The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management. [ncbi.nlm.nih.gov]

• Fever

  A 75-year-old woman presented with fever and right temporal, periorbital and facial pain for 7 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with mild exophthalmos. [ncbi.nlm.nih.gov]

  Pulmonary symptoms (eg, productive cough, high fever, dyspnea) are severe. [merckmanuals.com]

  Mucormycosis Symptom Fever The definition of fever is an elevation in body temperature or a high body temperature. [medicinenet.com]

• Malaise

  Presentation The onset of sinus mucormycosis may be associated with nonspecific symptoms such as nasal congestion, postnasal drip, dark blood-tinged or purulent rhinorrhea, sinus tenderness, headache, fever, and malaise. [aao.org]

  […] incidence of rhinocerebral mucormycosis, is expected.[ 1 5 7 ] It is essential for the clinician to maintain a high index of suspicion in populations at risk, as early diagnosis can be life-saving.[ 4 ] Clinical symptoms usually begin as nonspecific malaise [surgicalneurologyint.com]

• Wound Infection

  Several cases of rhinocerebral mucormycosis have been reported, but mucocutaneous mucormycosis has not been commonly reported to be a part of polymicrobial wound infections at multifocal sites. [ncbi.nlm.nih.gov]

  Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet. Mar 5-11 2005; 365(9462):876-8. 3. Kontoyiannis DP, Marr KA, Park BJ, et al. [webmedcentral.com]

• Fatigue

  J, a 74-year-old man from Costa Rica with diabetes, was admitted to the geriatric inpatient service with a 2-week history of fatigue, weakness, and confusion, and 1 day of vomiting. [consultant360.com]

• Anosmia

  An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. [ncbi.nlm.nih.gov]

  Physical examination revealed a Kussmaul respirations, Glasgow coma scale 12 points, right hemifacial edema, anosmia, nasal congestion, necrotic scar in the right nasal vestibule with foul smell. [oatext.com]

• Hyposmia

  Rhinocerebral disease may manifest as unilateral, retro-orbital headache, facial pain, numbness, fever, hyposmia, and nasal stuffiness, which progresses to black discharge. [webmedcentral.com]

• Maxillary Sinus Pain

  The physical examination revealed no fever, no meningeal signs, left maxillary sinus pain and three painless, papulo-erythematous scabbing lesions on the scalp of 3, 7000 leucocytes/µL (95% neutrophils), and low hemoglobin (10.1 g/dl). [omicsonline.org]

• Nausea

   ABDOMINAL PAIN,NAUSEA VOMITING, ,,,MAY PRESNT AS INTRAABDOMINAL ABSCESS,OR PERFORATION OF THE VISCUS.NEEDS BIOPSY. PROGNOSIS VERY POOR 19. [slideshare.net]

  Presentation is nonspecific, with abdominal pain, abdominal distension, nausea, and vomiting. [patient.info]

  Non-specific abdominal pain and distension, nausea, and vomiting are the most common symptoms, and gastrointestinal bleeding can occur. [cdc.gov]

  Patients typically complain of pressure or pain in the abdomen, nausea, and vomiting. Diagnosis Diagnosis is usually based on a combination of the patient's medical history and a visual examination of the nose, throat, and eyes. [medical-dictionary.thefreedictionary.com]

  In cases of tissue death, symptoms include nausea and vomiting, coughing up blood, and abdominal pain. [6] [9] Risk factors [ edit ] Predisposing factors for mucormycosis include HIV/AIDS, uncontrolled diabetes mellitus, cancers such as lymphomas, kidney [en.wikipedia.org]

• Jaw Claudication

  This case suggests that RCM can cause temporal artery thrombosis and should be considered as a differential diagnosis in severely immunocompromised patients with maxillary sinusitis presenting with jaw claudication. [ncbi.nlm.nih.gov]

• Chemosis

  We report a diabetic child who presented with blurred vision, chemosis, and pain in the left periorbital region noted for about 1 week during an episode of ketocidosis. [ncbi.nlm.nih.gov]

