ABSTRACT
INTRODUCTION: Mucormycosis is an invasive fungal infection that affects decompensated diabetics, immunosupressed patients and occasionally healthy individuals. Despite advances in anti-fungal therapy and surgical techniques, the morbidity and mortality remain high. Adjuvant hyperbaric oxygen therapy (HBO) has been proposed based on pathophysiology and several favorable clinical reports. MATERIAL AND METHODS: A chart review of mucormycosis patients referred to the HBO service was performed. Also an electronic search in Medline of relevant literature was undertaken. RESULTS: Five mucormycosis patients referred for HBO had complete charts available. Four had craniofacial involvement and one had left upper extremity involvement. The predisposing diseases were leukemia (n = 3), diabetes mellitus plus sarcoidosis (n = 1), and trauma (n = 1). All patients were managed with amphotericin B, surgical debridement and HBO. Survival was 60% (3/5) three months after the diagnosis was established. The literature was scarce but favors HBO. CONCLUSION: Considering the pathophysiology of mucormycosis adjuvant HBO therapy seems reasonable. However, the clinical experience is still too limited to make HBO part of the standard of care. Prospective, randomized, controlled trials will help to define the role of HBO in this devastating infection.
Subject(s)
Hyperbaric Oxygenation , Mucormycosis/therapy , Adult , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: The Miskito Indian lobster divers of Central America employ very provocative diving profiles and experience severe neurological decompression sickness (DCS) and/or arterial gas embolism (AGE). Scientific data are scarce regarding the clinical patterns of injury, response to treatment, and functional outcomes for such cases. METHODS: A retrospective review of 229 cases of DCS and/or AGE was conducted at 2 hyperbaric units in Central America. RESULTS: The following deficits were recorded on presentation: any neurological deficit: 94%; motor: 79%; sensory: 60%; urinary: 48%; reflex: 45%; and loss of consciousness: 20%. The patterns of weakness (n = 182) were as follows: paraparesis: 27%; paraplegia: 26%; lower extremity monoparesis: 14%; lower extremity monoplegia: 6%; quadriparesis: 4%; hemiparesis: 4%; hemiplegia: 3%; and quadriplegia: 2%. Treatment was delayed by a mean and median of 5 and 2 d, respectively. The majority received hyperbaric oxygen and systemic steroids. Motor function on discharge (n = 182) was as follows: normal: 30%; paraparesis: 15%; lower extremity monoparesis: 15%; paraplegia: 3%; quadriparesis: 2%; hemiparesis: 2%; and missing data/other: 33%. Gait on discharge (n = 182) was as follows: normal: 19%; abnormal: 19%; required one crutch: 10%; required two crutches: 16%; not ambulatory: 5%; and missing data: 31%. DISCUSSION: The majority of severe injuries could be localized to the thoracolumbar spinal cord. One-fifth had bilateral cerebral dysfunction manifested by loss of consciousness. Despite long delays to treatment, divers responded to hyperbaric oxygen. At the time of discharge, almost a third had complete recovery of strength and the majority were ambulatory.
Subject(s)
Decompression Sickness/etiology , Diving/adverse effects , Fisheries , Indians, Central American , Adolescent , Adult , Aged , Central America/epidemiology , Decompression Sickness/ethnology , Decompression Sickness/physiopathology , Humans , Hyperbaric Oxygenation , Male , Middle Aged , Retrospective StudiesABSTRACT
Introduction. Mucormycosis is an invasive fungal infection that affects decompensated diabetics, immunosupressed patients and occasionally healthy individuals. Despite advances in anti-fungal therapy and surgical techniques, the morbidity and mortality remain high. Adjuvant hyperbaric oxygen therapy (HBO) has been proposed based on pathophysiology and several favorable clinical reports. Material and methods. A chart review of mucormycosis patients referred to the HBO service was performed. Also an electronic search in Medline of relevant literature was undertaken. Results. Five mucormycosis patients referred for HBO had complete charts available. Four had craniofacial involvement and one had left upper extremity involvement. The predisposing diseases were leukemia (n = 3), diabetes mellitus plus sarcoidosis (n = 1), and trauma (n = 1). All patients were managed with amphotericin B, surgical debridement and HBO. Survival was 60% (3/5) three months after the diagnosis was established. The literature was scarce but favors HBO. Conclusion. Considering the pathophysiology of mucormycosis adjuvant HBO therapy seems reasonable. However, the clinical experience is still too limited to make HBO part of the standard of care. Prospective, randomized, controlled trials will help to define the role of HBO in this devastating infection.
Introducción. La mucormicosis es una infección micótica invasiva que se presenta principalmente en pacientes diabéticos descompensados, pacientes con afección del sistema inmune, e incluso en individuos previamente sanos. A pesar de los avances en medicamentos y técnicas quirúrgicas la morbimortalidad es todavía muy elevada. La terapia adjunta con oxígeno hiperbárico (OHB) ha sido sugerida con base en fundamentos fisiopatológicos y algunos reportes clínicos favorables. Material y métodos. Revisión de expedientes de pacientes referidos al Servicio de OHB con diagnóstico de infecciones micóticas invasivas. Búsqueda electrónica en Medline de literatura pertinente. Resultados. Cinco pacientes con diagnóstico clínico e histopatológico de mucormicosis con expediente completo fueron referidos a OHB para terapia adjunta. Cuatro presentaron afección craneofacial y uno afección de la extremidad superior izquierda. La enfermedad predisponente fue leucemia (n = 3), sarcoidosis y diabetes mellitus (n = 1) y trauma (n = 1). Todos fueron manejados con anfotericina B, debridación quirúrgica y OHB. La sobrevida fue 60% (3/5) tres meses después del diagnóstico. La literatura al respecto es escasa, pero favorece al OHB. Conclusión. Con base en la fisiopatología de la mucormicosis la terapia adjunta con OHB parece lógica. No obstante, la información clínica es todavía muy limitada para recomendar OHB rutinariamente en estos pacientes. Estudios prospectivos, aleatorios, controlados ayudarán a definir el papel del OHB en el manejo de esta devastadora infección.