Mucormycosis: A clinical-pathological case series study

Authors

DOI:

https://doi.org/10.33448/rsd-v13i2.44903

Keywords:

Mucormycosis; Opportunistic infections; Diabetes.

Abstract

The aim of this study was to provide an overview of the possible presentations or forms of this rare, invasive fungal infection of the face, comparing it from diagnosis to treatment. This is an observational, descriptive, case series study, in which all cases diagnosed with fungal infections on the face were reviewed from the files of the Hospital Estadual de Urgências Governador Otávio Lage de Siqueira, Goiânia, GO, Brazil. Clinical data were obtained from patient records and radiographic characteristics were evaluated in each case. All cases were reviewed microscopically to confirm the diagnosis. Three cases of patients with mucormycosis fungal infection were identified, 1 in a woman and 2 in men. Both with common clinical manifestations: amaurosis, maxillary sinusitis, facial nerve involvement and extensive necrosis of the involved region. The diagnostic elucidation of the cases was carried out through microbiological examinations and computed tomography. They were conducted using a multimodal approach, including control of underlying predisposing factors, early administration of active antifungal agents at optimal doses, and complete removal of any infected tissue. In conclusion, mucormycosis infections are rare, invasive and usually fatal, with a low survival rate. It is commonly disseminated in patients with compromised immunity, particularly those with decompensated diabetes. There is still a lack of literature on the definitive management of this disease involving the stomatognathic system. This article emphasizes the need for correction of the underlying predisposing factor and early diagnosis with an aggressive multimodal treatment approach to provide the best chance of survival.

References

Borjian Boroujeni, Z., Shamsaei, S., Yarahmadi, M., Getso, M. I., Salimi Khorashad, A., Haghighi, L., Raissi, V., Zareei, M., Saleh Mohammadzade, A., Moqarabzadeh, V., Soleimani, A., Raeisi, F., Mohseni, M., Mohseni, M. S., & Raiesi, O. (2021). Distribution of invasive fungal infections: Molecular epidemiology, etiology, clinical conditions, diagnosis and risk factors: A 3-year experience with 490 patients under intensive care. Microbial Pathogenesis, 152, 104616. https://doi.org/10.1016/j.micpath.2020.104616

Prabhu, R. M., & Patel, R. (2004). Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clinical Microbiology and Infection, 10, 31–47. https://doi.org/10.1111/j.1470-9465.2004.00843.x

Long, B., & Koyfman, A. (2015). Mucormycosis: what emergency physicians need to know? The American Journal of Emergency Medicine, 33(12), 1823–1825. https://doi.org/10.1016/j.ajem.2015.08.037

Kim, J.-G., Park, H. J., Park, J. H., Baek, J., Kim, H. J., Cha, I.-H., & Nam, W. (2013). Importance of immediate surgical intervention and antifungal treatment for rhinocerebral mucormycosis: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 39(5), 246–250. https://doi.org/10.5125/jkaoms.2013.39.5.246

Ardeshirpour, F., Bohm, L. A., Belani, K. K., Sencer, S. F., Lander, T. A., & Sidman, J. D. (2013). Surgery for pediatric invasive fungal sinonasal disease. The Laryngoscope, 124(4), 1008–1012. https://doi.org/10.1002/lary.24369

Alfano, C., Chiummariello, S., Dessy, L. A., Bistoni, G., & Scuderi, N. (2006). Combined mucormycosis and Aspergillosis of the rhinocerebral region. In Vivo (Athens, Greece), 20(2), 311–315. https://pubmed.ncbi.nlm.nih.gov/16634536/

Radowsky, J. S., Strawn, A. A., Sherwood, J., Braden, A., & Liston, W. (2011). Invasive mucormycosis and aspergillosis in a healthy 22-year-old battle casualty: case report. Surgical Infections, 12(5), 397–400. https://doi.org/10.1089/sur.2010.065

Paltauf, A. (1885). Mycosis mucorina. Archiv Für Pathologische Anatomie Und Physiologie Und Für Klinische Medicin, 102(3), 543–564. https://doi.org/10.1007/bf01932420

Jundt, J. S., Wong, M. E. K., Tatara, A. M., & Demian, N. M. (2018). Invasive Cutaneous Facial Mucormycosis in a Trauma Patient. Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons, 76(9), 1930.e1–1930.e5. https://doi.org/10.1016/j.joms.2018.01.022

Farias, L. A. B. G., Damasceno, L. S., Bandeira, S. P., Barreto, F. K. de A., Leitão, T. do M. J. S., & Cavalcanti, L. P. de G. (2021). COVID-19 associated Mucormycosis (CAM): Should Brazil be on alert? Revista Da Sociedade Brasileira de Medicina Tropical, 54, e0410. https://doi.org/10.1590/0037-8682-0410-2021

