Clinical Features and Outcome of Mucormycosis

Abstract

Mucormycosis (MCM) is a life-threatening infection that carries high mortality rates despite recent advances in its diagnosis and treatment. The objective was to report 14 cases of mucormycosis infection and review the relevant literature. We retrospectively analyzed the demographic and clinical data of 14 consecutive patients that presented with MCM in a tertiary-care teaching hospital in northern Mexico. The mean age of the patients was 39.9 (range 5–65). Nine of the patients were male. Ten patients had diabetes mellitus as the underlying disease, and 6 patients had a hematological malignancy (acute leukemia). Of the diabetic patients, 3 had chronic renal failure and 4 presented with diabetic ketoacidosis. All patients had rhinocerebral involvement. In-hospital mortality was 50%. All patients received medical therapy with polyene antifungals and 11 patients underwent surgical therapy. Survivors were significantly younger and less likely to have diabetes than nonsurvivors, and had higher levels of serum albumin on admission. The clinical outcome of patients with MCM is poor. Uncontrolled diabetes and age are negative prognostic factors.

Breaking the Mold

“…16 Six distinct clinical syndromes caused by invasive mucormycosis can occur in susceptible hosts, including rhino-orbitalcerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated, and miscellaneous infection (Table 1). No clinical history is specific for the diagnosis of invasive mucormycosis.…”

Cutaneous mucormycosis in an acute lymphoblastic leukemia child during bone marrow suppression: A case report

“…Mucormycosis infection could also be found in patients with normal immune function, especially those with trauma or skin damage [15]. It is of great difficulty to treat mucormycosis once the infection spread to the whole body or even to the intracranial tissues, and the mortality rate would increase to as high as 80%~90%.…”

“…Most successfully treated cases are resulting from the combination of active treatment for primary disease and antifungal therapy as well as surgical operation [15,22,23]. It has been confirmed that amphotericin B is a sensitive and effective drug for mucormycosis infection treatment and this drug is widely used in clinics [5,24].…”

“…At the same time, as the vascular occlusion and tissue necrosis caused by infection make it difficult for effective drug therapy, debridement treatment should be conducted as early as possible under an allowable physical condition. It is reported in numerous studies that surgical treatment can effectively improve the curative ratio of mucormycosis infections such as rhinocerebralmucormycosis and dermatomucormycosis [15,22,23,25]. The overall survival rate of mucormycosis infection is only 3% without treatment and simple amphotericin B treatment can improve this ratio to 61% while combination of amphotericin B treatment with surgical operation can further increase this rate by 1.5 times [6,20].…”

“…As fungal infection always results in large area of skin damage which is difficult to recover, free skin flap coverage after amphotericin B anti-infection treatment is an excellent method for wound healing if the patient is under a good systemic condition [15]. There is also a successfully treated case reported previously about a 4-year-old child with acute lymphoblastic leukemia in induction chemotherapy combined by mucormycosis infection on the right forearm.…”