Mucormycosis is a highly aggressive and fatal fungal infection. Due to its rapid progression, combination of early wide surgical debridement with administration of antifungal agent is extremely crucial. European Society for Clinical Microbiology and Infectious Diseases, and European Confedration of Medical Mycology recommended amphotericin B as the first-line of treatment and posaconazole as the salvage agent for mucormycosis. We report a case of rhino-orbital-cerebral mucormycosis successfully treated by changing antifungal agent from the first-line amphotericin B to the salvage agent posaconazole. A 57-years-old female with uncontrolled type 2 diabetes mellitus was presented with foot abscess and rhino-orbital-cerebral mucormycosis. The infection was intractable despite orbital orbital exenteration with surgical debridement and 2 months of antibiotics treatment including amphotericin B. Changing amphotericin B to posaconazole resulted in clinical improvement within the first week. Conclusively the newly administered antifungal agent, posaconazole is expected to be an effective salvage treatment option for mucormycosis after failure of initial treatment of amphotericin B with surgical management.
Abscess ; Amphotericin B ; Anti-Bacterial Agents ; Communicable Diseases ; Debridement ; Diabetes Mellitus, Type 2 ; Female ; Foot ; Humans ; Mucormycosis* ; Mycology ; Orbit

BACKGROUND: Fungal infections are frequent encountered conditions presented in various clinical forms. The prevalence of fungal infection is gradually growing because of the increase in aged population and immune-compromised host which is susceptible factor of fungal infection. Broad array of studies of fungal infection have been published in Korea. However, epidemiologic study of fungal infection in admitted patients via emergency department has not been conducted. OBJECTIVE: The purpose of this study is to generate background data for emergency department visits in relation to fungal infection for developing a subsequent management and control system. METHODS: The data was collected from National Emergency Department Information System (NEDIS) in Korea from 2011 to 2013. Data analysis was done to evaluate the age distribution of admission, regional variance and sex of the patients with fungal infection. RESULTS: The patients were divided into five groups according to their primary diagnosis which were skin fungal infection, subcutaneous mycoses, opportunistic mycoses, systemic mycoses and other mycoses. The annual admission ratio of general fungal infections increased from 2.15 persons per 100,000 in 2011 to 2.46 persons per 100,000 in 2013. The highest admission ratio was seen in opportunistic mycoses group followed by cutaneous fungal infections, other mycoses, subcutaneous mycoses and systemic mycoses groups. CONCLUSION: This study provides a basic set of data pertaining to fungal infections in emergency departments. Therefore, more systemically approached researches are required to implement sounder management and control systems of fungal infections presented in emergency departments.
Age Distribution ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Epidemiologic Studies ; Epidemiology* ; Humans ; Information Systems ; Korea* ; Mycoses ; Prevalence ; Skin ; Statistics as Topic