• Users Online: 3042
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 2003  |  Volume : 51  |  Issue : 3  |  Page : 231-236

Rhino-Orbito-Cerebral Mucormycosis. A Retrospective Analysis of Clinical Features and Treatment Outcomes

Department of Ophthalmology, St. John's National Academy of Health Sciences, Bangalore, India

Correspondence Address:
S Nithyanandam
Department of Ophthalmology, St. John's National Academy of Health Sciences, Bangalore
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 14601848

Rights and PermissionsRights and Permissions

Objective: The conventional management of rhino-orbito-cerebral (ROC) mucormycosis includes control of metabolic abnormality, administration of amphotericin B and surgery that spans simple sinus clearance, radical debridement and orbital exenteration. Recent literature includes anecdotal descriptions of successful treatment with conservative management of involved orbits. We evaluated the clinical features and outcome of treatment for the different stages of ROC mucormycosis. Method: In this retrospective case series, 34 case records of patients with a histopathological diagnosis of ROC mucormycosis treated between 1992 and 2000 were reviewed. Three clinical stages and three treatment groups were identified. Patients with limited sino-nasal disease (Clinical stage I) underwent sino-nasal debridement (Treatment group A). Patients with limited rhino-orbital disease (Clinical stage II) underwent either sino-nasal debridement alone (Treatment group A) or orbital exenteration in addition to sino-nasal debridement (Treatment group B). Patients with rhino-orbito-cerebral disease (Clinical stage III) did not undergo any surgical procedure (Treatment group C). Thirty-three patients received intravenous amphotericin B. Outcome for each group was measured as "Treatment success" (disease free, stable patient with metabolic abnormality under control) and "Treatment failure" (progression of disease with worsening general condition or mortality due to the disease). Results: Uncontrolled diabetes in 30 (88.2%) of 34 patients was the commonest underlying disease and 16 (53.3%) of 30 diabetics had ketoacidosis. Chronic renal failure (n = 4), hepatic disease (n = 3) and idiopathic thrombocytopenia (n = 1) were the other underlying diseases. Eleven patients had stage I disease, 16 patients had stage II disease and seven patients had stage III disease. All 11 patients with stage I disease received treatment A; of 16 patients with stage II disease, 7 received treatment A and the remaining with stage III disease received treatment B; 7 patients with stage II disease received treatment C. Ten of 11 patients (91%) with stage I disease had treatment success. In patients with stage II disease, 7 of 7 (100%) with treatment A and 1 of 9 (11.1%) with treatment B had treatment success. All seven patients with stage III disease had treatment failure.
Conclusion: Debridement of the sinuses is necessary in all cases of rhino-orbito-cerebral mucormycosis. Diagnosis in the early stage needs a high degree of suspicion. There is a definite role for retention of orbits in patients whose metabolic derangement is rapidly controlled and orbital involvement is non-progressive.

Keywords: Rhino-orbito-cerebral mucormycosis, clinical features, treatment outcome, exenteration, conservation of orbits.

How to cite this article:
Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D'Souza O. Rhino-Orbito-Cerebral Mucormycosis. A Retrospective Analysis of Clinical Features and Treatment Outcomes. Indian J Ophthalmol 2003;51:231-6

How to cite this URL:
Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D'Souza O. Rhino-Orbito-Cerebral Mucormycosis. A Retrospective Analysis of Clinical Features and Treatment Outcomes. Indian J Ophthalmol [serial online] 2003 [cited 2022 Sep 27];51:231-6. Available from: https://www.ijo.in/text.asp?2003/51/3/231/14677

