A prospective case series on rhino orbital cerebral mucormycosis in Egypt: Epidemiology, systemic implications, and treatment. (July 2022)

• Record Type: Journal Article
• Authors: Elmonofy, Omar; Ghanem, Mohamed; Abdelwahab, Mohamed; Mubarak, Fahmy A.
• Is Part Of: International journal of surgery open. Volume 44(2022)
• Publication Date: 2022-07
• Subjects: Mucormycosis -- Zygomycosis -- Rhizopus -- Diabetes mellitus -- Hematological disorder -- Amphotericin B; Surgery -- Periodicals; 617.005
• DOI: 10.1016/j.ijso.2022.100505
• Languages: English
• ISSNs: 2405-8572

Abstract

Abstract: Introduction and importance: To identify and recognize systemic implications, clinical, characteristics, and management of a group of patients with rhino orbitocerbral mucormycosis infection. Case presentation: The study included twenty-five patients aged range (12–71 years) with rhino orbital cerebral mucormycosis infection who were admitted to the oral and maxillofacial department in Cairo, Egypt from January 2016 to January 2021. The diagnosis was based on clinical examination, radiographic evaluation, and histopathological reports. Cases were managed according to severity and extension of the infection. Clinical discussion: sixteen (64%) males and 9 (36%) females mean age was 44.17 years in a presented sample. 98% of orbital involvement was unilaterally always related to the Right eye (for unknown cause) mortality rate of about six patients (25%). Identified risk factors included eighteen patients (72%) who had diabetes mellitus of these patients ten were undiagnosed at the time of examination, while seven (18%) patients with the hematological disorder as Hodgkin or non-Hodgkin lymphoma, aplastic anemia, and Wegener's disease. These patients were managed by aggressive surgical debridement, antifungal drugs (Amphotericin B), and adjunctive treatment with hyperbaric oxygen Hyperbaric oxygen was used in five patients post-surgically. All investigations were done with mean values of blood glucose level, hemoglobin and WBC were noticeably abnormal. Conclusions: Early identification and reorganization of systemic implications, early clinical diagnosis of patients with mucormycosis infection will facilitate and improve management strategies and outcome of those patients. Understanding this disease will help in rapid and proper management into place to face this lethal opportunistic infection. The most common predisposing factor was diabetes mellitus followed by patients with hematological malignancies. Highlights: Surgical & medical Management of rhino orbitocerbral mucormycosis infection. Mucormycosis is one of the most aggressive fungal infections. The risk of mucormycosis infection increases in immunocompromised patients. Treatment is based on multifactor early surgical intervention, anti-fungal drug. Functional endoscopic sinus surgery is insignificant lead to treatment delaying.