Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review

Abstract

The diagnosis of gastrointestinal (GI) mucormycosis is always a challenge due to its non-specific clinical presentations and often diagnosed at autopsy. Recently increased number of GI mucormycosis has been reported in immunocompetent hosts and during 1948 through 2017, 200 cases of GI mucormycosis are available in literature. We could review 176 cases where case details were available. Majority (50.6%) of the cases were reported from Asia. The disease is nearly equally recorded in adults and paediatric population. The infection commonly affected the intestine (64.2%) followed by stomach (33%). A significant improvement in antemortem diagnosis was noted since 2001. Rhizopus species were the predominant (67.5%) aetiological agents. Amphotericin B was the most commonly used drug (93.4%). Despite improvement of antemortem diagnosis and therapy, the mortality was 60.5% and 67.5% in adults and children respectively. Combined medical and surgical therapy (reported in 47.8% patients) had significantly better survival rate than those receiving either of them. Analysing the clinical presentations, we propose to suspect GI mucormycosis in a malnourished/ dehydrated child (especially premature neonate) with history of exposure to broad-spectrum antibiotics or formula/spoon feeding and presenting with mass in abdomen, abdominal distension or bilious vomiting; and an adult presenting with abdominal distension, fever or GI bleed with underlying risk factors for mucormycosis.

Mucormycosis of stomach

“…Even after surgical treatment and antifungal treatment mortality remains high (60-70%). 5 In the past many antifungals have been tried but mucorales are resistant to each one. Only Amphotericin B is active against the mucorales.…”

Invasive Mucormycosis: An Unusual Cause of Intestinal Gangrene in an Immunocompetent Adult

“…1 Mucormycosis of the gastrointestinal tract is rare and possibly accounts for around 8% of all cases of mucormycosis and is associated with a mortality of around 50%. 2 It is difficult to diagnose. In particular, gastrointestinal mucormycosis has been seen in premature neonates, often in association with widespread disseminated disease.…”

“…Rare cases of gastrointestinal mucormycosis have been described in association with other immune-compromising conditions, including AIDS, systemic lupus erythematosus, and organ transplantation. 2 In a recent systematic review on gastrointestinal mucormycosis, most of the reported cases were from Asia. Although gastric mucormycosis may be easy to diagnose, a recent review suggests that the stomach is the commonest organ involved in adults, whereas intestinal involvement is more frequent in children.…”

“…Although gastric mucormycosis may be easy to diagnose, a recent review suggests that the stomach is the commonest organ involved in adults, whereas intestinal involvement is more frequent in children. 2 Though rare, gastrointestinal mucormycosis has been also reported in posttraumatic peritonitis. 3 In the present case, the patient also had peritonitis due to jejunal perforation following the blunt trauma abdomen.…”

“…The key to successful therapy is treatment with a combination of amphotercin B and surgical debridement. 2 Since the diagnosis of gastrointestinal mucormycosis seems to be increasing even in the immunocompetent individuals, the index of suspicion must remain high.…”