Click here to view

Click here to view

Click here to view

Click here to view

Click here to view

Click here to view

Click here to view

Click here to view
Mucormycosis is an acute, fulminant and fatal fungal infection in humans.[1],[2] Demonstration of tissue invasion on histopathology is mandatory for diagnosis.[2],[3] Histopathology is characterised by the presence of broad aseptate filamentous fungi branching at right angles with a predilection for intravascular invasion.[3] The rhino-orbito-cerebral form is the commonest form of disease.[1],[2],[4] The term rhino-orbito-cerebral (ROC) mucormycosis refers to the entire spectrum of the disease.[2],[4] With rare exceptions it usually starts in the sino-nasal tissues (limited sino-nasal disease), progresses to the orbits (limited rhino-orbital disease) and finally affects the central nervous system (rhino-orbito-cerebral disease). Patients manifest with signs and symptoms relating to the involved tissues. The progression of the disease to the orbits produces a constellation of pathgnomonic signs and symptoms, which makes early diagnosis and treatment possible.[5],[6]

Aggressive surgical debridement of all involved tissues including exenteration of involved orbits with prolonged administration of Amphotericin B is the most common treatment regime. [6],[7],[8],[9] However, there are increasing reports of success with limited or no surgical intervention in the orbit. [2],[10],[11],[12],[13],[14],[15],[16] In this retrospective study we evaluated the clinical characteristics and treatment outcome for the different stages of ROC mucormycosis.

  Materials and Methods Top

Charts of 34 patients with histopathologically confirmed diagnosis of ROC mucormycosis treated at St. John's Medical College Hospital, Bangalore, India from January 1992 to December 2000 were analysed. Evaluation at presentation included a detailed history, and otorhinolaryngologic, ophthalmic and neurologic examinations to assess the extent of the disease. We identified three distinct clinical stages based on the signs and symptoms and degree of disease progression [Table - 1][Table - 2]. Clinical stage I had signs and symptoms referable to only sino-nasal disease. Clinical stage II had rhino-orbital disease. Loss of vision, ocular motility restriction, proptosis, external and internal ophthalmoplegia, conjunctival pallor, chemosis and central retinal artery occlusion (CRAO) indicated orbital involvement. Clinical stage III had the full spectrum of ROC disease, indicated by cavernous sinus thrombosis, hemiplegia and altered sensorium. Facial nerve palsy indicated spread of infection to the infratemporal fossa through the inferior orbital fissure.

Initial investigations included complete blood counts, blood urea, serum creatinine, serum glucose, urine for ketone bodies and blood gas analysis. Diagnosis was made on histopathological examination and KOH preparation of biopsy specimens obtained from the nasal cavity and/or paranasal sinuses and the palate. An orbital fine needle aspiration cytological (FNAC) study was done in some patients when histopathological diagnosis from other sites was equivocal. Computerised tomographic scans of the paranasal sinuses, orbits and brain were obtained to assess the extent of disease.

Treatment with systemic Amphotericin B was started as soon as a diagnosis of mucor was established in all patients, along with treatment to stabilise the underlying metabolic derangement. After a test dose of 1 mg of amphotericin B in 100 ml of normal saline, 0.7 mg/kg/day of amphotericin B was given over 6 hours. The dose was increased by 25 mg/day on alternate days to a maximum of 100 mg/day and continued till a cumulative dose of 2.5 - 3 gms was reached. Three distinct treatment groups were identified based on the nature of surgery that the patients underwent. Patients in treatment group A (TG-A) underwent sino-nasal debridement only. Some patients in this group who had orbital involvement also received intraorbital Amphotericin B (1mg/ml/dose retrobulbar injection once a day or through an irrigating cannula). Treatment group B (TG-B) consisted of sino-nasal debridement with orbital exenteration. Treatment group C (TG-C) received only medical treatment with intravenous amphotericin B as all these patients refused surgery.

The outcome for each treatment group was evaluated in terms of treatment success and treatment failure. Treatment success was defined as a disease-free, stable patient with controlled metabolic status. Treatment failure was defined as progression of disease to a more advanced stage, worsening general condition or mortality due to the infection.

  Results Top

Disease demographics

The average age of the 18 male and 16 female patients was 48.2 years (14-69 years). Twenty-four (70.6%) patients presented between June and September; eight (23.5%) patients presented in December and January, and two (5.9%) patients presented February and May.

