eMedicine Specialties > Ophthalmology > Infectious Disease

Mucormycosis: Follow-up

Author: Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Coauthor(s): Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Dec 31, 2008

Follow-up

Further Inpatient Care

  • Serial imaging and evaluation is performed as needed to assess the extent of the disease and to decide if reoperation is necessary.
  • After amphotericin B is discontinued, close assessment for recurrence needs to be performed.
  • Treatment often is long term and disfiguring.

Further Outpatient Care

  • Closely manage the patient's underlying medical condition and medications.
  • Reconstructive surgery, if necessary, can be considered only after complete resolution of infection.

Inpatient & Outpatient Medications

Complications

  • Intracranial invasion
  • Cavernous sinus thrombosis
  • Blindness
  • Central retinal artery occlusion
  • Airway obstruction from head and neck infections
  • Spread to carotid sheath or mediastinum through fascial planes

Prognosis

  • Prognosis is guarded in these patients; however, with early detection and early treatment, the survival rate may be improved. Over the last 40 years, prognosis has improved greatly.20,21

Patient Education

  • Immediately evaluate patients at risk if any signs or symptoms develop.

Miscellaneous

Medicolegal Pitfalls

  • The clinician must retain a high clinical suspicion for mucormycosis in patients at risk. A delay in diagnosis may be fatal and could result in liability claims against the physician.

Special Concerns

  • Early treatment and detection is the key.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.



More on Mucormycosis

Overview: Mucormycosis
Differential Diagnoses & Workup: Mucormycosis
Treatment & Medication: Mucormycosis
Follow-up: Mucormycosis
Multimedia: Mucormycosis
References
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References

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  2. Rocha G, Garza G, Font RL. Orbital pathology associated with diabetes mellitus. Int Ophthalmol Clin. Spring 1998;38(2):169-79. [Medline].

  3. Yohai RA, Bullock JD, Aziz AA, et al. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. Jul-Aug 1994;39(1):3-22. [Medline].

  4. Guevara N, Roy D, Dutruc-Rosset C, et al. Mucormycosis--early diagnosis and treatment. Rev Laryngol Otol Rhinol (Bord). 2004;125(2):127-31. [Medline].

  5. Turunc T, Demiroglu YZ, Aliskan H, et al. Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients. Diabetes Res Clin Pract. Nov 2008;82(2):203-8. [Medline].

  6. Nithyanandam S, Jacob MS, Battu RR, et al. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. Sep 2003;51(3):231-6. [Medline].

  7. Bhansali A, Sharma A, Kashyap A, et al. Mucor endophthalmitis. Acta Ophthalmol Scand. Feb 2001;79(1):88-90. [Medline].

  8. Arndt S, Aschendorff A, Echternach M, et al. Rhino-orbital-cerebral mucormycosis and aspergillosis: differential diagnosis and treatment. Eur Arch Otorhinolaryngol. Jan 2009;266(1):71-6. [Medline].

  9. Doty CI, Lucchesi M. Mucormycosis manifesting as proptosis and unilateral blindness. Acad Emerg Med. Aug 2000;7(8):944-6. [Medline].

  10. Strasser MD, Kennedy RJ, Adam RD. Rhinocerebral mucormycosis. Therapy with amphotericin B lipid complex. Arch Intern Med. Feb 12 1996;156(3):337-9. [Medline].

  11. Tarani L, Costantino F, Notheis G, et al. Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatr Diabetes. Sep 17 2008;[Medline].

  12. Reed C, Bryant R, Ibrahim AS, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. Aug 1 2008;47(3):364-71. [Medline].

  13. Luna JD, Ponssa XS, Rodriguez SD, et al. Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis. Ophthalmic Surg Lasers. Aug 1996;27(8):706-8. [Medline].

  14. Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthal Plast Reconstr Surg. Jan 1999;15(1):28-31. [Medline].

  15. Hargrove RN, Wesley RE, Klippenstein KA, et al. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. Jul-Aug 2006;22(4):286-91. [Medline].

  16. Pelton RW, Peterson EA, Patel BC, et al. Successful treatment of rhino-orbital mucormycosis without exenteration: the use of multiple treatment modalities. Ophthal Plast Reconstr Surg. Jan 2001;17(1):62-6. [Medline].

  17. Hargrove RN, Wesley RE, Klippenstein KA, et al. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. Jul-Aug 2006;22(4):286-91. [Medline].

  18. Croce A, Moretti A, D'Agostino L, et al. Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital. Aug 2008;28(4):193-9. [Medline].

  19. Lari AR, Kanjoor JR, Vulvoda M, et al. Orbital reconstruction following sino-nasal mucormycosis. Br J Plast Surg. Jan 2002;55(1):72-5. [Medline].

  20. Dhiwakar M, Thakar A, Bahadur S. Improving outcomes in rhinocerebral mucormycosis--early diagnostic pointers and prognostic factors. J Laryngol Otol. Nov 2003;117(11):861-5. [Medline].

  21. Fairley C, Sullivan TJ, Bartley P, et al. Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology. Mar 2000;107(3):555-8. [Medline].

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Further Reading

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Keywords

mucormycosis , Mucor, rhinocerebral mucormycosis, rhino-orbital cerebral mucormycosis

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Contributor Information and Disclosures

Author

Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Kimberly G Yen, MD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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