Ten-year experience of rhinocerebral zygomycosis in a teaching hospital in Tehran

Rhinocerebral zygomycosis is a rare, rapidly progressive and often fatal fungal infection occurring in several immunocompromised states. Prior investigators have reported an increasing incidence among Iranian population; therefore, we decided to present the clinical features and treatment outcome of a group of patients with rhinocerebral zygomycosis. Patients and Medical records of all cases with the diagnosis of rhinocerebral zygomycosis attending Rasoul-e-Akram Hospital, Tehran, Iran, were retrospectively reviewed from 1997 to 2007. Age, gender, predisposing illness, surgical procedures, and treatment outcomes were reviewed. Totally, 30 patients (17 males and 13 females) were reviewed with a mean age of 49.4±20.3 years. The lag time between onset of symptoms referable to zygomycosis and commencement of amphotericin B was 1 to 90 days with median of 10 days. An association between delayed treatment and mortality was found (p=0.01). Visual loss was observed in 53.3%. The ethmoid (86.6%) and maxillary sinuses (66.6%) were most commonly involved. Eighteen patients had underlying diabetes mellitus (60%). All patients received medical treatment, while 28 (93.3%) underwent surgical intervention. Twenty three patients (76.7%) had orbital involvement with a mortality rate of 43.5%. The overall mortality rate was 40% (12 cases). Patients with higher doses of amphotericin B and multiple surgical intervention had lower mortality rate (p=0.00 and p=0.01, respectively). Factors such as age, gender, predisposing diseases, orbital involvement, multi-sinus involvement, and white blood cell count had no impact on survival rate. Institution of aggressive surgical debridement of devitalized tissue and the timely initiation of systemic medical therapy is critical for good outcome