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Published on: July 5, 2021
The surgical management of rhinocerebral mucormycosis
Imad Abu El-Naaj1, Y Leiser, A Wolff
1The Department of Oral and Maxillofacial Surgery, Rambam Medical Centre, P.O.B 9602, Haifa 35254, Israel.
Background:
Rhinocerebral mucormycosis is a rare, rapidly progressive life threatening opportunistic fungal disease that usually occurs in immunocompromised patients.
Aim:
The aim of the study is to present a case series of six immunocompromised patients who were diagnosed with rhinocerebral mucormycosis, review the diagnostic criteria and treatment approach.
Patients And Materials:
Six patients were treated in our department between the years 2005-2010. Their diagnostic criteria, surgical treatment and mortality rate are analyzed and discussed.
Results:
All six immunocompromised patients suffered from a primary hematological malignancy and received chemotherapy to treat their primary disease. Symptoms such as pain mimicking sinusitis, facial swelling, oral or dental pain, and fever were found in most patients. The diagnosis was based on both clinical signs and a biopsy for microbiological culture and histological examination. All patients underwent aggressive surgical resection and were treated simultaneously with anti fungal therapy. Four patients died from their primary illness. One patient died due to uncontrolled spreading of mucormycosis and one patient, the youngest and with the most extensive form of the disease (brain invasion) survived and clinically recovered with no evidence of recurrent disease following the surgical management.
Conclusions:
Rhinocerebral mucormycosis is a rapidly progressing disease with a high mortality rate, which requires immediate surgical and medical intervention. It seems from the data presented that the presence of mucormycosis is an ominous sign in immunocompromised patients. The extent of the disease is of less prognostic value, since the only patients in our series who survived had the most extensive disease, yet his primary haemato-oncological disease was under control. Controlling the underlying disease with early diagnosis and aggressive surgical intervention appears to be the most important factor for survival.
Insights
Rhinocerebral mucormycosis is a severe fungal infection in immunocompromised patients. Early diagnosis and aggressive surgical intervention are crucial for survival, even in extensive cases.
Area of Science:
- Mycology
- Infectious Diseases
- Oncology
Background:
- Rhinocerebral mucormycosis is a rare, aggressive opportunistic fungal infection.
- It primarily affects immunocompromised individuals, often those with hematological malignancies.
Observation:
- A case series of six immunocompromised patients with rhinocerebral mucormycosis was analyzed.
- Patients presented with sinusitis-like symptoms, facial swelling, oral pain, and fever.
- Diagnosis relied on clinical signs, biopsy, microbiological culture, and histology.
Findings:
- All patients had hematological malignancies and received chemotherapy.
- Aggressive surgical resection and antifungal therapy were administered.
- Mortality was high; however, one patient with extensive disease (brain invasion) survived after aggressive management.
Implications:
- Rhinocerebral mucormycosis has a high mortality rate, necessitating prompt surgical and medical intervention.
- Controlling the underlying hematological disease is key for survival.
- Early diagnosis and aggressive treatment are critical for improving outcomes in these patients.
