Rhino-orbital and rhino-orbito-cerebral mucormycosis.
BACKGROUND
Rhino-orbito-cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols.


METHODS
All had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases.


RESULTS
Sixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end-stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%.


CONCLUSIONS
ROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival-dependent classification of ROCM are offered.
Talmi
Yoav P
YP
Departments of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Israel. talmi@ibm.net
Goldschmied-Reouven
Anna
A
Bakon
Mati
M
Barshack
Iris
I
Wolf
Michael
M
Horowitz
Zeev
Z
Berkowicz
Miriam
M
Keller
Nathan
N
Kronenberg
Jona
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D016921:Meningitis, Fungal / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D009668:Nose Diseases / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D009894:Opportunistic Infections / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D018570:Risk Assessment; D012494:Sampling Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000935:Antifungal Agents