[Treatment of mucormycosis with adjunctive hyperbaric oxygen: five cases treated at the same institution and review of the literature].
BACKGROUND
Mucormycosis is an invasive fungal infection that affects decompensated diabetics, immunosupressed patients and occasionally healthy individuals. Despite advances in anti-fungal therapy and surgical techniques, the morbidity and mortality remain high. Adjuvant hyperbaric oxygen therapy (HBO) has been proposed based on pathophysiology and several favorable clinical reports.


METHODS
A chart review of mucormycosis patients referred to the HBO service was performed. Also an electronic search in Medline of relevant literature was undertaken.


RESULTS
Five mucormycosis patients referred for HBO had complete charts available. Four had craniofacial involvement and one had left upper extremity involvement. The predisposing diseases were leukemia (n = 3), diabetes mellitus plus sarcoidosis (n = 1), and trauma (n = 1). All patients were managed with amphotericin B, surgical debridement and HBO. Survival was 60% (3/5) three months after the diagnosis was established. The literature was scarce but favors HBO.


CONCLUSIONS
Considering the pathophysiology of mucormycosis adjuvant HBO therapy seems reasonable. However, the clinical experience is still too limited to make HBO part of the standard of care. Prospective, randomized, controlled trials will help to define the role of HBO in this devastating infection.
García-Covarrubias
Lisardo
L
Departamento de Cirugía, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. lgarcia@tulane.edu
Barratt
Diana M
DM
Bartlett
Robert
R
Van Meter
Keith
K
D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D009091:Mucormycosis / Q000628:therapy*; D012189:Retrospective Studies