RESUMO
Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.
Assuntos
Encefalopatias/terapia , Oxigenoterapia Hiperbárica , Mucormicose/terapia , Doenças Nasais/terapia , Adulto , Anfotericina B/uso terapêutico , Terapia Combinada , Desbridamento , Diabetes Mellitus Tipo 1/complicações , Seguimentos , Humanos , MasculinoRESUMO
Se presenta un paciente, diabético insulino-dependiente, portador de una mucormicosis rino-sinuso-orbitaria, que habiendo sido tratado con debridamiento quirúrgico en dos oportunidades y anfotericina B en una dosis totald e 2900 mg, mantenía signos clínicos y tomográficos de actividad infecciosa con persistencia del hongo en a lesión. Se realizó debridamiento amplio con técnica microquirúrgica, se incrementó la dosis de anfotericina B hasta 3900 mg agregándose terapéutica adyuvante con oxígenio hiperbárico. El resultado fue exitoso, sin evidencias de recaída en 16 meses de seguimiento. Esta observación confirma la utilidad del oxígeno hiperbárico como terapéutica adyuvante en mucormicosis (AU)
Assuntos
Humanos , Adulto , Masculino , Mucormicose/terapia , Oxigenoterapia Hiperbárica , Doenças Nasais/terapia , Encefalopatias/terapia , Diabetes Mellitus Tipo 1/complicações , Anfotericina B/uso terapêutico , Desbridamento , Terapia Combinada , SeguimentosRESUMO
Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.
RESUMO
Se presenta un paciente, diabético insulino-dependiente, portador de una mucormicosis rino-sinuso-orbitaria, que habiendo sido tratado con debridamiento quirúrgico en dos oportunidades y anfotericina B en una dosis totald e 2900 mg, mantenía signos clínicos y tomográficos de actividad infecciosa con persistencia del hongo en a lesión. Se realizó debridamiento amplio con técnica microquirúrgica, se incrementó la dosis de anfotericina B hasta 3900 mg agregándose terapéutica adyuvante con oxígenio hiperbárico. El resultado fue exitoso, sin evidencias de recaída en 16 meses de seguimiento. Esta observación confirma la utilidad del oxígeno hiperbárico como terapéutica adyuvante en mucormicosis