Gupta Saroj, Goyal Rashmi, Kaore Navinchandra M
1Department of Ophthalmology, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020 MP India.
2Department of ENT & HNS, Rajasthan University of Health Sciences- College of Medical Sciences, Jaipur, Rajasthan 302018 India.
Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):104-111. doi: 10.1007/s12070-019-01774-z. Epub 2019 Dec 5.
To study the clinical presentation and management outcomes in a series of patients with invasive rhino-orbital-cerebral mucormycosis presenting to a tertiary care center in central India. Medical records of eleven consecutive cases of invasive rhino-orbital-cerebral mucormycosis were reviewed. All clinically diagnosed cases, confirmed on microbiological examination were included. Their demographic data, clinical manifestations, underlying systemic conditions, microbiological and radiological reports, medical treatments, and surgical interventions were recorded and analyzed. There were nine male and two female patients with mean age of 46.8 years. Uncontrolled diabetes mellitus was noted in all patients. One patient had history of renal transplantation. The common presenting features were-ophthalmoplegia (73%), diminution of vision, (64%) proptosis (36%) and periorbital swelling (27%). CT scan/MRI revealed sino-orbital involvement in eight cases and rhino-orbital-cerebral involvement in three cases. Ethmoid sinus (100%) was the commonest paranasal sinus involved. KOH preparation and histopathology revealed broad aseptate filamentous fungi branching at right angles with tissue invasion. Culture on sabouraud's dextrose agar showed growth of mucor species. All patients received intravenous amphotericin B and had undergone radical debridement of involved sinuses. The mean duration of follow up was 13 months. All survived except three, who developed cerebral mucormycosis. Rhino-orbital-cerebral mucormycosis is a fetal fungal infection requiring multidisciplinary approach. Uncontrolled diabetes mellitus is the main predisposing factor. Early diagnosis, reversal of predisposing co-morbidities, aggressive medical and surgical management are vital in managing this highly aggressive disease.
为研究一系列侵袭性鼻眶脑毛霉菌病患者在印度中部一家三级医疗中心的临床表现及治疗结果，回顾了连续11例侵袭性鼻眶脑毛霉菌病患者的病历。纳入所有临床诊断且经微生物学检查确诊的病例，记录并分析其人口统计学数据、临床表现、潜在全身状况、微生物学和放射学报告、药物治疗及手术干预情况。患者共9男2女，平均年龄46.8岁，所有患者均有未控制的糖尿病，1例有肾移植史。常见表现为眼球运动障碍（73%）、视力减退（64%）、眼球突出（36%）和眶周肿胀（27%）。CT扫描/MRI显示8例鼻窦-眼眶受累，3例鼻眶脑受累，筛窦（100%）是最常受累的鼻窦。氢氧化钾制片及组织病理学检查显示有宽的无隔丝状真菌，呈直角分支并侵犯组织。在沙氏葡萄糖琼脂培养基上培养显示毛霉属生长。所有患者均接受静脉注射两性霉素B，并对受累鼻窦进行了根治性清创术。平均随访时间为13个月，除3例发生脑毛霉菌病外均存活。鼻眶脑毛霉菌病是一种致命的真菌感染，需要多学科方法治疗。未控制的糖尿病是主要的易感因素。早期诊断、逆转易感合并症、积极的药物和手术治疗对于管理这种高侵袭性疾病至关重要。
