OPTIMAL DIABETIC CONTROL - THE PRIMARY-TREATMENT MODALITY IN THE MANAGEMENT OF RHINOCEREBRAL MUCORMYCOSIS

Rhinocerebral mucormycosis is a potentially lethal fungal disease, whi ch typically starts in the nose and then spreads in a stepwise fashion to the sinuses, orbit and brain. All fatalities have been associated with intracranial extension. Various treatment modalities ranging from amphotericin B therapy alone, to combined amphotericin B and radical surgery, have been advocated to improve survival, but none of these ha s been found to be entirely successful. In the present series, rhinoce rebral mucormycosis was diagnosed in 9 keto-acidotic diabetic patients . In 7 patients more emphasis was directed at eradicating the disease with radical surgery and amphotericin B than on the medical treatment. All 7 patients died. In 2 patients emphasis was directed primarily at diabetic control, in 1 with a combination of a highly energetic antik eto-acidotic diabetic treatment regimen, debridement surgery and ampho tericin B therapy and in the other with highly energetic antiketo-acid otic diabetic treatment regimen alone. Both patients survived. A succe ssful outcome in patients with rhinocerebral mucormycosis is dependent on arresting the progression of the disease before intracranial exten sion occurs. In a diabetic patient this goal is achieved with optimal diabetic control, with a combination of a highly energetic antiketo-ac idotic diabetic medical treatment regimen and adjunctive debridement s urgery and amphotericin B therapy and not by neglecting the medical tr eatment and trying to eradicate the disease with radical surgery and a mphotericin B therapy alone.