Invasive Mycotic Infection in Orofacial Region

Abstract

The authors describe the occurrence of zygomycosis in orofacial region in two patients with hematological malignancy.Invasive mycotic infections represent serious complications in the therapy of oncological patients. Most invasive mycoses are caused by the Candida and Aspergillus strains, but we increasingly encounter infections by rare filamentous fungi such as zygomycosis due to medicament prophylaxis.Clinical development becomes manifest in the beginning as a periosteal inflammation of atypical course and rapidly developing necroses of soft and hard tissues. The predisposing factor for the origin of zygomycosis is immune compromise of the patient. Patients with hematological malignancies are endangered, especially in transplantation of hematopoietic tissue, after transplantation of solid tumors with subsequent immunosuppression, diabetics with ketoacidosis, patients with chronic uremia and acidosis, as well as long-term use of antibiotics, cytostatic and immunosuppressive drugs.Zygomycosis is one of much feared opportune mycoses of aggressive course and mortality. A vascular invasion and subsequent vascular thromboembolism with devastating necroses of adjacent tissues is a typical manifestation. The therapy is based on radical surgical removal of all foci of zygomycosis. Amfotericin B is the treatment of first choice. In case of intolerance we administer the antimycotic Posakonazol.The characteristic property of this invasive mycotic infection is an extremely rapid progression, mostly of fulminant course, which has recently become accompanying manifestation of hemato oncological diseases.

Keywords

• invasive mycotic infection
• zygomycosis
• necrosis
• immunosuppression