Mucormycosis

Rhizopus is the genus responsible for most cases of mucormycosis in humans. It is part of the normal nasopharyngeal flora in less than 2% of normal individuals. Rhizopus is an opportunistic fungus that is non-pathogenic, except in patients with poorly controlled diabetes mellitus and especially diabetic ketoacidosis. The rhinocerebral form affects the para-nasal sinuses, orbit and brain and accounts for 80-90% of all cases. It usually begins in the sinuses and extends into the orbit, at which point the disease becomes clinically apparent. The characteristic clinical findings include headache, orbital pain, facial and/or peri-orbital swelling, proptosis and external ophthalmople-gia [25]. Visual loss secondary to occlusion of the central retinal artery may occur and represents an important feature which distinguishes mucormycosis from bacterial cavernous sinus thrombophlebitis, as vision is almost always preserved in the latter. Unchecked, continued invasion of the brain follows with rapid abscess formation. Mucormycosis, like Aspergillus, has a predilection for vascular invasion, leading to thrombosis, infarction and dissecting aneurysm. Rarely, dissemination from a pulmonary source may cause brain abscess, but this appears to be limited to immunocompromised patients.

Compared to other fungal diseases, which often follow a protracted clinical course, mucormycosis is a fulminant and rapidly fatal process, unless aggressive treatment is instituted. Treatment consists of aggressive drainage and debridement of involved tissue, along with control of the underlying illness. Amphotericin

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