Signs and symptoms

The signs and symptoms with their frequency of occurrence are listed in [Table - 1]. Eleven patients had sino-nasal disease (clinical stage I), 16 had rhino-orbital disease (clinical stage II) and seven had rhino-orbito-cerebral disease (clinical stage III) [Table - 2]. Differences in the severity of orbital signs between TG-A and TG-B of clinical stage II are shown in [Table - 3]. The severity of proptosis was the main orbital differentiating determinant between the two treatment groups in this stage. There was no difference in the occurrence of CRAO or ophthalmoplegia between the two groups.

Predisposing condition

Uncontrolled diabetes in 30 (88.2%) patients was the commonest underlying disease and 16 of 30 patients (53.3%) had diabetic ketoacidosis. The other underlying diseases included chronic renal failure (n = 4), hepatic disease (n = 3) and idiopathic thrombocytopenia (n = 1). [Table - 4] lists the underlying disease for each treatment group. Patients in TG-B and TG-C had more severe metabolic derangement with some patients having more than one underlying disease. There was also a marked difference in the severity of the underlying disease in clinical stage II patients undergoing TG-A and TG-B [Table - 3][Table - 4]. Patients in TG-B had more severe forms of metabolic derangement, such as refractory hyperglycemia in 3 of 9 (33.3%) patients; and ketoacidosis in 6 of 9 (66.7%) patients; two or more concurrent underlying diseases were present in 3 of 9 (33.3%) patients. All patients in TG-A had hyperglycemia, which responded to intensive medical treatment, including the three patients with ketoacidosis.


Evidence of maxillary and ethmoidal sinusitis was present in 31 patients while 3 had maxillary disease only [Figure - 1]. In 18 patients orbital changes on CT were evident which included pre-septal oedema, proptosis, medial rectus thickening and minimal obliteration of fat shadow at the orbital apex [Figure - 2][Figure - 3]. Intracranial disease on CT included cerebral infracts (n = 2), cerebellar infarct (n = 1), cavernous sinus thrombosis

(n = 2) and a mass in the cavernous sinus (n = 1) [Figure - 4]. Remarkably, CT findings were absent in 5 patients with clinical evidence of orbital disease [Figure - 5] and 2 patients with CNS disease.

Medical treatment

Thirty-three patients received intravenous amphotericin B as soon as a diagnosis of mucor was established. The cumulative dose ranged from 25mg to 2500mg. Two patients with rising serum creatinine and two patients due to drug hypersensitivity were switched to oral ketoconazole. Local amphotericin B into the orbit was administered in four patients in clinical stage II, who received Treatment A.

Surgical treatment

Surgical treatment varied depending on the clinical stage as shown in [Table - 4]. Overall 18 patients received Treatment A (TG-A), 9 received Treatment B (TG-B) and 7 patients received Treatment C (TG-C). All 11 patients with sino-nasal disease underwent debridement of all necrotic tissue in the sinuses and the nasal cavity (TG-A). Either endoscopic sinus clearance or the external approach was used. Seven of 16 patients with rhino-orbital disease underwent sinus debridement alone (TG-A). Four of these received local amphotericin B into the orbit. The remaining nine patients with clinical stage II disease underwent orbital exenteration with extensive sinus debridement (TG-B). This included partial maxillectomy and excision of necrosed facial skin in four patients. None of the seven patients in clinical stage III underwent any surgical procedure (TG-C).


Patients undergoing Treatment A had the best outcome with 17 of 18 (94.4%) treatment success [Table - 4]. All 17 patients had no evidence of disease at follow-up ranging from 2 months to 8 years. This included 10 patients with sino-nasal disease and all 7 patients with rhino-orbital disease. One patient from clinical stage I died due to amphotericin B-induced acute renal failure and not as a consequence of the infection per se . Treatment failure occurred in 8 of 9 (88.9%) patients with rhino-orbital disease undergoing Treatment B with treatment success in 1 of 9 (11.1%) patient. Seven of these patients died due to uncontrolled disease and one patient was discharged on request with spread of infection to the contralateral side. All 7 patients with rhino-orbito-cerebral disease who received Treatment C were treatment failures. Three patients died due to uncontrolled disease. Four were discharged on request with worsening condition and did not return for follow-up. Thus treatment success was seen in 18 (52.9%) patients, treatment failure was seen in 16 (47.1%) patients and the overall mortality was 32.4% (11 patients).

