amphotericin-b and Cranial-Nerve-Diseases

Topics: Amphotericin B; Antifungal Agents; Cavernous Sinus Thrombosis; Cheek; Cranial Nerve Diseases; Dermatomycoses; Facial Dermatoses; Fatal Outcome; Humans; Male; Middle Aged; Mucormycosis

Signo del cornete negro en un caso de mucormicosis rinocerebral.

Topics: Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Dexamethasone; Diagnosis, Differential; Disease Progression; Encephalitis; Ethmoid Sinusitis; Fatal Outcome; Humans; Interferons; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Melanoma; Mucormycosis; Opportunistic Infections; Rhizopus; Spinal Neoplasms; Tomography, X-Ray Computed; Turbinates

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cellulitis; Cranial Nerve Diseases; Delayed Diagnosis; Diabetes Complications; Disease Progression; Disease Susceptibility; Encephalitis; Fatal Outcome; Female; Fungemia; Humans; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Sinusitis; Vision Disorders

Mucormycosis is an invasive fungal infection usually observed in immunocompromised patients. Mucormycosis is rapidly fatal without an early diagnosis and treatment. We report five patients of rhino-orbital-cerebral mucormycosis and a literature review.. The medical records of five patients presenting with rhino-orbital-cerebral mucormycosis, admitted between January 1995 and December 2007, were analyzed. All patients underwent tissue biopsy. The histologic sections revealed the presence of non-septate hyphae of the order Mucorales.. The five patients, three men and two women, between 27 and 61 years of age, were all diabetic. The main symptoms were exophthalmia (five patients), facial swelling (four patients), periorbital cellulitis (four patients), and cranial nerve palsy (four patients). Anterior rhinoscopy revealed palatine or nasal necrotic lesions in four patients. All presented with diabetic ketoacidosis and CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Four patients underwent surgical debridement of necrotic tissue. Two patients survived.. Mucormycosis is usually a fatal infection in diabetic patients. Early diagnosis should be based on imaging data and histology. Amphotericin B must be rapidly initiated and associated with aggressive surgical debridement to reduce mortality.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Debridement; Diabetes Complications; Diabetic Ketoacidosis; Disease Susceptibility; Drug Substitution; Encephalitis; Exophthalmos; Female; Humans; Ketoconazole; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Cellulitis; Retrospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Mucormycosis is a rare fungal infection that can involve the sino-orbito-cerebral region. Sino-orbito-cerebral mucormycosis is most common in patients who are immunocompromised or have diabetes mellitus, severe malnutrition or burns. This condition can be fatal if it is not diagnosed early and treated aggressively. This article presents 4 cases of mucormycosis, including 2 with orbital apex syndrome, 1 with cavernous sinus syndrome, and 1 with multiple cranial nerve involvement. All of the patients were presented with painful ophthalmoplegia. The predisposing factors for mucormycosis included diabetes mellitus (three patients) and chronic leukemia (one patient). In all cases, mucormycosis was diagnosed by examining endoscopic sinus drainage material and was treated with surgical debridement and amphotericin B. Two patients with central nervous system involvement died. The others have survived, but still exhibiting various neurologic abnormalities after aggressive treatment. Patients with mucormycosis rarely present with orbital apex syndrome. The possibility of mucormycosis should be investigated in any patient with painful ophthalmoplegia, and prompt otorhinolaryngologic examination is recommended to ensure rapid diagnosis and treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Cavernous Sinus; Central Nervous System Fungal Infections; Chronic Disease; Cranial Nerve Diseases; Debridement; Diabetes Complications; Female; Humans; Leukemia; Male; Middle Aged; Mucormycosis; Ophthalmoplegia; Orbital Diseases

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cranial Nerve Diseases; Humans; Magnetic Resonance Imaging; Male; Maxillary Diseases; Middle Aged; Mucormycosis; Nasal Cavity; Orbital Diseases; Rhizopus; Vancomycin

Contrary to the more frequent hematogenously spread cerebral aspergillosis, localized invasive intracranial aspergillosis is a fungal infection that can also occur in patients who are not severely immunosuppressed. This illness can be effectively treated in some of these patients by early and rigorous therapy. Localized invasion of the fungus, generally from one of the nasal sinuses, causes intracranial growth mainly along the base of the skull and larger vessels,where fibrous, granulomatous tissue develops. This generally leads to damage of the cranial nerves (primarily I-VI) as well as localized pain syndromes. We report on the clinical course documented by MRI of a patient with localized invasive intracranial aspergillosis who had multiple failure of cranial nerves following surgery for an aspergilloma of the maxillary sinus. Clinical course, imaging findings, and treatment of the illness are discussed with a review of the relevant literature.

Topics: Aged; Amphotericin B; Aspergillosis; Cranial Nerve Diseases; Cranial Sinuses; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Itraconazole; Magnetic Resonance Imaging; Maxillary Sinus; Neuroaspergillosis; Neurologic Examination; Postoperative Complications; Skull Base

The clinical course of cryptococcal meningitis in AIDS shows some important differences from the features of the illness in non-AIDS patients. Complications such as raised intracranial pressure and visual impairment that are recognised in non-AIDS patients may be less frequent in those with AIDS. Persistent intracranial hypertension should be managed actively to prevent visual impairment. In AIDS patients, in whom ventriculo-peritoneal shunts carry additional risks, acetazolamide can be used successfully to lower the CSF pressure and prevent visual loss.. 2 AIDS patients are described who had cryptococcal meningitis accompanied by increased intracranial pressure (ICP) and visual complications, a finding thought to be relatively rare in AIDS. Of the 2-6% of AIDS patients who develop cryptococcal meningitis, many have disseminated and recurrent infections. The 1st case was a 45-year old Ugandan woman who presented with stiff neck, and right VIth cranial nerve palsy. She was treated with amphotericin B and flucytosine with some improvement, but on the 9th day she awoke with headache, drowsiness, and total blindness, although no papilledema. Her CSF pressure was 40 cm H20. She recovered after a month of intravenous chemotherapy and acetazolamide, but remained blind. Her sudden blindness was thought to be due to bilateral optic nerve infarction. The 2nd case was a 32-year old male homosexual, admitted with headache, vomiting, confusion, and drowsiness. He had stiff neck, and a CSF of 40 cm containing Cryptococcus neoformans. He was given amphotericin B, flucytosine, and has CSF drained every other day. On day 21 papilledema was seen in the right eye, and acetazolamide was started to lower CSF pressure. This patient recovered without loss of vision. 3 published series of cryptococcus meningitis in AIDS patients remarked about the low incidence of raised ICP, while 1 reported 9 of 27 with neurological and ophthalmic complications. The visual complications and increased ICP in these patients was thought to be due to inflammatory arachnoiditis or direct cryptococcal infiltration.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Blindness; Cranial Nerve Diseases; Cryptococcus neoformans; Female; Flucytosine; Humans; Intracranial Pressure; Male; Meningitis, Cryptococcal; Middle Aged; Papilledema; Uganda