Mucormycosis surgery
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Mucormycosis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Surgical therapy can be very extensive for mucormycosis, and in some cases of rhinocerebral disease, removal of infected brain tissue may be required. In some cases surgery may be disfiguring because it may involve removal of the palate, nasal cavity, or eye structures. Surgery may be extended to more than one operation. It has been hypothesized that hyperbaric oxygen may be beneficial as an adjunctive therapy because higher oxygen pressure increases the ability of neutrophils to kill the organism.
Surgical Treatment in Mucormycosis
Rhinocerebral mucormycosis[1]
- Debridement of the sinuses is necessary in all cases of rhino-orbito-cerebral mucormycosis.
- In rhinocerebral mucormycosis, early surgical excision of the infected sinuses and appropriate debridement of the retro-orbital space can often prevent the infection from extending into the eye, thereby obviating the need for enucleation and resulting in extremely high cure rates (>85%)
Pulmonary mucormycosis[2]
- In cases refractory to traditional amphotericin B, aggressive surgery may lead to prolonged survival for patients.
- Lobectomy and chest wall removal may be required in complicated cases.[3]
Cutaneous mucormycosis[4]
- Cutaneous mucormycosis treated with aggressive surgical debridement and adjunctive antifungal therapy has a mortality of <10%[5]
- Surgery may be highly disfiguring for the patient and reconstructive surgery with skin grafting is usually done after treatment.
References
- ↑ Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D'Souza O (2003). "Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes". Indian J Ophthalmol. 51 (3): 231–6. PMID 14601848.
- ↑ Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE (1994). "Pulmonary mucormycosis: results of medical and surgical therapy". Ann. Thorac. Surg. 57 (4): 1044–50. PMID 8166512.
- ↑ Asai K, Suzuki K, Takahashi T, Ito Y, Kazui T, Kita Y (2003). "Pulmonary resection with chest wall removal and reconstruction for invasive pulmonary mucormycosis during antileukemia chemotherapy". Jpn. J. Thorac. Cardiovasc. Surg. 51 (4): 163–6. doi:10.1007/s11748-003-0055-y. PMID 12723589.
- ↑ Adam RD, Hunter G, DiTomasso J, Comerci G (1994). "Mucormycosis: emerging prominence of cutaneous infections". Clin. Infect. Dis. 19 (1): 67–76. PMID 7948560.
- ↑ Adam RD, Hunter G, DiTomasso J, Comerci G (1994). "Mucormycosis: emerging prominence of cutaneous infections". Clin. Infect. Dis. 19 (1): 67–76. PMID 7948560.