Mucormycosis in immunocompetent individuals: an increasing trend.
OBJECTIVE
Mucormycosis is a fatal infection of the immunocompromised individual. It is unusual to affect healthy individuals. We report eight such cases of infection caused by this emerging fungal pathogen in healthy patients. Of the eight cases, three were infected with Apophysomyces elegans, again an unusual pathogen causing mucormycosis.


METHODS
Retrospective case review conducted at a tertiary referral center.


METHODS
From 1999 to 2003, eight cases of mucormycosis were managed in otherwise healthy patients. Seven of them were treated with surgery. Clinical presentation, imaging studies, mycologic findings, operative findings at surgery, and postoperative results were evaluated. A review of the literature pertaining to mucormycosis infecting otherwise healthy patients and A. elegans infecting otherwise healthy patients in the nose and paranasal sinuses also was done.


RESULTS
Of the eight cases, three were infected with A. elegans, with no history of trauma or any invasive procedure. Seven patients underwent surgical treatment. Histopathologic examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis.


CONCLUSIONS
Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites, not only in immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires tissue débridement and injection of amphotericin B.
Sridhara
Suryanrayan Rao
SR
Department of Otolaryngology and Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Paragache
Gilbert
G
Panda
Naresh K
NK
Chakrabarti
Arunaloke
A
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002481:Cellulitis; D003646:Debridement; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache; D006801:Humans; D007121:Immunocompetence; D007267:Injections; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D009916:Orbital Diseases; D012189:Retrospective Studies; D012852:Sinusitis; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B