Sino orbital mucormycosis treated with fluconazole

Authors

  • Assaye N. Alebachew Department of Otolaryngology Head and Neck Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
  • Dawit K. Dibaba Department of Otolaryngology Head and Neck Surgery, College of Health Sciences, Addis Ababa University, Ethiopia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20250121

Keywords:

Amphotericin B, Fluconazole, Invasive fungal sinusitis, Mucormycosis

Abstract

The successful treatment of mucormycosis requires; early diagnosis; reversal of underlying predisposing risk factors, if possible, surgical debridement, where applicable and prompt antifungal therapy. Amphotericin B is the gold standard antifungal treatment against mucormycosis to date. However, there are newer agents described recently like posaconazole and isavuconazole which can be used as an option in a few instances. Although amphotericin B especially the liposomal preparation is the preferred agent, the availability and the cost limit its use, especially in resource-limited setups. Generally, azole drugs, especially the first generations such as fluconazole, are not effective against zygomycetes. However, few reports showed complete recovery after use of fluconazole for adjunct treatment. Here we report on a 35-year-old newly diagnosed diabetic woman with Sinoorbital mucormycosis who has been treated with surgical debridement and intermittent bases of amphotericin B and was discharged home without optimal response but returned completely improved after three months of oral fluconazole.

 

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References

Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: A review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(1):31-47. DOI: https://doi.org/10.1111/j.1470-9465.2004.00843.x

Torres HA, Hachem RY, Chemaly RF, Kontoyiannis DP, Raad II. Posaconazole: a broad-spectrum triazole antifungal. Lancet Infect Dis. 2005;5(12):775-85. DOI: https://doi.org/10.1016/S1473-3099(05)70297-8

Selcen D, Secmeer G, Aysun S, Kanra G, Onerci M, Gököz A, et al. Mucormycosis in a diabetic child and its treatment with fluconazole: a case report. Turk J Pediatr. 1995;37(2):165-8.

Funada H, Miyake Y, Kanamori K, Okafuji K, Machi T, Matsuda T. Fluconazole therapy for pulmonary mucormycosis complicating acute leukemia. Jpn J Med. 1989;28(2):228-31. DOI: https://doi.org/10.2169/internalmedicine1962.28.228

Spellberg B, Edwards J, Ibrahim A. Novel perspectives on mucormycosis: Pathophysiology, presentation and management. Clin Microbiol Rev. 2005;18(3):556-69. DOI: https://doi.org/10.1128/CMR.18.3.556-569.2005

Cho H-J, Jang M-S, Hong SD, Chung S-K, Kim HY, Dhong H-J. Prognostic factors for survival in patients with acute invasive fungal rhinosinusitis. Am J Rhinol Allergy. 2015;29(1):48-53. DOI: https://doi.org/10.2500/ajra.2015.29.4115

Spellberg B, Ibrahim AS. Recent advances in the treatment of mucormycosis. Curr Infect Dis Rep. 2010;12(6):423-9. DOI: https://doi.org/10.1007/s11908-010-0129-9

Espinel-Ingroff A, Chakrabarti A, Chowdhary A, Cordoba S, Dannaoui E, Dufresne P, et al. Multicenter evaluation of MIC distributions for epidemiologic cutoff value definition to detect amphotericin B, posaconazole and itraconazole resistance among the most clinically relevant species of Mucorales. Antimicrob Agents Chemother. 2015;59(3):1745-50. DOI: https://doi.org/10.1128/AAC.04435-14

Sipsas N V., Gamaletsou MN, Anastasopoulou A, Kontoyiannis DP. Therapy of mucormycosis. J Fungi. 2018;4(3):1-17. DOI: https://doi.org/10.3390/jof4030090

Espinel-Ingroff A. Antifungal Agents. Encycl Microbiol Third Ed. 2009;187(7):205-22. DOI: https://doi.org/10.1016/B978-012373944-5.00331-X

Borba HHL, Steimbach LM, Riveros BS, Tonin FS, Ferreira VL, Bagatim BA de Q, et al. Cost‐effectiveness of amphotericin B formulations in the treatment of systemic fungal infections. Mycoses. 2018;61(10):754-63. DOI: https://doi.org/10.1111/myc.12801

Smith C, Lee SC. Current treatments against mucormycosis and future directions. PLoS Pathog. 2022;18(10):1-7. DOI: https://doi.org/10.1371/journal.ppat.1010858

Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR, et al. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis. 2016;16(7):828-37. DOI: https://doi.org/10.1016/S1473-3099(16)00071-2

Vehreschild JJ, Birtel A, Vehreschild MJGT, Liss B, Farowski F, Kochanek M, et al. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol. 2013;39(3):310-24. DOI: https://doi.org/10.3109/1040841X.2012.711741

Greenberg RN, Mullane K, Van Burik J-A, Raad I, Abzug MJ, Anstead G, et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006;50(1):126-33. DOI: https://doi.org/10.1128/AAC.50.1.126-133.2006

Sun QN, Fothergill AW, McCarthy DI, Rinaldi MG, Graybill JR. In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother. 2002;46(5):1581-2. DOI: https://doi.org/10.1128/AAC.46.5.1581-1582.2002

Pfaller MA, Messer SA, Hollis RJ, Jones RN. Antifungal activities of posaconazole, ravuconazole and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY Antimicrobial Surveillance Program, 2000. Antimicrob Agents Chemother. 2002;46(4):1032-7. DOI: https://doi.org/10.1128/AAC.46.4.1032-1037.2002

Gomez-Lopez A, Cuenca-Estrella M, Monzon A, Rodriguez-Tudela JL. In vitro susceptibility of clinical isolates of Zygomycota to amphotericin B, flucytosine, itraconazole and voriconazole. J Antimicrob Chemother. 2001;48(6):919-21. DOI: https://doi.org/10.1093/jac/48.6.919

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Published

2025-01-27

How to Cite

Alebachew, A. N., & Dibaba, D. K. (2025). Sino orbital mucormycosis treated with fluconazole . International Journal of Otorhinolaryngology and Head and Neck Surgery, 11(1), 71–74. https://doi.org/10.18203/issn.2454-5929.ijohns20250121