Global Cutaneous Mucormycosis: A Systematic Review

Abstract

Cutaneous mucormycosis is the third most common clinical type of mucormycosis. The signs and symptoms vary widely, and it is important to make the diagnosis as early as possible in order to achieve a better outcome. We present a systematic review of its epidemiology, clinical presentation, diagnosis, and treatment, analyzing cases published from 1958 until 2021. The review was conducted according to the PRISMA guidelines and included 693 cases from 485 articles from 46 countries. Most publications were from North America (256 cases, 36.9%) and Asia (216 cases, 31.2%). The most common risk factors were diabetes mellitus (20%) and hematological malignancies (15.7%). However, a large proportion of published cases (275, 39.6%) had no identified underlying disease. The most common mode of transmission was trauma (54%), and 108 (15.6%) cases were healthcare-associated. In this review, 291 (42.5%) patients had localized infection, and 90 (13%) had disseminated mucormycosis. In Europe, N. America and S. America, the most common genus was Rhizopus spp., while in Asia it was Apophysomyces spp. (34.7%). Treatment was performed with antifungals, mainly amphotericin B, and/or surgery. Mortality was significantly lower when both antifungals and surgery were applied (29.6%).

Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases

“…However, cutaneous mucormycosis was associated with a mortality of 34.6%, which was lower than that reported by Guarro et al 100 (80%), Pamidimukkala et al 9 (46%) and Skiada et al 104 (42%). Also, no significant difference in mortality was observed between Indian patients (34.2%) and those from other countries (35.4%), which contradict the statements of previous studies.…”

“…However, a considerable number (61.6%) of patients died despite combined medical and surgical management, which could be due to delay in diagnosis and initiation of treatment. Also, Apophysomyces species demonstrate variable degrees of susceptibility to AmB, with high MICs reported in several studies 4,5,104 . This might be another reason for therapeutic failure of AmB in these patients, causing fatal consequences.…”

An old confusion: Entomophthoromycosis versus mucormycosis and their main differences

“…This study also included neonates with abdominal pain and vomiting (40%) and gastrointestinal perforation (30%). In addition, fever, obstruction, and abdominal distension occurred in 20% of the neonates studied ( Skiada et al, 2022 ). Imaging findings may contribute to the diagnosis.…”

“…Although the bibliography highlights the black eschar. The analysis of 623 patients with cutaneous mucormycosis found that only 55% of the cases were associated with the term’s “necrosis,” “necrotic,” or “necrotizing” ( Skiada et al, 2022 ). An individualized, holistic analysis of the patient’s risk factors, potential mechanisms of infection, and clinic is essential.…”

“…The most important risk factors are corticosteroid use and diabetes ( Michalak et al, 1980 ; Spellberg, 2012 ). In a systematic review of 80 cases with gastrointestinal mucormycosis, abdominal pain occurred in 50%, fever in 37%, and perforation in 27% ( Skiada et al, 2022 ). This study also included neonates with abdominal pain and vomiting (40%) and gastrointestinal perforation (30%).…”