title: Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature.
abstract: OBJECTIVE
  To review the current literature on mucormycosis in immunocompentent/otherwise healthy individuals, to which five new cases with maxillary sinus involvement have been added.
  
  
  METHODS
  We searched in the PudMed database all articles in the English language related to human infections caused by fungi of the order Mucorales, in immunocompetent/otherwise healthy patients, starting from January 1978 to June 2009. In addition, we updated the literature by reporting five new cases diagnosed and treated at the oral medicine unit of our institution.
  
  
  RESULTS
  The literature review showed at least 126 articles published from 35 different countries in the world, to a total of 212 patients described. The most affected country was India with 94 (44.3%) patients and the most representative clinical form was the cutaneous/subcutaneous with 90 (42.5%) patients. Our five immunocompetent patients with a diagnosed infection of Mucorales localized at the maxillary sinus completely healed with lyposomial amphotericin B.
  
  
  CONCLUSIONS
  The literature analysis revealed that even in immunocompetent/otherwise healthy individuals mucormycosis infection has a worldwide distribution. What might be the real predisposing factors involved in its pathogenesis in such patients and the real causes of this peculiar geographic distribution still remains unknown. It is likely that, in our cases, a chronic insult of a well-defined and localized body area might have resulted in a local immunocompromission, thus fostering the development of an invasive fungal infection.
authors.affiliation: Oral Medicine Unit, Department of Odontostomatological and Maxillo-facial Science of School of Medicine and Surgery, Federico II University of Naples, Naples, Italy. mignogna@unina.it
authors.forename: Michele D
authors.initials: MD
authors.lastname: Mignogna
authors.forename: Giulio
authors.initials: G
authors.lastname: Fortuna
authors.forename: Stefania
authors.initials: S
authors.lastname: Leuci
authors.forename: Daniela
authors.initials: D
authors.lastname: Adamo
authors.forename: Elvira
authors.initials: E
authors.lastname: Ruoppo
authors.forename: Maria
authors.initials: M
authors.lastname: Siano
authors.forename: Umberto
authors.initials: U
authors.lastname: Mariani
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009061:Mouth Mucosa / Q000382:microbiology; D009090:Mucorales / Q000187:drug effects / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B