phenylephrine-hydrochloride and Opportunistic-Infections

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare fulminant opportunistic fungal infection that despite relevant treatment has high mortality. We present a case of a 3-year-old girl with acute lymphoblastic leukemia and ROCM, who was treated successfully with excessive surgery, systemic antifungal treatment with amphotericin B (AmB), posaconazole, and terbinafine as well as hyperbaric oxygen. Surgery included, beside extracranial and intracranial removal of infected areas, endoscopic sinus and skull base surgery with local AmB installation and in addition placement of an Ommaya reservoir for 114 intrathecal administrations of AmB. In addition, we review the literature of ROCM in pediatric patients with hematological diseases.

Topics: Amphotericin B; Antifungal Agents; Brain; Child, Preschool; Female; Humans; Hyperbaric Oxygenation; Mucormycosis; Naphthalenes; Nose; Opportunistic Infections; Orbit; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Terbinafine; Triazoles

Rhinocerebral mucormycosis (RCM) is a rare, fulminating opportunistic fungal infection caused by a fungus of order Mucorales. These fungi are ubiquitus, subsisting on decaying vegetation and diverse organic material. Although fungi and spores of Mucorales show minimal intrinsic pathogenicity towards normal person, they can initiate aggressive and fulminating infection in immunocompromised host. Since RCM occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.. We present a patient with classical presentation of RCM involving paranasal sinuses, orbit, and cranial base who was treated by combination of aggressive surgical and medical therapy.. The purpose of this paper is to draw attention to the clinical presentation and pathogenesis of RCM and to emphasize need for high index of suspicion in diagnosis and treatment.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Fatal Outcome; Female; Humans; Infusions, Intravenous; Lip Diseases; Maxilla; Middle Aged; Mouth Diseases; Mucormycosis; Nose; Nose Diseases; Opportunistic Infections; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Anterior tamponade with Surgicel (oxidized cellulose) was performed on a 5-year-old girl with megakaryoblastic leukemia (M7 AML) and epistaxis. Several days later necrosis of the nasal ala occurred. Debridement was performed and mucormycosis caused by Rhizopus was found in the material. Having cured mucormycosis, a defect of the complete nasal ala remained. The question of a surgical resolution of the disfiguring nasal defect arises.

Topics: Child, Preschool; Female; Humans; Leukemia, Megakaryoblastic, Acute; Mucormycosis; Nose; Opportunistic Infections; Quality of Life; Surgery, Plastic

Topics: Amphotericin B; Antifungal Agents; Biopsy; Debridement; Fatal Outcome; Female; Hemochromatosis; Hepatic Encephalopathy; Humans; Intubation, Gastrointestinal; Liver; Liver Failure, Acute; Middle Aged; Mucormycosis; Necrosis; Nose; Nose Diseases; Opportunistic Infections; Triazoles

The prosthetic rehabilitation is a surgical alternative in functional-aesthetic facial reconstruction when the conventional reconstructive surgery cannot be applied either because of the psychophysical conditions of the patient or because of an excessive substance loss. From May 2002, 35 facial prosthesis (111 implants) have been positioned. Defects were congenital (N = 12), consequent to trauma (N = 8) and to demolitive surgery for malignant tumors (N= 8), and infection (N = 7). In 4 patients, implants were placed in previously irradiated areas. A total of 111 titanium implants were placed to support 21 auricular prostheses (bilateral in 2 cases), 4 orbital prostheses, 8 nasal prostheses, and 2 complex midfacial prostheses. Implant failure was observed for 2 of the 3 implants placed to support a nasal epithesis in a patient with hepatitis C virus, with an important parodontal disease, who experienced a postinfective necrosis of the nose after a liver transplantation; it was necessary to place an adhesive prosthesis. An implant failure was also observed in a diabetic patient with an extensive midfacial defects due to a mycotic infection, but it did not compromise the retention of the prosthesis. According to our experience, the indication to epithesis is when the conventional reconstructive interventions is inapplicable.

Topics: Adult; Aged; Craniofacial Abnormalities; Diabetes Complications; Ear Auricle; Face; Female; Head and Neck Neoplasms; Hepatitis C; Humans; Liver Transplantation; Male; Maxillofacial Injuries; Maxillofacial Prosthesis Implantation; Middle Aged; Mycoses; Nose; Opportunistic Infections; Orbital Implants; Periodontal Diseases; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Surgical Wound Infection; Titanium

Topics: Acremonium; Ankle; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Colony Count, Microbial; Dermatomycoses; Facial Dermatoses; Fusarium; Humans; Immunocompromised Host; Leg Dermatoses; Leukemia, Myeloid, Acute; Male; Nose; Opportunistic Infections

Topics: Child; Cytokines; Female; Humans; Immunologic Deficiency Syndromes; In Vitro Techniques; Interferon-gamma; Mitogens; Mycobacterium Infections; Necrosis; Nose; Opportunistic Infections; Recombinant Proteins; Skin Ulcer; T-Lymphocytes

Topics: Child; Ecthyma; Female; Gangrene; Humans; Leukemia, Myeloid, Acute; Necrosis; Nose; Opportunistic Infections; Osteonecrosis; Pseudomonas Infections; Skin