Early identification of rhinocerebral mucormycosis.
OBJECTIVE
Mucormycosis is an acute and often fatal infection caused by a fungus of the Mucorales order of the Zygomycetes class. In the majority of cases, it is associated with an underlying disorder, such as diabetes mellitus with ketoacidosis, or with immunocompromising factors, but it may appear in healthy people, although rarely. Early diagnosis and treatment are critical to prevent an otherwise fatal outcome. This article presents and discusses the early (alarming) signs and symptoms and the predisposing factors that should be considered to avoid delays in diagnosis.


METHODS
We review seven cases of rhinocerebral mucormycosis admitted to our hospitals from 1998 to 2003.


RESULTS
All patients had an underlying immunocompromising factor and/or diabetes mellitus. Five patients had palatal necrotic ulcers and/or black eschars. Three patients had unilateral blindness, and two patients required orbital exenteration. Four patients died because of a delayed diagnosis.


CONCLUSIONS
Early diagnosis is critical in the prevention of intracranial extension of the infection, which is the cause of death in 80% of cases. Therefore, a high index of clinical suspicion is essential in immunocompromised or diabetic patients with acute sinus infection. Identification of a fungal organism on histopathology is the most specific element for diagnosis. A team approach to management is recommended for early surgical debridement, correction of diabetic ketoacidosis, and systemic antifungal agents. Timely medical-surgical treatment proves extremely important for prognosis.
Safar
Ali
A
Department of Otolaryngology, University of Ottawa, Ottawa, Ontario.
Marsan
Joseph
J
Marglani
Osama
O
Al-Sebeih
Khalid
K
Al-Harbi
Jamal
J
Valvoda
Miloslav
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000382:microbiology; D001927:Brain Diseases / Q000175:diagnosis* / Q000382:microbiology; D002648:Child; D003646:Debridement; D018450:Disease Progression; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis*; D009296:Nasal Cavity / Q000382:microbiology; D009668:Nose Diseases / Q000382:microbiology*; D010159:Palate / Q000382:microbiology; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000382:microbiology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014420:Turbinates / Q000382:microbiology