  Discussion Top

Most reports state that rhino-orbito-cerebral mucormycosis is a rather uncommon disease. [1],[10],[17]. The unusually high incidence of ROC mucormycosis at our centre could be a reflection of poor diabetic control, poor socio-economic factors and the low level of patient education and awareness. Currently we do not have a proper explanation for the apparent seasonal predilection (June to September) of ROC mucormycosis. Diabetic patients with ROC mucormycosis have the best chance of survival, as the underlying metabolic derangement is most amenable to treatment.[1],[2],[5],[18] Patients with other immunocompromised states had a poor outcome. Patients with liver disease rarely develop mucormycosis. [3],[19] None of our patients had AIDS; the literature has only 12 reported cases of mucormycosis for all organs in AIDS patients. [20],[21],[22]

Intravenous amphotericin B, is the drug of choice for mucormycosis. In our series it could not be administered to four patients (all in Treatment group A), due to well-known adverse reactions.[23] These four patients received oral ketoconazole. Successful use of oral ketoconazole only is also reported [24]. Liposomal amphotericin B increases the efficacy of the drug facilitating prolonged administration for ROC mucormycosis, without side effects [25],[26]. Direct infiltration of the drug into the orbit helps in higher levels of drug reaching the affected areas.[10],[13],[14],[15] Treatment outcome is good when the disease is anatomically confined to the sinuses.[2] In this series the treatment success rate was 91% in stage I disease.

The argument for radical debridement of all affected tissue in a patient with mucormycosis, is based on the capacity of the fungus to spread along the walls and the lumen of blood vessels, leading to necrotising arteritis and ischaemic necrosis of the involved tissues. [7],[8],[9] This results in poor penetration of systemically administered drugs. However, there is evidence including ours that there exists a clinical group of patients who do well with conservative management.[2],[10],[11],[12],[13],[14],[15],[16] It would appear that addition of exenteration (TG-B) to the surgical plan was actually detrimental to patients in our series. But this was actually due to severity of disease. Stage II patients who received Treatment A had only moderate systemic disease that was rapidly stabilised and the orbital disease was not progressive.

On the other hand stage II patients who received Treatment B had rapidly progressive, severe orbital disease with proptosis, periorbital cellulitis and necrosis of the eyelid skin and the skin over the maxilla. The underlying metabolic derangement was severe, such as ketoacidosis, liver disease and idiopathic thrombocytopenic purpura.

All the patients with ROC mucormycosis stage III did not do well. All patients in this group at presentation had intracranial disease, which is associated with poor prognosis. A surgical clearance of all infected tissues including an exenteration was mandatory.

A rapidly corrected underlying metabolic derangement is the most important criterion for considering conservation of orbits. This is applicable even in the presence of total ophthalmoplegia and CRAO.[2] Conservative management can also be considered in patients with isolated extraocular muscle involvement, preserved vision and absence of progression. Infiltration of amphotericin B into the orbit and surrounding sinuses is benificial in these patients. In all cases, sinus and palatal disease debridement should be done wherever possible. This would help in reducing the load of infection in the sinuses and also obtain tissue for histopathological diagnosis. Exenteration should be prescribed in advanced involvement of orbit.

To conclude, the treatment of rhino-orbito-cerebral mucormycosis mandates a high index of suspicion in predisposed individuals. The management following a diagnostic biopsy includes rapid correction of the underlying metabolic and immunological derangements, intravenous amphotericin B and surgical clearance of all infected nasal and sinus tissue. The severity of predisposing factors, extent and aggressiveness of orbital disease at presentation, rate of progression and response to initial treatment should guide surgical management of the orbit. There is a definite role for the conservative management of the orbit in a select group of patients.

