Table 1.
Characteristics and underlying disease in 15 rhino-orbito-cerebral mucormycosis cases
| Case no. | Sex/age | Underlying disease* | Area involved (CT scan) | Clinical signs and symptoms | Histopathological findings | Mycological findings | Treatment | Outcome | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | M/64 | UDM* | Ethmoid, maxilla, orbit, sphenoid |
-Facial swelling, dysesthesia, pain -Ptosis, proptosis, loss of vision -Nasal crust, discharge, necrosis of the turbinate, cranial nerve palsy -Headache 3-10 d before hospitalization -Fever and chills |
H&E (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Expired | ||||||
| 2 | F/28 | BT, D, UDM | Ethmoid, maxilla, sphenoid | -Nasal crust, discharge, necrosis of the turbinate -Cranial nerve palsy -Headache 3-10 d before hospitalization -Fever |
H&E and PAS (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Expired | ||||||
| 3 | F/54 | MT, C | Nose, maxilla, hard palate, orbit | Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Nasal crust, discharge, necrosis of the turbinate -Palate necrosis -Cranial nerve palsy -Headache 3-10 d before hospitalization |
H&E (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Expired | ||||||
| 4 | F/60 | AML, C | Nose, maxilla, medial concha, orbit |
Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Nasal crust, discharge, necrosis of the turbinate -Cranial nerve palsy |
H&E (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (Mucor spp.) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 5 | F/59 | UDM | Ethmoid, medial, inferior concha, orbit | Nasal crust, discharge, necrosis of the turbinate -Ptosis, proptosis, loss of vision, pain -Cranial nerve palsy -Headache 3-10 d before hospitalization -Ear itching, pain |
Not performed | Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 6 | F/61 | UDM | Nose, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Nasal crust, discharge, necrosis of the turbinate -Cranial nerve palsy |
H&E and PAS (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (Mucor spp.) |
Sino-nasal debridement+ orbital exenteration + medical treatment with cAMB |
Cured | ||||||
| 7 | M/47 | UDM | Maxilla, posterior turbinate, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain |
H&E (aseptate hyphae) |
Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement | Cured | ||||||
| 8 | F/69 | UDM | Ethmoid, orbit, medial concha | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Headache 3-10 d before hospitalization --Ear itching, pain |
H&E (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement | Cured | ||||||
| 9 | F/47 | UDM | Ethmoid, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain |
H&E and PAS (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (not performed) |
Sino-nasal debridement | Cured | ||||||
| 10 | F/61 | UDM | Maxilla, nose, hard palate, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, and pain -Nasal crust, discharge, necrosis of the turbinate -Palate necrosis -Cranial nerve palsy -Headache 3-10 d before hospitalization |
H&E (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (Mucor spp.) |
Sino-nasal debridement+ Medical treatment with cAMB | Expired | ||||||
| 11 | M/70 | UDM | Ethmoid, sphenoid | -Facial swelling, dysesthesia, and pain | H&E (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (Rhizopus spp.) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 12 | F/56 | UDM | Ethmoid, maxilla, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Nasal crust, discharge, necrosis of the turbinate -Fever and chills |
H&E and PAS (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 13 | M/53 | UDM | Ethmoid, maxilla, orbit | -Ptosis, proptosis, loss of vision, chemosis, pain -Cranial nerve palsy -Headache 3–10 d before hospitalization |
H&E (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (negative) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 14 | F/52 | UDM | Maxilla, orbit | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain |
H&E (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (not performed) |
Sino-nasal debridement+ medical treatment with cAMB | Cured | ||||||
| 15 | F/33 | UDM | Maxilla, orbit, nose | -Facial swelling, dysesthesia, and pain -Ptosis, proptosis, loss of vision, pain -Nasal crust, discharge, necrosis of the turbinate -Cranial nerve palsy -Headache 3-10 d before hospitalization |
H&E and PAS (aseptate hyphae) | Direct smear (aseptate hyphae) Culture (Mucor spp.) |
sino-nasal debridement+ Orbital exenteration+ Medical treatment with cAMB |
Cured | ||||||
*
UDM: uncontrolled diabetes mellitus; BT: beta-thalassemia; AML: acute myeloid leukemia; MT: malignant T-cell lymphoma; D: deferoxamine therapy; C: chemotherapy; cAMB conventional amphotericin B