micafungin and Orbital-Diseases

We report the first case of Neosartorya laciniosa invasive sinusitis involving the orbit in an immunocompromised male with aplastic anemia. Treatment included surgical debridement with enucleation of the eye and combination voriconazole and micafungin therapy followed by voriconazole alone. The fungus was identified using sequencing of partial benA and calmodulin genes.

Topics: Aged; Anemia, Aplastic; Antifungal Agents; Debridement; DNA, Fungal; Echinocandins; Eye Enucleation; Fungal Proteins; Humans; Lipopeptides; Male; Micafungin; Molecular Sequence Data; Mycoses; Neosartorya; Orbital Diseases; Phylogeny; Pyrimidines; Sequence Analysis, DNA; Sequence Homology; Sinusitis; Triazoles; Voriconazole

Mucormycosis is a rapidly progressive fungal infection that usually occurs in patients with diabetes mellitus or in immunocompromised patients. Sinus involvement is the most common clinical presentation and the rates of mortality increase with the orbital extension. The treatment of mucormycosis includes aggressive surgical debridement and systemic antifungal therapy. Early diagnosis and prompt initiation of effective antifungal drugs are essential for successful outcome. However, the role of orbital exenteration for the case of orbital involvement remains controversial, and the drugs effective against mucormycosis are limited. We present a successfully treated case with rhino-orbital mucormycosis caused by Rhizopus oryzae in a diabetic and dialysis patient. The early diagnosis, surgical debridement and a new combination therapy with liposomal amphotericin B and micafungin were effective. This new combination antifungal therapy will be useful for the treatment of mucormycosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Drug Therapy, Combination; Echinocandins; Endoscopy; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinusitis; Micafungin; Necrosis; Opportunistic Infections; Orbital Diseases; Rhinitis; Rhizopus; Tomography, X-Ray Computed; Turbinates

The frequency of invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids, onset of diabetes mellitus, and the administration of antibacterial agents. We report on the clinical features and outcomes of four patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of antifungal agents and surgical intervention is discussed.. We treated four patients with IFS between March 2003 and November 2007 at Ehime University Hospital. Patients were two males and two females, aged from 61 to 74 years (mean 67.8 years).. With regard to clinical symptoms, headache was observed in all patients, and cranial nerve paralysis (visual disturbance, blindness, cheek paresthesia) was seen in 3 patients. β-D-Glucan levels in four patients were high compared with normal values. Aspergillus was histopathologically identified from biopsy specimens in all patients. One patient was complicated with Candida in addition to the Aspergillus infection. Orbital exenteration and ESS were performed in 2 patients as surgical debridement. In all patients, systemic administration of antifungal agents was initiated after surgery.. All patients received strategic treatment with surgery and systemic administration of anti-fungal agents. The single fatality was due to brain infarction caused by the spread of Aspergillus, and the remaining three patients are still alive. Our observations in these patients suggest that early diagnosis and strategic treatment may improve the prognosis of IFS.

Topics: Aged; Antifungal Agents; Aspergillosis; Biopsy; Blindness; Brain Infarction; Candidiasis; Cavernous Sinus; Combined Modality Therapy; Debridement; Early Diagnosis; Echinocandins; Fatal Outcome; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Lipopeptides; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Micafungin; Middle Aged; Orbit Evisceration; Orbital Diseases; Postoperative Complications; Pyrimidines; Sphenoid Sinusitis; Tomography, X-Ray Computed; Triazoles; Voriconazole