  References Top

Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbito-cerebral mucormucosis. Surv Ophthalmol 1994; 39:3-22.  Back to cited text no. 1
Peterson KL, Wang M, Canalis FR, Abemayor E. Rhinocerebral mucormycosis: Evolution of the disease and treatment options. Laryngoscope 1997; 107:855-62.  Back to cited text no. 2
Parfrey NA. Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases. Medicine 1986; 65:113-23.  Back to cited text no. 3
Ferry AP, Abedi S. Diagnosis and management of rhino-orbito-cerebral mucormycosis (phycomycosis): A report of 16 personally observed cases. Ophthalmology 1983; 90:1096-104.   Back to cited text no. 4
Pagano L, Ricci P, Tonso A Nosari A, Cudillo L, Montillo M et al. Mucormycosis in patients with haematological malignancies: A retrospective clinical study of 37 cases. Br J Haematology 1997; 99: 331-36.  Back to cited text no. 5
Boelaert JR, Fenves AZ, Coburn JW. Desferrioxamine therapy and mucormycosis in dialysis patients: Report of an International Registry. Am J Kidney Dis 1991; 18:660-67.  Back to cited text no. 6
Ochi JW, Harris JP, Feldman JI, Press GA. Rhinocerebral mucormycosis: Results of aggressive surgical debridement and amphotericin B. Laryngoscope 1988; 98:1339-42.  Back to cited text no. 7
Abedi E, Sismanis A, Choi K, Pastore P. Twenty-five years experience treating cerebro-rhino-orbital mucormycosis. Laryngoscope 1984; 94:1060-62,  Back to cited text no. 8
Rangel-Guerra R, Martinez HR, Saenz C. Mucormycosis. Report of 11 cases. Arch Neurol 1985; 42:5478-81.  Back to cited text no. 9
Kohn R, Hepler R. Management of limited rhino-orbital mucormycosis without exenteration. Ophthalmology 1985; 92:1440-43.  Back to cited text no. 10
Bullock JD, Jampol LM, Fezza AJ. Two cases of orbital phycomycosis with recovery. Am J Ophthalmol 1974; 78:811-15.  Back to cited text no. 11
Ferry AP. Discussion on limited rhino-orbital mucormycosis. Ophthalmology 1985; 92:1443-44.  Back to cited text no. 12
Luna JD, Ponssa XS, Rodriguez SD, Luna NC, Juarez CP. Intraconal amphotericin B for the treatment of rhino orbital mucormycosis. Ophthal Surg Lasers 1996; 27:706-8.  Back to cited text no. 13
Pelton RW, Peterson EA, Patel BC, Davis K. Successful treatment of rhino-orbital mucormycosis without exenteration: The use of multiple treatment modalities. Ophthal Plast Reconstr Surg 2001; 17: 62-66   Back to cited text no. 14
Seif SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthal Plast Reconstr Surg 1999; 15: 28-32   Back to cited text no. 15
Avet PP, Kline LB, Sillers MJ. Endoscopic sinus surgery in the management of mucormycosis. J Neuroophthalmol 1999; 19:56-61   Back to cited text no. 16
Maniglia AJ, Mintz DH, Novak S. Cephalic phycomycosis: A report of eight cases. Laryngoscope 1982; 92:755-60.  Back to cited text no. 17
Biltzer A, Lawson W, Meyers BR, Biller HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope 1980; 90:635-48.  Back to cited text no. 18
Qingli L, Orcutt JC, Seifter LS. Orbital mucormycosis with retinal and ciliary artery occlusion. Br J Ophthalmol 1989; 73:680-83.  Back to cited text no. 19
Lee BL, Holland GN, Glasgow BJ. Chiasmal infarction and sudden blindness caused by mucormycosis in AIDS and diabetes mellitus. Am J Ophthalmol. 1996; 122:895-96.  Back to cited text no. 20
Sanchez MR, Ponge-Wilson I, Moy JA, Rosenthal S. Zygomycosis and HIV infection. J Am Acad Dermatol 1994; 30:904-8.  Back to cited text no. 21
Blatt SP, Lucey DR, Dehoff D, Zellmer RB, Rhinocerebral zygomycosis in a patient with AIDS [letter]. J Infect Dis 1991; 164:215-16.  Back to cited text no. 22
Butler WT, Bennet JE, Alling DW, Wertlake PT, Utz JP, Hill GJ. Nephrotoxicity of amphotericin B: Early and late effects in 81 patients. Ann Int Med 1964; 61:175-83.  Back to cited text no. 23
O'Keefe M, Orcutt JC, Seifter LS. Orbital mucormycosis with survival. Br J Ophthalmol 1989; 73:634-36.  Back to cited text no. 24
Fisher EW, Toma A, Fisher PH, Cheeseman AD. Rhinocerebral mucormycosis : Use of liposomal amphotericin B. J. Laryngol Otol 1991; 105:575-77.  Back to cited text no. 25
Ericsson M, Anniko M, Gustafsson H, Hjalt CA, Stenling R, Tarnvik A. Case of chronic progressive rhinocerebral mucormycosis treated with liposomal amphotericin B and surgery [letter].. Clin Infect Dis 1993; 16:585-86.  Back to cited text no. 26


