Edit concept Question Editor Create issue ticket

Rhinocerebral Mucormycosis


Presentation

  • The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.[ncbi.nlm.nih.gov]
  • The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality.[ncbi.nlm.nih.gov]
  • CASE REPORT: We present a patient with classical presentation of RCM involving paranasal sinuses, orbit, and cranial base who was treated by combination of aggressive surgical and medical therapy.[ncbi.nlm.nih.gov]
  • Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Survival is directly linked to early detection and treatment.[ncbi.nlm.nih.gov]
  • The patient had been experiencing symptoms of diabetes for one month before presentation to the hospital in state of diabetic ketoacidosis.[ncbi.nlm.nih.gov]
Fever
  • RCM typically presents in a rapidly fulminant manner with headache, fever, mucosal necrosis, and ophthalmic symptoms.[ncbi.nlm.nih.gov]
  • Abstract A 75-year-old woman presented with fever and right temporal, periorbital and facial pain for 7 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with mild exophthalmos.[ncbi.nlm.nih.gov]
  • Pulmonary symptoms (eg, productive cough, high fever, dyspnea) are severe.[merckmanuals.com]
  • […] include: Cough Coughing blood (occasionally) Fever Shortness of breath Symptoms of gastrointestinal mucormycosis include: Abdominal pain Blood in the stools Diarrhea Vomiting blood Symptoms of kidney (renal) mucormycosis include: Fever Pain in the upper[medlineplus.gov]
  • Mucormycosis Symptom Fever The definition of fever is an elevation in body temperature or a high body temperature.[medicinenet.com]
Malaise
  • Presentation The onset of sinus mucormycosis may be associated with nonspecific symptoms such as nasal congestion, postnasal drip, dark blood-tinged or purulent rhinorrhea, sinus tenderness, headache, fever, and malaise.[aao.org]
  • […] incidence of rhinocerebral mucormycosis, is expected.[ 1 5 7 ] It is essential for the clinician to maintain a high index of suspicion in populations at risk, as early diagnosis can be life-saving.[ 4 ] Clinical symptoms usually begin as nonspecific malaise[surgicalneurologyint.com]
Anosmia
  • An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa.[ncbi.nlm.nih.gov]
  • Physical examination revealed a Kussmaul respirations, Glasgow coma scale 12 points, right hemifacial edema, anosmia, nasal congestion, necrotic scar in the right nasal vestibule with foul smell.[oatext.com]
Hyposmia
  • Rhinocerebral disease may manifest as unilateral, retro-orbital headache, facial pain, numbness, fever, hyposmia, and nasal stuffiness, which progresses to black discharge.[webmedcentral.com]
Maxillary Sinus Pain
  • The physical examination revealed no fever, no meningeal signs, left maxillary sinus pain and three painless, papulo-erythematous scabbing lesions on the scalp of 3, 7000 leucocytes/µL (95% neutrophils), and low hemoglobin (10.1 g/dl).[omicsonline.org]
Nasal Ulcer
  • The association of mites with a fungus was detected on direct microscopic examination of the scrapings of a nasal ulcer. The mite and the fungus were identified as Demodex folliculorum and Apophysomyces elegans species complex, respectively.[ncbi.nlm.nih.gov]
Eruptions
  • In another patient, brown necrotic area extending from the left premaxilla until the last erupted molar (not crossing the midline) was seen.[ijhas.in]
Chemosis
  • We report a diabetic child who presented with blurred vision, chemosis, and pain in the left periorbital region noted for about 1 week during an episode of ketocidosis.[ncbi.nlm.nih.gov]
  • However, the incidence rates of ptosis, conjunctival injection, and chemosis exhibited no differences between the diseases.[journals.plos.org]
  • .  Later ,proptosis, chemosis and ophthalmoplegia.  Fever and confusion.  Black necrotic eschar on the nasal turbinates or palate : very characteristic 11.[slideshare.net]
  • Retro-orbital extension produces proptosis, chemosis, ophthalmoplegias and blindness. As the brain is involved, there are decreasing levels of consciousness.[patient.info]
  • As the infection progresses, late symptoms may include facial or periorbital swelling or numbness, blurred vision, chemosis, proptosis, diplopia, ophthalmoplegia, corneal anesthesia, and loss of vision, which are indicative of invasion of the orbital[aao.org]
Diplopia
  • Diplopia may be due to involvement of the extraocular nerves. Hyperglycemia is usually manifested as blurry vision, but not diplopia.[oatext.com]
  • Late symptoms from invasion of the orbital nerves and vessels include diplopia and visual field loss. These are late symptoms with a poor prognosis and usually are followed by reduced consciousness.[patient.info]
  • Involvement of the superior orbital fissure and its contents, such as cranial nerves III, IV, and VI, and branches of V1 and V2, may cause diplopia, ophthalmoplegia, and sensory loss to the corresponding areas of the cornea and face.[aao.org]
  • Other causes include periocular trauma, previous surgery, dacryocystitis, and periodontal infection.[ 12 – 14 ] Common signs and symptoms of BOC include proptosis, chemosis, hyperemia, diplopia, and pain during eye movement.[journals.plos.org]
  • Initially, mucormycosis may mimic sinusitis.(5) Late symptoms that indicate invasion of the orbital nerves and vessels include diplopia and visual loss. These late symptoms indicate a poor prognosis and are usually followed by reduced consciousness.[webmedcentral.com]
Blepharoptosis
