Mandibular Mucormycosis in Immunocompromised Patients: Report of 2 Cases and Review of the Literature

Department of Oral and Maxillofacial Surgery, Gaziantep University, Gaziantep, Turkey.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons (Impact Factor: 1.43). 08/2011; 70(6):1362-8. DOI: 10.1016/j.joms.2011.05.012
Source: PubMed


Mucormycosis, also known as zygomycosis, is an opportunistic fungal infection caused by a series of fungi in the Mucorales family in people with immune disorders. It is harmless to a healthy person, but when it has invaded the internal organs, it is frequently fatal in immunocompromised patients. It is known for having a very poor prognosis; however, with aggressive medical and surgical management, survival rates are currently thought to exceed 80%. It has 7 predominant clinical forms: rhinocerebral, pulmonary, cutaneous, gastrointestinal, central nervous system, disseminated, and, rarely, miscellaneous (ie, bone, kidney, cardiac, mediastinum, oral). Although oral involvement of this condition has been reported relatively frequently in the literature, mandibular involvement is a rarer condition than oral involvement. The purpose of this article is to report the treatment of isolated cases of mandibular mucormycosis and a review of the literature.

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    • "Mucormycosis is known for having a very poor prognosis: survival rates are currently thought to exceed 80%. Even with successful treatment, Mucorales can reappear during future courses of chemotherapy and neutropenia [29]. There may be predictive factors on the evolution of complications: patients who presented with “blindness” seem to have a higher prevalence of survival (p ≤ 0.04) while patients who presented with “decreased consciousness” seem to have an higher prevalence of death (p ≤ 0.04). "
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    ABSTRACT: Zygomycosis is a rare life-threatening fungal infection affecting mostly patients with predisposing conditions such as diabetes mellitus, immunodeficiency, haemochromatosis or major trauma. We describe a case of rhinocerebral zygomycosis in a girl with type 1 diabetes and review previous published cases and treatment options. A 14-year-old girl with type 1 diabetes mellitus occurred with dental pain, facial swelling, ecchymosis and left eye decreased visual acuity, unresponsive to antibiotic therapy. The coltures of the sinusal mucosa were positive for fungal species belonging to the Zygomycetes. She performed antifungal therapy with posaconazole (POS) with a very slow improvement and a poor glycemic control, leading to blindness of the left eye. Our report adds further awareness on rhinocerebral zygomycosis and emphasizes on urgent diagnosis and timely management of this potentially fatal fungal infection through an adequate treatment.
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    ABSTRACT: Rhino-orbito-cerebral mucormycosis is an uncommon aggressive life-threatening opportunistic fungal infection that affects mainly the immunocompromised population with mortality rate up to 50%. Due to its aggressive nature, early detection and prompt management are of great importance for a good prognosis. Our report describes a fatal outcome of a case of rhino-orbito-cerebral mucormycosis following tooth extraction in an uncontrolled non-insulin-dependent diabetes mellitus patient after 14 days of admission.
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