Romero-Zamora JL, Bonifaz A, Sánchez CJ, Lagunas-Ramírez A, Hidalgo-Loperena H

Language: Spanish
References: 19
Page: 178-184
PDF size: 324.72 Kb.

ABSTRACT

Patients with cell-mediated immune dysfunction such Diabetes Mellitus are susceptible to ubiquitous fungi infection as mucormycosis and other mucorales. A clinical study of twelve patients with poorly controlled Diabetes Mellitus types I y II and ketoacidosis, were done during years 1993 to 2000. The clinical picture were: nasal congestion and unilateral obstruction, periorbital edema, palatine obtundation, necrosis, perforation of the nasal septum, and lesion on the III, IV, V and VI cranial nervous. Diagnosis proceeding was based on culture positive to Staphylococcus aureus, Klebsiella sp., Rhizopus oryzae (n = 8), Mucor sp. (n = 3), Absidia sp. (n = 1) and histologic section was founded vascular invasion and thrombosis by hiphae, ischemic and necrosis. CT scan head was done to determination to soft tissue and bone. Surgery was useful on ten patients. Patient 1 died because a superinfection on the 28th day with Pseudomonas aeruginosa. Patients 5 and 7 died 3 days after admission because metabolic decompensation. Treatment with amphotericin B and fluconazole was administered to total twelve cases. Conclusion proposed: Patients with periorbital lesion, necrosis on hard palate and/or nasal septum, lesion on III, IV, V, VI cranial nerves is mandatory to realize diagnosis proceeding to Mucormycosis. Lesions of craneofacial structures are best diagnosed by biopsy and histologic section. Cultural confirmation should be attempted. Early diagnosis helps to specific and safety treatment and to a better prognosis. Combined treatment with amphotericin B plus fluconazole is efficient without side effects.

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