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Mucormycosis is a devastating, rapidly progressive, life-threatening disease that necessitates urgent intervention, particularly in immunocompromised patients. So far, data on invasive mold infections from the Middle East and other developing countries are limited. We present three patients with invasive mucormycosis and document cures and survival in two of the three patients using conventional systemic antifungal therapy combined with wide surgical debridement. J Invasive Fungal Infect 2011;5(4):118-22.
Mucormycosis is an aggressive, rapidly progressive, and often fatal disease. Although this opportunistic fungal infection remains rare, its occurrence has steadily increased since the mid-1990s and has become more commonly seen in individuals who are metabolically and/or immunologically compromised [1,2]. Recent reclassification has placed the order Mucorales in the subphylum Mucoromycotina, and abolished the class Zygomycetes [3]. Members of the family Mucoraceae are the most common cause of mucormycosis in humans, commonly presenting as rhinocerebral or pulmonary disease, and are often the cause of invasive diseases that lead to tissue destruction and vascular invasion [1]. Most frequently, these pathogens are transmitted through inhalation of spores from the surrounding environment, infecting patients who are at the highest risk, namely those with immunosuppression (particularly those with neutropenia), poorly controlled diabetes, or hematological malignancies [1,4,5]. Some recent data have indicated that this increase in incidence may be explained by differences in environmental factors, changes in transplant procedures, and the frequent use of voriconazole as a prophylaxis for opportunistic fungal infections [6]. It has been suggested that as voriconazole has no activity against Mucoraceae, it may select for growth of this class of fungi [1].
A high suspicion for the presence of this disease is important for early diagnosis and initiating effective therapy. In addition, controlling or reversing the underlying predisposing illness, systemic antifungal therapy, and aggressive surgical debridement remain the mainstay of therapy [7]. In this study, we report three cases of mucormycosis: rhinocerebral mucormycosis in a patient with diabetes, and rhinomucositis in two patients with hematological malignancies.
Case 1
A 60-year-old woman with poorly controlled diabetes presented with acute onset right eye palsy. In the clinic, she had a drooping right eyelid associated with numbness in the right side of the face and periorbital pain. Physical examination identified right 3rd, 4th, 5th, and 6th cranial nerve palsy along with...