  However, the incidence rates of ptosis, conjunctival injection, and chemosis exhibited no differences between the diseases. [journals.plos.org]

   Later ,proptosis, chemosis and ophthalmoplegia.  Fever and confusion.  Black necrotic eschar on the nasal turbinates or palate : very characteristic 11. [slideshare.net]

  Retro-orbital extension produces proptosis, chemosis, ophthalmoplegias and blindness. As the brain is involved, there are decreasing levels of consciousness. [patient.info]

  As the infection progresses, late symptoms may include facial or periorbital swelling or numbness, blurred vision, chemosis, proptosis, diplopia, ophthalmoplegia, corneal anesthesia, and loss of vision, which are indicative of invasion of the orbital [aao.org]

• Diplopia

  Diplopia may be due to involvement of the extraocular nerves. Hyperglycemia is usually manifested as blurry vision, but not diplopia. [oatext.com]

  Late symptoms from invasion of the orbital nerves and vessels include diplopia and visual field loss. These are late symptoms with a poor prognosis and usually are followed by reduced consciousness. [patient.info]

  Involvement of the superior orbital fissure and its contents, such as cranial nerves III, IV, and VI, and branches of V1 and V2, may cause diplopia, ophthalmoplegia, and sensory loss to the corresponding areas of the cornea and face. [aao.org]

  Other causes include periocular trauma, previous surgery, dacryocystitis, and periodontal infection.[ 12 – 14 ] Common signs and symptoms of BOC include proptosis, chemosis, hyperemia, diplopia, and pain during eye movement. [journals.plos.org]

  Initially, mucormycosis may mimic sinusitis.(5) Late symptoms that indicate invasion of the orbital nerves and vessels include diplopia and visual loss. These late symptoms indicate a poor prognosis and are usually followed by reduced consciousness. [webmedcentral.com]

• Blepharoptosis

  […] cirrhosis. 1,2 Mucormycosis in an immunocompetent host is rare, is usually related to trauma, and has a better prognosis. 3,4 Symptoms that suggest rhinocerebral mucormycosis include unilateral periorbital facial pain, orbital inflammation, eyelid edema, blepharoptosis [consultant360.com]

  The ocular symptoms of ROCM, such as facial edema, pain, and blepharoptosis, are similar to those of bacterial orbital cellulitis (BOC) soon after infection onset. [journals.plos.org]

• Unilateral Blindness

  Three patients had unilateral blindness, and two patients required orbital exenteration. Four patients died because of a delayed diagnosis. [ncbi.nlm.nih.gov]

• Facial Pain

  The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness. [ncbi.nlm.nih.gov]

  Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. Volume 2 covers tumors, the phacomatoses, and vascular disease. [books.google.com]

  Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations [lifeinthefastlane.com]

  Here we present a case report of 70 year old diabetic male patient who presented with a perforation in the palate, nasal discharge, periorbital cellulitis, and facial pain. [journalgateway.com]

• Facial Edema

  Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. [ncbi.nlm.nih.gov]

  After patient started to complain of nasal congestion, left upper jaw teeth-pain and left facial paresthesia, with left facial edema, nasopharinx swab was done and Rhizopus oryzae was isolated. [aspergillus.org.uk]

  Case report N 2 : A 66-year-old woman with an 18-year history of diabetes mellitus presented with a 13 days history of left facial edema, headache, periorbital swelling, and fever. Palatal necrosis was noted. [latunisiemedicale.com]

  1 5 7 ] It is essential for the clinician to maintain a high index of suspicion in populations at risk, as early diagnosis can be life-saving.[ 4 ] Clinical symptoms usually begin as nonspecific malaise and headache, progressing to acute sinusitis, facial [surgicalneurologyint.com]

  The ocular symptoms of ROCM, such as facial edema, pain, and blepharoptosis, are similar to those of bacterial orbital cellulitis (BOC) soon after infection onset. [journals.plos.org]

