The surgical management of rhinocerebral mucormycosis.
BACKGROUND
Rhinocerebral mucormycosis is a rare, rapidly progressive life threatening opportunistic fungal disease that usually occurs in immunocompromised patients.


OBJECTIVE
The aim of the study is to present a case series of six immunocompromised patients who were diagnosed with rhinocerebral mucormycosis, review the diagnostic criteria and treatment approach.


METHODS
Six patients were treated in our department between the years 2005-2010. Their diagnostic criteria, surgical treatment and mortality rate are analyzed and discussed.


RESULTS
All six immunocompromised patients suffered from a primary hematological malignancy and received chemotherapy to treat their primary disease. Symptoms such as pain mimicking sinusitis, facial swelling, oral or dental pain, and fever were found in most patients. The diagnosis was based on both clinical signs and a biopsy for microbiological culture and histological examination. All patients underwent aggressive surgical resection and were treated simultaneously with anti fungal therapy. Four patients died from their primary illness. One patient died due to uncontrolled spreading of mucormycosis and one patient, the youngest and with the most extensive form of the disease (brain invasion) survived and clinically recovered with no evidence of recurrent disease following the surgical management.


CONCLUSIONS
Rhinocerebral mucormycosis is a rapidly progressing disease with a high mortality rate, which requires immediate surgical and medical intervention. It seems from the data presented that the presence of mucormycosis is an ominous sign in immunocompromised patients. The extent of the disease is of less prognostic value, since the only patients in our series who survived had the most extensive disease, yet his primary haemato-oncological disease was under control. Controlling the underlying disease with early diagnosis and aggressive surgical intervention appears to be the most important factor for survival.
The Department of Oral and Maxillofacial Surgery, Rambam Medical Centre, P.O.B 9602, Haifa 35254, Israel.
Imad
I
Abu El-Naaj
Y
Y
Leiser
A
A
Wolff
M
M
Peled
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000382:microbiology; D002423:Cause of Death; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis; D008875:Middle Aged; D009091:Mucormycosis / Q000601:surgery*; D009668:Nose Diseases / Q000382:microbiology* / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000382:microbiology* / Q000601:surgery; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B; D065819:Voriconazole