patients underwent single stage debridement however 34 patients underwent debridement in two successive stage and two patients required third surgery for disease clearance.


Conclusion – Repeated surgical debridement is must for complete disease eradication in case of rhinoorbitocerebral mucormycosis. Also, medical management can prolong the survival of patients with disease in areas which are inaccessible by surgical clearance. Serial radiography with CT, MRI and PET scan are not only contributary but mandatory.


 

Article Details

How to Cite
Singh, D. I. ., Gopal, D. A. ., Sharma, . D. R., Negi, D. S., Rastogi, . D. S., Mandal, D. S., Singh, . D. R. ., & Kumar, D. R. . (2023). Mucormycosis - An Adamant Parasitic Fungal Infection Requiring Multiple Surgeries. International Journal of Medical Science and Clinical Research Studies, 3(06), 1203–1212. https://doi.org/10.47191/ijmscrs/v3-i6-32
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References

I. Paltauf A. Mycosis mucorina; ein beitrag zur kenntniss der menschlichem fadenpilzee krankunger. Virchow’s Arch Path Anat. 1885;102:543.

II. Kaushal D, Rajan N, Soni K., Sharma A., Choudhury B., Yadav T et al. Reducing mortality in mucormycosis of the head and neck in diabetic patients: A CARE case series. Ann Fr Oto-Rhino-Laryngol Pathol Cer-Fac 2022. 139(3);145-52.

III. Brown JS, Shaw RJ. Reconstruction of themaxilla and midface: introducing a new classification. Lancet Oncol 2010;11:1001-8

IV. Eucker J, Sezer O, Graf B, Possinger K Mucormycoses. Mycoses 2001; 44:253-60.

V. Skiada A, Lanternier F, Groll AH et al. Diagnosis and treatment of mucormycosis in patients with haematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica 2013; 98: 492–504.

VI. Meas T, Mouly S, Kania R et al. Zygomycosis: an uncommon cause for peripheral facial palsy in diabetes. Diabetes Metab 2007; 33: 227– 229.

VII. Lanternier F, Dannaoui E, Morizot G et al. A global analysis of mucormycosis in France: the RetroZygo Study (2005-2007). Clin Infect Dis 2012; 54 (Suppl 1): S35–S43.

VIII. Hot A, Maunoury C, Poiree S, Lanternier F, Viard JP, Loulergue P et al. Diagnostic contribution of positron emission tomography with [18F] fluorodeoxyglucose for invasive fungal infections. Clin Microbiol Infect 2011;17:409-17.

IX. Liu Y, Wu H, Fan Z. Utility of 18F-FDG PET/Ct in diagnosis and management of muycormycosis. Clin Nucl Med 2013;38:e370-71

X. Blitzer A, Lawson W, Meyers BR, Biller HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope 1980; 90: 635–648.

XI. Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 1997;107(7):855-62

XII. Talmi YP, Goldschmied-Reouven A, Bakon M et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002; 127: 22–31

XIII. Delbrouck C, Jacobs F, Fernandez,Aguilar S, Devroede B, Choufani G,Hassid S. Carotid artery occlusion dueto fulminant rhinocerebral mucormycosis.Acta Otorhinolaryngol Belg.2004;58(2):135-140.

XIV. McLean FM, Ginsberg LE, Stanton CA. Perineural spread of rhino - cerebral mucormycosis. AJNR Am J Neuroradiol. 1996;17(1):114-116.

XV. Bitterman H. Oxygen: an anti-inflammatory drug. Isr Med Assoc J 2007; 9: 874–6.

XVI. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am 2008; 26 (2): 571–595