• Facial Numbness

  Case Report In October 2008 a 43-year-old previously healthy man presented to our hospital with complain of headache, unilateral facial numbness in the distribution area of V1 and V2 branches of trigeminal nerve, facial nerve paralysis, proptosis, blindness [hindawi.com]

  On admission, he was also complaining of palsy of the 7th and 6th cranial nerves and of facial numbness. A fistula on the left side of the palate wi th nasal necrosis was noted. [latunisiemedicale.com]

• Headache

  On follow-up 4 weeks after the first functional endoscopic sinus surgery (FESS), she complained of a severe headache and was readmitted for a second period. [ncbi.nlm.nih.gov]

• Seizure

  A 53-year-old woman with poorly controlled diabetes mellitus and treated with azathioprine and metil-prednisone for autoimmune cholangitis, came to our emergency department for having two episodes of tonico-clonic generalized seizures. [omicsonline.org]

  Progressive extension of necrosis to the brain can cause signs of cavernous sinus thrombosis, seizures, aphasia, or hemiplegia. Pulmonary mucormycosis resembles invasive aspergillosis. [merckmanuals.com]

  Prolonged preictal psychosis in refractory seizures: A report of three cases. Epilepsy & Behavior 2008; 13: 252-255. 5. Tarulli A. Devinsky O, Alper K. Progression of postictal to interictal psychosis. Epilepsia 2001; 42:1468-1471. 6. [neurowikia.es]

  The occurrence of mental status changes, hemiparesis, or seizures suggests intracranial invasion. 6 The time from onset of initial symptoms to late symptoms and signs that are diagnostic of the disease may be as short as one day. 7 The development of [aao.org]

• Confusion

  Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Survival is directly linked to early detection and treatment. [ncbi.nlm.nih.gov]

  Rhinocerebral mucormycosis is severe sinusitis with caused by a non- Aspergillus mold, most commonly Rhizopus arrhizus CLINICAL FEATURES Rhinocerebral mucormycosis headache facial pain confusion fever purulent nasal discharge (black) Other manifestations [lifeinthefastlane.com]

   Fever and confusion.  Black necrotic eschar on the nasal turbinates or palate : very characteristic 11. [slideshare.net]

  J, a 74-year-old man from Costa Rica with diabetes, was admitted to the geriatric inpatient service with a 2-week history of fatigue, weakness, and confusion, and 1 day of vomiting. [consultant360.com]

  Symptoms of brain involvement include headache, confusion, hemiparesis, and seizure. [journals.plos.org]

• Cranial Nerve Involvement

  Cranial nerve involvement causing diplopia, restricted eye movements and visual field defects. Black discharge may also be seen in cutaneous variants. Predisposing factors such as diabetes, malignancy or disorders of iron metabolism. [patient.info]

  Cranial nerve involvement in malignant external otitis – implications on clinical outcome. Laryngoscope 117: 907-910, 2007 78. Badran, K., Sudhoff, H., Gray, R. An unusual air gun injury to the ethmoid sinus. [klinikumbielefeld.de]

• Papilledema

  Neurologic examinations revealed that there was a decreased range of motion in the upward and lateral gaze, along with incomplete pupillary dilatation and papilledema of the left eye. [ncbi.nlm.nih.gov]

MUCORMYCOSIS WORKUP BIOPSY-OF INVOLVED TISSUE. SWABS OF TISSUE DISCHARGE ARE UNRELIABLE. CBC FOR NEUTROPENIA ABG TO CORRECT ACIDOSIS RBS-SUGAR CONTROL 24. IMAGING STUDIES PLAIN X-RAY CT SCAN MRI SCANS CHEST CT/MRI 25. [slideshare.net]

23] Blindness Nystagmus Visual loss secondary to retinal artery thrombosis or direct fungal invasion Neurologic findings include the following: Palsies of cranial nerves II, III, IV, V, VI, and VII - Commonly observed, prompting a thorough neurologic workup [emedicine.medscape.com]

Clinical Testing and Workup Doctors will take samples of affected tissue and a special doctor called a pathologist will study the tissue for changes caused by disease (histopathology). This can show the presence of mold. [rarediseases.org]