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

This article has been cited by
1 Isolated orbito-cerebral mucormycosis
Lau, C.-I., Wang, H.-C., Yeh, H.-L., Li, C.-H.
Neurologist. 2011; 17(3): 151-153
2 Primary orbital mycosis in immunocompetent infants
Chawla, B., Sharma, S., Kashyap, S., Kabra, S.K., Pushker, N., Bajaj, M.S.
Journal of AAPOS. 2011; 15(2): 211-213
3 Hyperglycemic hyperosmolar state and rhino-orbital mucormycosis
Pinto, M.E., Manrique, H.A., Guevara, X., Acosta, M., Villena, J.E., Solís, J.
Diabetes Research and Clinical Practice. 2011; 91(2): e37-e39
4 Fatal rhinocerebral mucormycosis under the shade of hepatic encephalopathy
Ataseven, H., Yüksel, I., Gültuna, S., Köklü, S., Uysal, S., Başar, O., Şaşmaz, N.
Annals of Hepatology. 2010; 9(4): 462-464
5 Rhinocerebral mucormycosis treated with posaconazole: A case report | [Posakonazol ile tedavi edilen rinoserebral mukormikoz olgusu]
Demiroǧlu, Y.Z., Turunç, T., Erkan, A.N., Alkan, Ö., Alişkan, H.E., Çolakoǧlu, Š., Arslan, H.
Klimik Dergisi. 2010; 23(3): 130-133
6 Multilocus microsatellite typing for Rhizopus oryzae
Baghela, A., Thungapathra, M., Shivaprakash, M.R., Chakrabarti, A.
Journal of Medical Microbiology. 2010; 59(12): 1449-1455
7 Rhinocerebral mucormycosis: An update
Mallis, A., Mastronikolis, S.N., Naxakis, S.S., Papadas, A.T.
European Review for Medical and Pharmacological Sciences. 2010; 14(11): 987-992
8 Recent advances in the treatment of mucormycosis
Spellberg, B., Ibrahim, A.S.
Current Infectious Disease Reports. 2010; 12(6): 423-429
9 Role of histopathology as an aid to prognosis in rhino-orbito-cerebral zygomycosis
Goel, A., Kini, U., Shetty, S.
Indian Journal of Pathology and Microbiology. 2010; 53(2): 253-257
10 Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India
Ramesha, K.N., Kate, M.P., Kesavadas, C., Radhakrishnan, V.V., Nair, S., Thomas, S.V.
Annals of Indian Academy of Neurology. 2010; 13(2): 112-116
11 Rhino-orbital mucormycosis and aspergillosis: Differences in outcome, clinical and imaging characteristics
Nithyanandam, S., Correa, M.A.
European Archives of Oto-Rhino-Laryngology. 2010; 267(1): 161-162
12 Rhinocerebral mucormycosis complicated by diabetes insipidus: A case report and literature review
Magri, C.J., Piscopo, T., Farrugia, E., Fava, S.
Infectious Diseases in Clinical Practice. 2010; 18(1): 56-61
13 Orbital apex syndrome secondary to mucormycosis after a tooth extraction in an immunocompetent patient
Varghese, A., Thomas, S.
Ear, Nose and Throat Journal. 2010; 89(4): e24
14 Invasive rhino-cerebral fungal granuloma
Selvam, M., Pande, A., Chakravarthy, V.M., Ramamurthi, R.
Neurology India. 2010; 58(2): 270-276
15 Rhino-orbito-cerebral mucormycosis, a retrospective study of 7 cases | [Mucormicosis rinoorbitocerebral, un estudio retrospectivo de 7 casos]
Santos Gorjón, P., Blanco Pérez, P., Batuecas Caletrío, A., Muńoz Herrera, A.M., Sánchez González, F., de la Fuente Cańibano, R.