  • […] cirrhosis. 1,2 Mucormycosis in an immunocompetent host is rare, is usually related to trauma, and has a better prognosis. 3,4 Symptoms that suggest rhinocerebral mucormycosis include unilateral periorbital facial pain, orbital inflammation, eyelid edema, blepharoptosis[consultant360.com]
  • The ocular symptoms of ROCM, such as facial edema, pain, and blepharoptosis, are similar to those of bacterial orbital cellulitis (BOC) soon after infection onset.[journals.plos.org]
Lacrimation
  • Linear enhancement on MRI beginning at the orbital apex was correlated with fungal tracking of the trigeminal and lacrimal nerves.[ncbi.nlm.nih.gov]
Facial Pain
  • The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness.[ncbi.nlm.nih.gov]
  • Abstract A 75-year-old woman presented with fever and right temporal, periorbital and facial pain for 7 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with mild exophthalmos.[ncbi.nlm.nih.gov]
  • Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. Volume 2 covers tumors, the phacomatoses, and vascular disease.[books.google.com]
  • Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations[lifeinthefastlane.com]
  • RHINOCEREBRAL MUCORMYCOSIS Clinical features  Onset with nasal stuffiness ,epistaxis and facial pain.  Later ,proptosis, chemosis and ophthalmoplegia.  Fever and confusion.  Black necrotic eschar on the nasal turbinates or palate : very characteristic[slideshare.net]
Facial Edema
  • Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission.[ncbi.nlm.nih.gov]
  • After patient started to complain of nasal congestion, left upper jaw teeth-pain and left facial paresthesia, with left facial edema, nasopharinx swab was done and Rhizopus oryzae was isolated.[aspergillus.org.uk]
  • 1 5 7 ] It is essential for the clinician to maintain a high index of suspicion in populations at risk, as early diagnosis can be life-saving.[ 4 ] Clinical symptoms usually begin as nonspecific malaise and headache, progressing to acute sinusitis, facial[surgicalneurologyint.com]
  • The ocular symptoms of ROCM, such as facial edema, pain, and blepharoptosis, are similar to those of bacterial orbital cellulitis (BOC) soon after infection onset.[journals.plos.org]
Headache
  • RCM typically presents in a rapidly fulminant manner with headache, fever, mucosal necrosis, and ophthalmic symptoms.[ncbi.nlm.nih.gov]
  • A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye.[ncbi.nlm.nih.gov]
  • Abstract We report a case of rhinocerebral mucormycosis in a 31 year old immunocompetent female presenting initially like acute rhinosinusitis with nasal stuffiness, severe headache, vomiting who soon developed isolated right lateral rectus palsy.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye.[ncbi.nlm.nih.gov]
  • The most common clinical feature at admission was ocular lesions, followed by headache, nostril lesions, and consciousness disturbance.[ncbi.nlm.nih.gov]
Seizure
  • A 53-year-old woman with poorly controlled diabetes mellitus and treated with azathioprine and metil-prednisone for autoimmune cholangitis, came to our emergency department for having two episodes of tonico-clonic generalized seizures.[omicsonline.org]
  • Progressive extension of necrosis to the brain can cause signs of cavernous sinus thrombosis, seizures, aphasia, or hemiplegia. Pulmonary mucormycosis resembles invasive aspergillosis.[merckmanuals.com]
  • Prolonged preictal psychosis in refractory seizures: A report of three cases. Epilepsy & Behavior 2008; 13: 252-255. 5. Tarulli A. Devinsky O, Alper K. Progression of postictal to interictal psychosis. Epilepsia 2001; 42:1468-1471 . 6.[neurowikia.es]
  • The occurrence of mental status changes, hemiparesis, or seizures suggests intracranial invasion. 6 The time from onset of initial symptoms to late symptoms and signs that are diagnostic of the disease may be as short as one day. 7 The development of[aao.org]
  • There was no history of fall, trauma, seizures, loss of consciousness, vomiting. On examination, the patient was conscious, oriented to time, place and person, febrile (temperature 100 F), pulse rate was 120/min, his blood pressure was 110/70mmHg.[oapublishinglondon.com]
Confusion
  • Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Survival is directly linked to early detection and treatment.[ncbi.nlm.nih.gov]
  • Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations[lifeinthefastlane.com]
  • .  Fever and confusion.  Black necrotic eschar on the nasal turbinates or palate : very characteristic 11.[slideshare.net]
  • J, a 74-year-old man from Costa Rica with diabetes, was admitted to the geriatric inpatient service with a 2-week history of fatigue, weakness, and confusion, and 1 day of vomiting.[consultant360.com]
  • Symptoms of brain involvement include headache, confusion, hemiparesis, and seizure.[journals.plos.org]
Cranial Nerve Involvement
  • Cranial nerve involvement causing diplopia, restricted eye movements and visual field defects. Black discharge may also be seen in cutaneous variants. Predisposing factors such as diabetes, malignancy or disorders of iron metabolism.[patient.info]
  • Cranial nerve involvement in malignant external otitis – implications on clinical outcome. Laryngoscope 117: 907-910, 2007 78. Badran, K., Sudhoff, H., Gray, R. An unusual air gun injury to the ethmoid sinus.[klinikumbielefeld.de]
Papilledema
  • Neurologic examinations revealed that there was a decreased range of motion in the upward and lateral gaze, along with incomplete pupillary dilatation and papilledema of the left eye.[ncbi.nlm.nih.gov]

