A middle aged woman presents with black nasal discharge, right globe fixation and proptosis. Investigations reveal elevated blood sugar and positive urinary ketones. What is the appropriate therapy for this condition?
Ref: Harrison's Principles of Internal Medicine, 18th edition, Pages 1661-1664Explanation:RHINOCEREBRAL MUCORMYCOSISCaused by the fungus Khizopus oryzae of Mucorales family.Causes infection in high risk groups:o Diabetics with DKA.o Defects in phagocyte function like neutropenics.o Glucocorticoid therapyo High free iron levelso ESRD on desferoxamine.Clinical Featureso Eye and facial paino Soft tissue swelling.o Extends to orbit - Proptosis. Chemosis, Ophthalmoplegia - Cavernous sinus thrombosis.o Infected tissue becomes edematous--Black necrotic eschar.o Pulmonary mucormycosis develops in leukemic patients on chemotherapy, o Lobar consolidation. cavitation, hemoptysis.o Other sites--Cutaneous. GIT.Biopsy--Thich ribbon-like hyphae which branch at right angles.DOC: Amphotericin B [Liposomal AmB less nephrotoxic |.Others: Capsofungin, Micafungin, Anidulafungin.
Amphotericin
Itraconazole
Broad spectrum antibiotic
Ketoconazole
Drugs