Acta Otorrinolaringologica Espanola. 2010; 61(1): 48-53
16 Invasive zygomycosis in India: Experience in a tertiary care hospital
Chakrabarti, A., Chatterjee, S.S., Das, A., Panda, N., Shivaprakash, M.R., Kaur, A., Varma, S.C., (...), Sakhuja, V.
Postgraduate Medical Journal. 2009; 85(1009): 573-581
17 Rhino-orbital-cerebral mucormycosis and aspergillosis: Differential diagnosis and treatment
Arndt, S., Aschendorff, A., Echternach, M., Daemmrich, T.D., Maier, W.
European Archives of Oto-Rhino-Laryngology. 2009; 266(1): 71-76
18 Rhinocerebral mucormycosis in patients without predisposing medical conditions: A review of the literature
Elinav, H., Zimhony, O., Cohen, M.J., Marcovich, A.L., Benenson, S.
Clinical Microbiology and Infection. 2009; 15(7): 693-697
19 Recent advances in the management of mucormycosis: from bench to bedside
Spellberg, B., Walsh, T.J., Kontoyiannis, D.P., Edwards Jr., J.J., Ibrahim, A.S.
Clinical Infectious Diseases. 2009; 48(12): 1743-1751
20 Early onset sinonasal mucormycosis during induction therapy of acute lymphoblastic leukemia: Good outcome without surgical intervention
Ganesan, P., Swaroop, C., Ahuja, A., Thulkar, S., Bakhshi, S.
Journal of Pediatric Hematology/Oncology. 2009; 31(2): 152-153
21 Rhinocerebral mucormycosis: Common presentation of an uncommon and fatal condition
Tunuguntla, R., Dang, S., Milanez, M., Kaiser, R.M.
Clinical Geriatrics. 2009; 17(2): 25-27
22 Successful treatment of a giant isolated cerebral mucormycotic (zygomycotic) abscess using endoscopic debridement: case report and therapeutic considerations
Metellus, P., Laghmari, M., Fuentes, S., Eusebio, A., Adetchessi, T., Ranque, S., Bouvier, C., (...), Grisoli, F.
Surgical Neurology. 2008; 69(5): 510-515
23 Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome
Songu, M., Unlu, H.H., Gunhan, K., Ilker, S.S., Nese, N.
American Journal of Rhinology. 2008; 22(1): 98-103
24 Plasmablastic lymphoma mimicking orbital cellulitis
Barkhuysen, R., Merkx, M.A.W., Weijs, W.L.J., Gerlach, N.L., Bergé, S.J.
Oral and Maxillofacial Surgery. 2008; 12(3): 125-128
25 Acute oral and ocular changes in a patient with diabetic ketoacidosis
Mitchell, G.E., Reddy, A., Shepherd, M.E.
American Family Physician. 2008; 77(11): 1584-1587
26 Rhinocerebral mucormycosis: Anatomoclinical study of seventh cases | [Mucormycose rhinocérébrale : étude anatomoclinique de sept cas]
Charfi, S., Ayadi, L., Makni, S., Marrakchi, C., Ellouze, S., Kallel, R., Gouiaa, N., (...), Ben Jemaa, M.
Journal de Mycologie Medicale. 2008; 18(1): 46-52
27 Antifungal therapy used in central nervous system fungal infections
Yao, Z., Liao, W., Liang, J.
Central Nervous System Agents in Medicinal Chemistry. 2007; 7(3): 166-172
28 Rhinocerebral mucormycosis: A deadly disease on the rise
Mane, R.S., Watve, J.K., Mohite, A.A., Patil, B.C.