Workup

  • MUCORMYCOSIS WORKUP BIOPSY-OF INVOLVED TISSUE. SWABS OF TISSUE DISCHARGE ARE UNRELIABLE. CBC FOR NEUTROPENIA ABG TO CORRECT ACIDOSIS RBS-SUGAR CONTROL 24. IMAGING STUDIES PLAIN X-RAY CT SCAN MRI SCANS CHEST CT/MRI 25.[slideshare.net]
Sinus Opacification
  • Complete sinus opacification, gas-fluid levels and obliteration of the nasopharyngeal tissue planes can also occur.[radiopaedia.org]
  • Magnetic resonance imaging (MRI) showed infarct with encephalomalacia in the left parietal lobe abutting the sylvian fissure, and right maxillary, ethmoidal and sphenoidal sinus opacification extending into the right orbit with compression of optic nerve[jiaomr.in]

Treatment

  • The response to treatment may be evaluated by physical examination, microbiological cultures, radiological and pathological studies.[ncbi.nlm.nih.gov]
  • Additionally, it emphasizes that such treatment can have an excellent outcome, and mortality and significant morbidity can be avoided. Finally, we provide a review of the literature regarding mucormycosis infections and treatment options.[ncbi.nlm.nih.gov]
  • The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment.[ncbi.nlm.nih.gov]
  • CONCLUSION: 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.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis was analyzed according to the predisposing factors, including underlying disease, extent of disease and surgical intervention.[ncbi.nlm.nih.gov]
  • Multinucleate giant cell granulomas and arteritis are only exceptionally associated with rhinocerebral mucormycosis, but these histologic findings may be correlated with a progressive disease with better prognosis.[ncbi.nlm.nih.gov]
  • CONCLUSION: Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.[ncbi.nlm.nih.gov]
  • Abstract Rhinocerebral mucormycosis (RCM) is an angioinvasive fungal infection most often caused by Rhizopus oryzae It is usually associated with an underlying risk factor and is associated with a poor prognosis.[ncbi.nlm.nih.gov]
  • Very early diagnosis, established with the demonstration of characterised hyphae in tissues, greatly improves the prognosis of RCM.[ncbi.nlm.nih.gov]

