title: Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B.
abstract: OBJECTIVE
  Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.
  
  
  METHODS
  Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.
  
  
  RESULTS
  The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.
  
  
  CONCLUSIONS
  Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.
authors: Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran. saedi@tums.ac.ir
authors: B
authors: B
authors: Saedi
authors: M
authors: M
authors: Sadeghi
authors: P
authors: P
authors: Seilani
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003646:Debridement; D048909:Diabetes Complications / Q000382:microbiology; D004198:Disease Susceptibility; D016503:Drug Delivery Systems / Q000379:methods; D004724:Endoscopy; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D009668:Nose Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D009916:Orbital Diseases / Q000382:microbiology; D010254:Paranasal Sinus Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B