Indian Journal of Otolaryngology and Head and Neck Surgery. 2007; 59(2): 112-115
29 Zygomycetes and zygomycosis in the new era of antifungal therapies | [Zigomicetos y zigomicosis en la era de las nuevas terapias antifúngicas]
Torres-Narbona, M., Guinea Ortega, J., Muńoz, P., Bouza, E.
Revista Espanola de Quimioterapia. 2007; 20(4): 375-386
30 Mucormycosis in patients with complicated cirrhosis
Abbas, Z., Jafri, W., Rasool, S., Abid, S., Hameed, I.
Singapore Medical Journal. 2007; 48(1): 69-73
31 Rhinocerebral mucormycosis: The disease spectrum in 27 patients
Mohindra, S., Mohindra, S., Gupta, R., Bakshi, J., Gupta, S.K.
Mycoses. 2007; 50(4): 290-296
32 Zygomycosis: an uncommon cause for peripheral facial palsy in diabetes
Meas, T., Mouly, S., Kania, R., Hervé, D., Herman, P., Kévorkian, J.P., Virally, M., (...), Guillausseau, P.J.
Diabetes and Metabolism. 2007; 33(3): 227-229
33 Nosocomial fungal infections: Epidemiology, diagnosis, and treatment
Perlroth, J., Choi, B., Spellberg, B.
Medical Mycology. 2007; 45(4): 321-346
34 Mucormycosis: An emerging disease?
Bouza, E., Muñoz, P., Guinea, J.
Clinical Microbiology and Infection. 2006; 12(Supp 7): 7-23
35 Zygomycosis: The re-emerging fungal infection
Chayakulkeeree, M., Ghannoum, M.A., Perfect, J.R.
European Journal of Clinical Microbiology and Infectious Diseases. 2006; 25(4): 215-229
36 Rhinocerebral mucormycosis in four diabetics | [La mucormycose rhinocérébrale chez le diabétique: À propos de quatre observations]
Ferchichi, L., Chadli-Debbiche, A., Koubâa, W., Khayat, O., Labbène, N., Ben Gamra, O., Khedim, A., Ben Ayed, M.
Journal des Maladies Vasculaires. 2006; 31(2): 85-87
37 Prosthetic rehabilitation of face following naso-orbital mycosis
Deshpande, S., Bhat, S., Sharma, R., Singh, S., Fernandes, J.
Indian Journal of Plastic Surgery. 2006; 39(1): 73-75
38 Fatal Rhino-Orbito-Cerebral Zygomycosis Caused by Apophysomyces elegans in a Healthy Patient
Schütz, P., Behbehani, J.H., Khan, Z.U., Ahmad, S., Kazem, M.A., Dhar, R., Eskaf, W., (...), Cunningham Jr., L.L.
Journal of Oral and Maxillofacial Surgery. 2006; 64(12): 1795-1802
39 Novel perspectives on mucormycosis: Pathophysiology, presentation, and management
Spellberg, B., Edwards Jr., J., Ibrahim, A.
Clinical Microbiology Reviews. 2005; 18(3): 556-569
40 Mucormycosis presenting with painful ophthalmoplegia
Karakurum, B., Karatas, M., Cagici, A.C., Uncu, H., Yildirim, T., Hurcan, C., Karaca, S., (...), Tan, M.
Acta Neurologica Belgica. 2005; 105(4): 201-205
41 Mycoses of the head and neck | [Les mycoses ORL]
Rousseau, A., Cornet, M., Carnot, F., Brasnu, D., Bruneval, P., Badoual, C.
Annales de Pathologie. 2005; 25(2): 104-116


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Materials and Me...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded1    
    Comments [Add]    
    Cited by others 41    

Recommend this journal