Etiology

  • Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention.[ncbi.nlm.nih.gov]
  • The etiologic fungus isolated from tissue biopsy on mycological media was identified by the amplification and sequencing of the 5.8S RNA gene and of the adjacent internal transcriber spacer domains, ITS1/ITS4, as Rhizopous oryzae.[ncbi.nlm.nih.gov]
  • In this supplement, we review the current knowledge about the virulence traits used by the most common etiologic agent of mucormycosis, Rhizopus oryzae.[ncbi.nlm.nih.gov]
  • Each part surveys individual infections caused not only by well-known etiologic agents, but also by new and emerging species often taxonomically closely related to a major disea- producing microorganism and until recently not considered to be human pathogens[books.google.com]
  • ., An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis, Science, 244, 362, 1989. ‏[books.google.com]

Epidemiology

  • Epidemiology and outcome of zygomycosis: a review of 929 reported cases.. Clin Infect Dis 41 :, 634– – 653. [CrossRef] [Google Scholar] Spellberg B., Walsh T.J., Kontoyiannis D.P., Jr Edwards J., Ibrahim A.S.. ( 2010 ; ).[jmmcr.microbiologyresearch.org]
  • EPIDEMIOLOGY INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY. MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%). NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT. 7.[slideshare.net]
  • "Epidemiology and outcome of Mucormycosis: a review of 929 reported cases". Clin. Infect. Dis. 41 (5): 634–53. doi : 10.1086/432579. PMID 16080086. Lyndsay Mayer. "Mucormycosis". Food and Drug Administration.[en.wikipedia.org]
  • The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance.[journals.plos.org]
  • Epidemiology The condition is very rare but often unrecognised.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • We present a case of rhinocerebral mucormycosis and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.[ncbi.nlm.nih.gov]
  • We report a case of carotid artery occlusion due to RCM and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.[ncbi.nlm.nih.gov]
  • Pathophysiology Angioinvasion Vessel thrombosis Tissue necrosis 6. EPIDEMIOLOGY INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY. MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%). NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT. 7.[slideshare.net]
  • Spellberg B, Edwards J Jr, Ibrahim A (2005) Novel perspectives on mucormycosis: pathophysiology, presentation, and management. ClinMicrobiol Rev 18: 556-569.[omicsonline.org]
  • Novel perspectives on mucormycosis: pathophysiology, presentation and management. Clin Microbiol Rev 2005 Jul;18(3):556-69. 9. Sujatha RS, Rakesh N, Deepa J, Ashish L, Shridevi B.[oapublishinglondon.com]

Prevention

  • CONCLUSIONS: Early diagnosis is critical in the prevention of intracranial extension of the infection, which is the cause of death in 80% of cases.[ncbi.nlm.nih.gov]
  • Furthermore, a concerted team approach, systemic antifungal agents and early surgical intervention seem to be crucial for preventing rapid disease progression.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To illustrate that rapid diagnosis and aggressive treatment of rhinocerebral mucormycosis with internal carotid artery occlusion in a pediatric patient can prevent mortality and significant morbidity.[ncbi.nlm.nih.gov]
  • We eventually had to remove of all left orbita contents, including the eye ball, to prevent death. We recommend that fungus infection be given 2 classifications: benign and malignant.[ci.nii.ac.jp]
  • New strategies to prevent and treat mucormycosis are urgently needed. Understanding the pathogenesis of mucormycosis and the host response to invading hyphae ultimately will provide targets for novel therapeutic interventions.[ncbi.nlm.nih.gov]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!