Artikel
Invasive mucormycosis of the sinuses: costs and outcome
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Veröffentlicht: | 22. September 2005 |
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Gliederung
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Rhinocerebral Mucormycosis is an agressive, fungal infection of the sinuses, which leads to inflammatory invasion and destruction of the surrunding tissue and ends up with death in 80% of the cases. The illness progresses rapidely, sometimes fulminant, mainly in diabetic and immonosuppressed persons. An early diagnosis and treatment is very important for the outcome. It comprises radical surgery, management of the predisposing illness and systemic antifungal therapy. As standard medication Amphotericin is given in a water-soluble or lipid-associated form. The new antimycotic drug Posaconazol is an upcoming new alternative to Amphotericin.
During the last 2 years we treated 4 patients suffering from a mucormycosis. As predisposing illness two of them showed a poorly controlled diabetes mellitus, one suffered from CLL and one of a myelodysplastic syndrome. In every case radical surgery and a systemic antifungal therapy were performed, which led to costs of up to 26.000€ in one case only during the time in the clinic. Despite intensive therapy, 3 patients died within a time from 2 weeks to 3 month. Only one patient, who showed no cerebral invasion and received exclusively Posaconazol survived for about one year now. Although there is no possibility to predict the individual outcome, and despite high costs, treatment of patient suffering from mucormycosis should be started with maxiaml therapy. New promising drugs like Posaconazol are upcoming.