title: Rhino-orbital and rhino-orbito-cerebral mucormycosis.
abstract: 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.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Israel. talmi@ibm.net
authors.forename: Yoav P
authors.initials: YP
authors.lastname: Talmi
authors.forename: Anna
authors.initials: A
authors.lastname: Goldschmied-Reouven
authors.forename: Mati
authors.initials: M
authors.lastname: Bakon
authors.forename: Iris
authors.initials: I
authors.lastname: Barshack
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.forename: Zeev
authors.initials: Z
authors.lastname: Horowitz
authors.forename: Miriam
authors.initials: M
authors.lastname: Berkowicz
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.forename: Jona
authors.initials: J
authors.lastname: Kronenberg
mesh_terms: 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
chemical_list: D000935:Antifungal Agents