Rhinocerebral Mucormycosis

7/22/02 (Dickens)

Question: What is known about the disease process of rhinocerebral mucormycosis, and what are currently accepted treatment options?

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Unique Identifier:8572846

Authors: Strasser MD. Kennedy RJ. Adam RD.

Institution: University of Arizona, College of Medicine, USA.

Title: Rhinocerebral mucormycosis. Therapy with amphotericin B lipid complex. [see comments.]. [Review] [21 refs]

Source: Archives of Internal Medicine. 156(3):337-9, 1996 Feb 12.

Abstract: Rhinocerebral mucormycosis with intracranial involvement has a high mortality. The standard therapy consists of aggressive surgical debridement accompanied by high doses of amphotericin B deoxycholate. Even with this therapy, the mortality rate has been 48% in the series reported since 1980. We treated a 60-year-old diabetic woman with rhinocerebral mucormycosis involving the cavernous sinus whose infection responded to medical therapy with amphotericin B lipid complex. To our knowledge, this is the only well-documented medical cure of a patient with rhinocerebral mucormycosis and intracranial involvement. [References: 21] CAS Registry/EC Number 0 (Antibiotics, Antifungal). 1397-89-3 (Amphotericin B).

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Unique Identifier:9366697

Authors: deShazo RD. O'Brien M. Chapin K. Soto-Aguilar M. Gardner L. Swain R.

Institution: Department of Medicine and Pediatrics, University of South Alabama, Mobile, USA. rdeshazo@usamail.usouthal.edu

Title: A new classification and diagnostic criteria for invasive fungal sinusitis. [Review] [46 refs]

Source: Archives of Otolaryngology -- Head & Neck Surgery. 123(11):1181-8, 1997 Nov.

Abstract: OBJECTIVE: To develop criteria for the diagnosis of invasive fungal sinusitis. DESIGN: Review of the literature on invasive fungal sinusitis in the context of a population of 30 patients with fungal sinusitis and 24 patients with chronic bacterial sinusitis. SETTING: Tertiary care medical center. RESULTS: Our review revealed no consensus in the literature on the classification of the syndromes of invasive fungal sinusitis and no criteria for their diagnosis. Moreover, the existing syndromes of invasive fungal sinusitis lacked specificity and one of the more commonly cited syndromes, primary aspergillosis of the paranasal sinuses, is a granulomatous disease that occurs rarely outside Africa. Two of our 30 patients with fungal sinusitis had a previously unrecognized form of invasive disease. Both were middle-aged adults with well-controlled type 2 diabetes mellitus, apical orbital syndrome, and a similar course: proptosis resulting from fungal expansion out of an ethmoid sinus, a protracted illness of 6 months or longer, visual changes, late neurological symptoms reflecting cavernous sinus invasion, and death. The syndrome in these 2 patients is distinct from the syndrome of fulminant invasive fungal sinusitis, (eg, mucormycosis) with nasal eschar, intracerebral fungal dissemination by vascular invasion, and death in days, and the granulomatous form. CONCLUSIONS: We conclude that there are 3 forms of invasive fungal sinusitis and propose that they be termed (1) granulomatous, (2) acute fulminant, and (3) chronic invasive. The latter category reflects the syndrome seen in our 2 patients. Furthermore, the following 2 diagnostic criteria for invasive fungal sinusitis are proposed: (1) sinusitis confirmed by radiological imaging and (2) histopathological evidence of hyphal forms within sinus mucosa, submucosa, blood vessels, or bone. The specificity of hyphae within sinus mucosa for tissue invasion was supported by the absence of stainable hyphae in the mucosa of patients with chronic bacterial sinusitis or in the mucosa of our described patients with allergic fungal sinusitis and mycetoma. [References: 46]

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Unique Identifier:9227932

Authors: deShazo RD. Chapin K. Swain RE.

Institution: Department of Medicine, University of South Alabama, Mobile 36617, USA.

Title: Fungal sinusitis. [see comments.]. [Review] [50 refs]

Source: New England Journal of Medicine. 337(4):254-9, 1997 Jul 24.

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Unique Identifier:9636868

Authors: Walsh TJ. Hiemenz JW. Seibel NL. Perfect JR. Horwith G. Lee L. Silber JL. DiNubile MJ. Reboli A. Bow E. Lister J. Anaissie EJ.

Institution: Infectious Diseases Section, National Cancer Institute, Bethesda, Maryland 20892, USA.

Title: Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. [see comments.].

Source: Clinical Infectious Diseases. 26(6):1383-96, 1998 Jun.

Abstract: The safety and antifungal efficacy of amphotericin B lipid complex (ABLC) were evaluated in 556 cases of invasive fungal infection treated through an open-label, single-patient, emergency-use study of patients who were refractory to or intolerant of conventional antifungal therapy. All 556 treatment episodes were evaluable for safety. During the course of ABLC therapy, serum creatinine levels significantly decreased from baseline (P < .02). Among 162 patients with serum creatinine values > or = 2.5 mg/dL at the start of ABLC therapy (baseline), the mean serum creatinine value decreased significantly from the first week through the sixth week (P < or = .0003). Among the 291 mycologically confirmed cases evaluable for therapeutic response, there was a complete or partial response to ABLC in 167 (57%), including 42% (55) of 130 cases of aspergillosis, 67% (28) of 42 cases of disseminated candidiasis, 71% (17) of 24 cases of zygomycosis, and 82% (9) of 11 cases of fusariosis. Response rates varied according to the pattern of invasive fungal infection, underlying condition, and reason for enrollment (intolerance versus progressive infection). These findings support the use of ABLC in the treatment of invasive fungal infections in patients who are intolerant of or refractory to conventional antifungal therapy. CAS Registry/EC Number 0 (Abelcet). 0 (Antifungal Agents). 0 (Drug Combinations). 0 (Phosphatidylcholines). 0 (Phosphatidylglycerols). 1397-89-3 (Amphotericin B). 60-27-5 (Creatinine).