Jeong, W., Keighley, C., Wolfe, R., Lee, W. L., Slavin, M. A., Kong, D. C. M., & Chen, S. C.-A. (2019). The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clinical Microbiology and Infection, 25(1), 26–34. https://doi.org/10.1016/j.cmi.2018.07.011

Estrela, C. (2018). Metodologia Científica: Ciência, Ensino, Pesquisa. In Google Books. Artes Medicas. https://books.google.com.br/books/about/Metodologia_Cient%C3%ADfica.html?hl=pt-BR&id=67VIDwAAQBAJ&redir_esc=y

Merchán-Hamann, E., & Tauil, P. L. (2021). Proposta de classificação dos diferentes tipos de estudos epidemiológicos descritivos. Epidemiologia E Serviços de Saúde, 30(1). https://doi.org/10.1590/s1679-49742021000100026

Bonifaz, A., Macias, B., Paredes-Farrera, F., Arias, P., Ponce, R., & Araiza, J. (2008). Palatal zygomycosis: experience of 21 cases. Oral Diseases, 14(6), 569–574. https://doi.org/10.1111/j.1601-0825.2007.01433.x

Ravi, P., Ramadorai, A., & Narayanan, V. (2019). Rhinocerebral mucormycosis: A prospective analysis of an effective treatment protocol. Annals of Maxillofacial Surgery, 9(1), 192. https://doi.org/10.4103/ams.ams_231_18

Gomes, M. Z. R., Lewis, R. E., & Kontoyiannis, D. P. (2011). Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species. Clinical Microbiology Reviews, 24(2), 411–445. https://doi.org/10.1128/cmr.00056-10

Bonifaz, A., Tirado-Sánchez, A., Paredes-Farrera, F., Moreno-Moreno, J., Araiza, J., & González, G. M. (2020). Oral involvement in mucormycosis. A retrospective study of 55 cases. Enfermedades Infecciosas Y Microbiologia Clinica (English Ed.), S0213-005X(20)302937. https://doi.org/10.1016/j.eimc.2020.09.003

Nucci, M., Engelhardt, M., & Hamed, K. (2019). Mucormycosis in South America: A review of 143 reported cases. Mycoses, 62(9), 730–738. https://doi.org/10.1111/myc.12958

Oswal, N. P., Gadre, P. K., Sathe, P., & Gadre, K. S. (2012). Mucormycosis of Mandible with Unfavorable Outcome. Case Reports in Dentistry, 2012, 1–4. https://doi.org/10.1155/2012/257940

Mtibaa, L., Halwani, C., Tbini, M., Boufares, S., Souid, H., Ben Sassi, R., Gharsallah, H., Ben Mhamed, R., Akkari, K., & Jemli, B. (2020). Successful treatment of rhino-facial mucormycosis in a diabetic patient. Medical Mycology Case Reports, 27, 64–67. https://doi.org/10.1016/j.mmcr.2020.01.003

Garcia-Hermoso, D. (2013). Diagnostic microbiologique des mucormycoses. Médecine/Sciences, 29, 13–18. https://doi.org/10.1051/medsci/201329s104

Yeo, C. D., Kim, J. S., Kwon, S. H., Lee, E. J., Lee, M. H., Kim, S. G., You, Y. S., Kim, J. S., Lee, J. H., & Ryu, J. S. (2018). Rhinocerebral mucormycosis after functional endoscopic sinus surgery: A case report. Medicine, 97(51), e13290. https://doi.org/10.1097/MD.0000000000013290

Nilanonth, S., Shakya, P., Chotprasert, N., & Srithavaj, T. (2017). Combination prosthetic design providing a superior retention for mid-facial defect rehabilitation: A Case Report. Journal of Clinical and Experimental Dentistry. https://doi.org/10.4317/jced.53513

Vero, N., Mishra, N., Singh, B. P., Singh, K., Jurel, S. K., & Kumar, V. (2015). Assessment of swallowing and masticatory performance in obturator wearers: a clinical study. The Journal of Advanced Prosthodontics, 7(1), 8. https://doi.org/10.4047/jap.2015.7.1.8

Published

01/02/2024

How to Cite

MAGRI, L. V.; RIBEIRO, I. G. de S. .; BRITO, L. T.; FELGA, C. S. F.; PAULA, L. M. de .; SOBRINHO , L. C. P. .; SANTOS, J. M. F. dos . Mucormycosis: A clinical-pathological case series study. Research, Society and Development, [S. l.], v. 13, n. 2, p. e0213244903, 2024. DOI: 10.33448/rsd-v13i2.44903. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/44903. Acesso em: 24 nov. 2024.

Issue

Section

Health Sciences