Rhino-orbital Mucormycosis - A Dreaded Clinical Entity

Abstract

Orbital mucormycosis is a filamentous fungal infection which is found to be inflaming the orbit along with the cerebrum, initiating from paranasal sinus, is scrutinized in the department of Otorhinolaryngology. Mucorales remains common and frequently isolated microorganisms, causing mucormycosis but Mucor spp. and Rhizomucor spp., are responsible for 70% of total cases. Inflammation is initiated at paranasal sinus and is disseminated to orbit. The whole inflammatory process goes through four stages of pathogenesis. Germination is supported by high glucose, low oxygen concentration, high iron levels and acidic medium and then germinates into hyphae. This analytical review has tried to drag attention upon complete systematic steps of orbital mucormycotic infection including physical, clinical as well as the pathological presentation of orbital mucormycosis. Rhino-orbital mucormycosis is a dreaded clinical entity. It invades and occludes vascular lumina, forms a characteristic black eschar on paranasal sinus. The disease, through the ethmoid and maxillary sinuses, spreads to the paranasal sinuses into the orbit and then to the cranial cavity by way of the orbital apex, cribriform plate, orbital nerves or orbital vessels. It could be diagnosed by histopathologically, magnetic resonance imaging (MRI) and computed tomography (CT) scan. Epithelial cells and phagocytic cells help in host defence mechanism but Mucorales spores trap the nasal epithelial cells coming to contact with GRP78 through fungal spore coat protein CotH3 and harm the primary cell lining. By utilizing iron chelators, hyperbaric oxygen and immunityboosting of individuals can be proved as a complementary process to the management of orbital mucormycosis.

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