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      Fatal rhino-orbito-cerebral mucormycosis in a healthy individual

      case-report

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          Abstract

          Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.

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          Most cited references14

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          Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment.

          The class Zygomycetes is divided into two orders, Mucorales and Entomophthorales. These two orders produce dramatically different infections. Genera from the order Mucorales (Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella and Saksenaea) cause an angioinvasive infection called mucormycosis. Mucormycosis presents with rhino-orbito-cerebral, pulmonary, disseminated, cutaneous, or gastrointestinal involvement. Immunocompromising states such as haematological malignancy, bone marrow or peripheral blood stem cell transplantation, neutropenia, solid organ transplantation, diabetes mellitus with or without ketoacidosis, corticosteroids, and deferoxamine therapy for iron overload predispose patients to infection. Mucormycosis in immunocompetent hosts is rare, and is often related to trauma. Mortality rates can approach 100% depending on the patient's underlying disease and form of mucormycosis. Early diagnosis, along with treatment of the underlying medical condition, surgery, and an amphotericin B product are needed for a successful outcome. Genera from the order Entomophthorales produce a chronic subcutaneous infection called entomophthoramycosis in immunocompetent patients. This infection occurs in tropical and subtropical climates. The genus Basidiobolus typically produces a chronic subcutaneous infection of the thigh, buttock, and/or trunk. Rarely, it has been reported to involve the gastrointestinal tract. The genus Conidiobolus causes a chronic infection of the nasal submucosa and subcutaneous tissue of the nose and face. This paper will review the clinical manifestations, diagnosis and treatment of mucormycosis and entomophthoramycosis.
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            Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature.

            To review the current literature on mucormycosis in immunocompentent/otherwise healthy individuals, to which five new cases with maxillary sinus involvement have been added.
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              Mucormycosis in the Eastern Mediterranean: a seasonal disease.

              Mucormycosis is a fairly rare fungal infection caused by ubiquitous fungi of the order Mucorales and primarily affects immunocompromised hosts. A series of 16 cases of invasive mucormycosis admitted to three referral centres in Beirut, Lebanon between 1981 and 1999 is described. It includes 12 patients with rhinocerebral, three with cutaneous, and one with pulmonary infection. Onset of symptoms occurred in the summer and autumn in 15 out of 16 patients, showing a statistically significant seasonal variation (P=0.007) A recent report of 19 patients from Tel Aviv describes a strikingly similar seasonal pattern. Studies on atmospheric concentration of Mucorales spores in the Eastern Mediterranean are lacking. Weather pattern analysis in Beirut revealed clustering of onset of invasive mucormycosis at the end of a dry, warm period, which begins around May and ends in October. Mucormycosis incidence appears to be seasonal in the Eastern Mediterranean.
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                Author and article information

                Journal
                J Oral Maxillofac Pathol
                J Oral Maxillofac Pathol
                JOMFP
                Journal of Oral and Maxillofacial Pathology : JOMFP
                Medknow Publications & Media Pvt Ltd (India )
                0973-029X
                1998-393X
                Sep-Dec 2014
                : 18
                : 3
                : 460-463
                Affiliations
                [1] Department of Oral Pathology and Microbiology, Panineeya Institute of Dental Sciences and Research Center, Kamala Nagar, Dilsukhnagar, Hyderabad, India
                [1 ] Department of Pathology, Osmania Medical College, Koti, Hyderabad, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Rama Krishna Angali, Senior lecturer, Department of Oral Pathology and Microbiology, Panineeya Institute of Dental Sciences and Research Center, Road No: 5, Kamalanagar, Dilsukhnagar, Hyderabad - 500 060, India. E-mail: drramakrishna8074@ 123456gmail.com
                Article
                JOMFP-18-460
                10.4103/0973-029X.151355
                4409197
                25949007
                1b63608f-4b65-405a-a04e-d8a30cd3a6b9
                Copyright: © Journal of Oral and Maxillofacial Pathology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 January 2014
                : 02 January 2015
                Categories
                Case Report

                Pathology
                angiotrophic fungus,chronic sinusitis,rhino-orbito-cerebral zygomycosis
                Pathology
                angiotrophic fungus, chronic sinusitis, rhino-orbito-cerebral zygomycosis

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