TABLE 2.
Treatment and outcome of patients with rhino-orbitocerebral mucormycosis caused by A. elegansa
| Reference or source | Immunosuppressive treatment reported prior to diagnosis | Antimicrobial treatment (dose; duration) | Surgical and other treatments | Complications reported | Outcome | Length of followup |
|---|---|---|---|---|---|---|
| 31 | None | AMB (total dose, 3.5 g; 1.5 mg/kg/day), ceftazidime, clindamycin | Left eye enucleation, palatectomy, bilateral maxillectomy, multiple aggressive debridement | None | Cure | 1 yr after presentation |
| 9 | None | AMB (1 mg/kg/day; ∼10 days) | Orbital exenteration, debridement of sinuses | Thrombocytopenia, generalized oozing and bleeding from wound | Death | 15 days after sx onset |
| 2 | Prednisone (20 mg daily for 3 days, then tapered over 3 days) | AMB (1 mg/kg/day; 5 days), i.v. clindamycin | Bilateral Caldwell-Luc procedures | ARF secondary to AMB, anemia | Cure | 2 yr after initial surgery |
| 17 | None | Liposomal systemic and local AMB (total dose, 27.5 g; first course, ∼14 days; additional “brief” course for relapse), tobramycin, penicillin | Orbital exenteration, multiple surgical debridements, HBO2 (2.5 atm for 90 min twice daily; 14 days), G-CSF (600 μg; given for relapse) | Mild hypokalemia, ARF secondary to AMB | Cure (after additional therapy for initial relapse 18 days after discontinuing liposomal AMB) | 4 mo after hospital discharge (8 mo after the injury) |
| 15 | None | Liposomal AMB (5 mg/ kg/day; total dose, 14.7 g; 42 days) | Right orbital exenteration, radical debridement, two subsequent debridements | None | Cure | 12 mo after presentation |
| 7 | None | AMB (total dose, 1.5 g; 1 mo) | Local debridement and exenteration of right orbit | None | Cure | 1 mo after presentation |
| This study | Prednisone (30 mg daily for 10 days) | Liposomal AMB (5 mg/kg/day; ∼70 days), cefepime, metronidazole | Right eye exenteration, maxillectomy, sphenoidotomy, multiple aggressive debridements | ARF secondary to AMB, hypoxia | Cure | 1.5 yr after presentation |
a
i.v., intravenous; AMB, amphotericin B; TMP/SMX, trimethoprim/sulfamethoxazole; sx, symptom; ARF, acute renal failure; HBO2, hyperbaric oxygen therapy; atm, atmosphere absolutes; min, minutes; G-CSF, granulocyte colony stimulating factor.