Main Article Content
Zygomycosis is a rare opportunistic fungal infection, that often complicates patients with uncontrolled Diabetes Mellitus, primary and acquired immunodeficiencies as defects of the cell-mediated immunity, myelodisplastic syndrome, hematological malignancies undergoing chemotherapy , HIV and long term therapy with steroid . Mortality rate of these patient is very high, until 85% .
The causative organism is an aerobic saprophytic fungus, releasing spores, belonging to the order of Mucorales of the class Zygomycetes . Inhalation and direct contamination of skin lesions are the major causes of infection, so the sporangiospores can migrate up to the lungs, nasal cavity and paranasal sinuses, gut and cutaneous tissues causing primary infection, hyphae invade vassels producing thrombi. Rhinocerebral Zygomycosis occurs with cranial nerve palsies, eye proptosis, pain and often blindness. Zygomicetes can invade central nervous system (CNS) from paranasal sinuses or remote site of infecton .
This life-threatening infection could be defeat through early detection, surgical excision and appropriate debridement, aggressive antifungal therapy, and control of risk factors, like diabetes mellitus like in our cases.
We reported the follow up after long term therapy with Posaconazole in two Italian girls with Diabetes Mellitus Type 1 previously published [1,4].
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2.Palejwala SK et al.: An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormicosis. Surgical Neurology International. 2016 May 25;7:61. doi:10.4103/2152-7806.182964.
3.M. Chayakulkeeree et al.: Zigomycosis: the re-emerging fungal infection. Eur JClin Microbiolo Infect Dis (2006) 25: 215-229. DOI 10.1007/s10096-006-0107-1
4.Tarani et al.: Long term posaconazole treatment and follow up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatric Diabetes 2009: 10: 289-293. DOI 10.1111lj.1399-5448.2008.00465.x
5.A. Alastruey-Izquierdo et al. In vitro activity of antifungals against Zygomicetes. Clin Microbiol Infect. 2009 Oct;15 Suppl 5:71-6. doi: 10.1111/j.1469-0691.2009.02984.x. Review.
6.Schiller et al. Posaconazole: an extended spectrum triazole antifungal agent. Clin Ther 2007,29(9):1862-86
7.Peyton LR et al.: Triazole antifungals:a review. Drugs Today (Barc). 2015 Dec;51(12):705-18. doi: 10.1358/dot.2015.51.12.2421058. Review
8.Herbrecht R. et al.: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347: 408-15.
9.Greer ND. Posaconazole (Noxafil): a new triazole antifungal agent. Proc (Bayll Univ Med Cent)2007: 20:188-196
10.Kursun E et al. Evaluation of 28 cases of mucormycosis. Mycoses. 2015 Feb;58(2):82-7. doi: 10.1111/myc.12278. Epub 2015 Jan 15.
11.Manesh A et al. Posaconazole: an emerging therapeutic option for invasive rhino-orbito-cerebral mucormycosis. Mycoses. 2016 Jul 22. doi: 10.1111/myc.12529.
12.Cornely OA et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014 Apr;20 Suppl 3:5-26. doi: 10.1111/1469-0691.12371