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 ORIGINAL ARTICLE
Year : 2007  |  Volume : 55  |  Issue : 3  |  Page : 292--297

Predictors of mortality in rhinocerebral mycosis


1 Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, India
2 Govt. ENT Hospital, Koti, Hyderabad, India
3 Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, India
4 Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, India

Correspondence Address:
Sita S Jayalakshmi
Department of Neurology, NIMS, Punjagutta, Hyderabad - 500 082
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.35692

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Introduction: Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure. Aim: To determine the predictors of mortality in rhinocerebral mycosis. Materials and Methods: The demographic data, clinical features, radiological (MRI/CT) findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi-square test was used for P value. Results: There were 38 patients. The age range was 7-82 (mean 48.68) years; 30 (79%) were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%). Rhino-orbital involvement was noted in 24 (63.2%) and 12 (31.6%) had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%). Eighteen (47.4%) patients died. The predictors for mortality: odds ratio (95% CI) were 2.45 (1.01-3.89) for elderly age, 5.67 (4.13-7.21) for intracranial extension, 2.6 (1.26-3.94) for immunocompromised state, 2.62 (1.25-3.99) for infection with zygomycosis and 2.33 (1.01-3.65) for anemia. Conclusion: Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis.






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