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Rhinocerebral mucormycosis: predisposing factors, diagnosis, therapy, complications and survival
O Butugan1, T G Sanchez, F Gonçalez
1Otolaryngology Department, University of Sao Paulo School of Medicine.
Abstract:
Mucormycosis is the most acutely fatal fungal infection of the human being (5). Although relatively uncommon, its morbidity makes it an extremely important disease for the Otolaryngologist-Head and Neck Surgeon. A review of 11 cases of rhinocerebral mucormycosis (nine female and two male patients) admitted from 1961 to 1994 at Hospital das Clinicas, University of Sao Paulo was undertaken. The age range was from eight months to 49 years with a median age of 31 years. In the current study, we present and discuss the predisposing factors, the methods of diagnosis, the treatment given the complications observed and the survival of the disease. The survival rate for paranasal sinus mucormycosis in this study was 72.7% (8/11). All deaths occured within the first month after diagnosis and institution of treatment. All the patients that died presented with diabetic ketoacidosis. Hemiplegia as a neurological complication of the disease was seen in 66.6% (2/3) of the deaths. Survival analysis (Fisher Test p < 0.05) indicates that diabetic ketoacidosis and hemiplegia are negative prognostic factors in mucormycosis survival. The authors intend to add some more information to the limited literature on paranasal sinus mucormycosis.
Insights
Rhinocerebral mucormycosis survival is 72.7%, with diabetic ketoacidosis and hemiplegia being negative prognostic factors. Early diagnosis and treatment are crucial for improving outcomes in this severe fungal infection.
Area of Science:
- Medicine
- Infectious Diseases
- Otolaryngology
Background:
- Mucormycosis is a severe, acutely fatal fungal infection.
- Rhinocerebral mucormycosis poses significant morbidity for Head and Neck Surgeons.
- Limited literature exists on paranasal sinus mucormycosis.
Purpose of the Study:
- To analyze predisposing factors, diagnosis, treatment, complications, and survival rates of rhinocerebral mucormycosis.
- To identify prognostic factors influencing mucormycosis survival.
- To contribute to the existing knowledge on paranasal sinus mucormycosis.
Main Methods:
- Retrospective review of 11 rhinocerebral mucormycosis cases (1961-1994).
- Analysis of patient demographics, clinical presentation, and treatment outcomes.
- Statistical analysis (Fisher Test) to determine prognostic factors.
Main Results:
- Overall survival rate for paranasal sinus mucormycosis was 72.7% (8/11).
- All deaths occurred within one month of diagnosis and treatment initiation.
- Diabetic ketoacidosis and hemiplegia were observed in fatal cases and identified as negative prognostic factors.
Conclusions:
- Diabetic ketoacidosis and hemiplegia significantly decrease survival chances in mucormycosis patients.
- Prompt diagnosis and management are critical for patient survival.
- Further research is needed to understand and combat this devastating infection.