• Sinus Opacification

  Complete sinus opacification, gas-fluid levels and obliteration of the nasopharyngeal tissue planes can also occur. [radiopaedia.org]

  Magnetic resonance imaging (MRI) showed infarct with encephalomalacia in the left parietal lobe abutting the sylvian fissure, and right maxillary, ethmoidal and sphenoidal sinus opacification extending into the right orbit with compression of optic nerve [jiaomr.in]

  The clinical course can progress from normal to symptomatic in a week and from sinus opacification to uncal herniation and death in just a few days. [19, 20, 21, 22] General symptoms of rhinocerebral mucormycosis include the following: Headache Nausea [emedicine.medscape.com]

• Demodex Folliculorum

  The mite and the fungus were identified as Demodex folliculorum and Apophysomyces elegans species complex, respectively. [ncbi.nlm.nih.gov]

After a 3-month treatment course, it was determined that her mucormycosis was under appropriate control, allowing her to continue treatment for her leukemia with hematopoietic stem cell transplant with a plan for continued intravenous antifungal therapy [ncbi.nlm.nih.gov]

The prognosis was analyzed according to the predisposing factors, including underlying disease, extent of disease and surgical intervention. [ncbi.nlm.nih.gov]

Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. [ncbi.nlm.nih.gov]

Each part surveys individual infections caused not only by well-known etiologic agents, but also by new and emerging species often taxonomically closely related to a major disea- producing microorganism and until recently not considered to be human pathogens [books.google.com]

Organized by types of fungi, this volume covers microbiologic, epidemiologic and demographic aspects of fungal infections as well as diagnostic, clinical, therapeutic, and preventive approaches. Special patient populations are also detailed. [books.google.com]

Epidemiology and outcome of zygomycosis: a review of 929 reported cases.. Clin Infect Dis 41 :, 634– – 653. [CrossRef] [Google Scholar] Spellberg B., Walsh T.J., Kontoyiannis D.P., Jr Edwards J., Ibrahim A.S.. ( 2010 ; ). [jmmcr.microbiologyresearch.org]

The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance. [journals.plos.org]

EPIDEMIOLOGY INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY. MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%). NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT. 7. [slideshare.net]

"Epidemiology and outcome of Mucormycosis: a review of 929 reported cases". Clin. Infect. Dis. 41 (5): 634–53. doi : 10.1086/432579. PMID 16080086. Lyndsay Mayer. "Mucormycosis". Food and Drug Administration. [en.wikipedia.org]

We present a case of rhinocerebral mucormycosis and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options. [ncbi.nlm.nih.gov]

Pathophysiology Angioinvasion Vessel thrombosis Tissue necrosis 6. EPIDEMIOLOGY INTERNATIONALY 1% PATIENTS WITH LOW IMMUNITY. MUCOR MYCOSIS CARRIES A VERY HIGH MORTALITY (50%-85%). NO RACIAL FACTORS PREDISPOSE. SEX IS NOT LIKELY TO AFFECT. 7. [slideshare.net]

No obvious pathophysiology for facial nerve paralysis has been proposed yet. Some researchers believe that infection can reach from the pterygopalatine fossa to inferior orbital fissure, orbital apex, and infratemporal fossa [6]. [hindawi.com]

Spellberg B, Edwards J Jr, Ibrahim A (2005) Novel perspectives on mucormycosis: pathophysiology, presentation, and management. ClinMicrobiol Rev 18: 556-569. [omicsonline.org]

CONCLUSIONS: Early diagnosis is critical in the prevention of intracranial extension of the infection, which is the cause of death in 80% of cases. [ncbi.nlm.nih.gov]

We eventually had to remove of all left orbita contents, including the eye ball, to prevent death. We recommend that fungus infection be given 2 classifications: benign and malignant. [ci.nii.ac.jp]

Organized by types of fungi, this volume covers microbiologic, epidemiologic and demographic aspects of fungal infections as well as diagnostic, clinical, therapeutic, and preventive approaches. Special patient populations are also detailed. [books.google.com]