Predictors of mortality in rhinocerebral mycosis.
BACKGROUND
Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure.


OBJECTIVE
To determine the predictors of mortality in rhinocerebral mycosis.


METHODS
The demographic data, clinical features, radiological (MRI/CT) findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi-square test was used for P value.


RESULTS
There were 38 patients. The age range was 7-82 (mean 48.68) years; 30 (79%) were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%). Rhino-orbital involvement was noted in 24 (63.2%) and 12 (31.6%) had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%). Eighteen (47.4%) patients died. The predictors for mortality: odds ratio (95% CI) were 2.45 (1.01-3.89) for elderly age, 5.67 (4.13-7.21) for intracranial extension, 2.6 (1.26-3.94) for immunocompromised state, 2.62 (1.25-3.99) for infection with zygomycosis and 2.33 (1.01-3.65) for anemia.


CONCLUSIONS
Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis.
Jayalakshmi
Sita S
SS
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, India. sita_js@hotmail.com
Reddy
Ramana G
RG
Borgohain
Rupam
R
Subramanyam
C
C
Panigrahi
Manas
M
Sundaram
C
C
Meena
A K
AK
Mohandas
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000382:microbiology* / Q000401:mortality*; D002648:Child; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009181:Mycoses / Q000175:diagnosis / Q000401:mortality*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult