Mucormicosis rinoorbitaria. Estudio de cohorte de su tratamiento de acuerdo a la extensión de la enfermedad y reversión de su fisiopatología

espanolLa mucormicosis es una infeccion micotica oportunista y letal descrita en pacientes inmunocomprometidos. Se realizo un estudio de cohorte para comparar la evolucion del grupo de pacientes con mucormicosis rinoorbitaria, en el que se instituyo un protocolo terapeutico en el que sistematicamente se expone la fosa pterigomaxilar y se realiza o no exenteracion orbitaria en base a la extension de la infeccion al apex orbitario o a la fisura orbitaria, con un grupo historico en el que no se aplicaban estos criterios. Se incluyeron 15 casos: ocho en el grupo A historico y siete en el grupo B de estudio. Se realizo tratamiento medico con control de la enfermedad subyacente, anfotericina B, heparina de bajo peso molecular, tratamiento quirurgico mediante desbridacion extensa incluyendo etmoidectomia endoscopica y exploracion de la fosa pterigomaxilar, realizandose ademas exenteracion orbitaria solo a los pacientes que presentaron sindrome de apex orbitario en el grupo B. En el grupo A hubo una mortalidad del 50%, mientras que en el grupo B todos los pacientes obtuvieron curacion clinica; sin embargo, los dos pacientes con enfermedades hematologicas fallecieron por complicaciones no relacionadas. Con la estandarizacion de un protocolo diagnostico y terapeutico se pueden obtener buenos resultados en la curacion y sobrevida de la mucormicosis. EnglishMucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained. (Gac Med Mex. 2016;152:688-98) Corresponding author: Hector Manuel Prado-Calleros, hmpradoc@hotmail.com