Mucormycosis in South America: A review of 143 reported cases

Abstract

SummaryMucormycosis is a rare but important invasive fungal disease that most often affects immunocompromised hosts. The incidence of mucormycosis appears to be increasing worldwide, as risk factors such as the use of immunosuppressive therapies become more common. We report the results of a literature review of 143 mucormycosis cases reported in South America between 1960 and 2018. The number of reported cases has increased by decade, from 6 in the 1960s to 51 in the 2010s. The most common underlying conditions associated with mucormycosis in South America were diabetes mellitus (42.0%) and penetrating trauma/burns (20.0%). Underlying conditions involving immunosuppression, including treatment of haematologic malignancy, solid organ transplant, and corticosteroid use, also accounted for a large proportion of cases (45.5%). Between 1960 and 2018, cases of mucormycosis associated with conditions involving immunosuppression accounted for the highest mortality rate (58.5%), followed by diabetes mellitus (45.0%), and penetrating trauma/burns (37.9%). Overall mortality decreased from 100% to 39.4% during this period, mainly driven by the increasing availability and use of antifungal therapies and surgical intervention. However, these treatments are not yet universally utilised across the region in the treatment of mucormycosis; efforts to improve availability of effective treatments would be likely to improve outcomes.

Mucormycosis in the Middle East and North Africa: Analysis of the FungiScope® registry and cases from the literature

“…4 The species involved remained unidentified in more than half of cases, and Rhizopus and Mucor species were predominant among cases where the species was identified. This aligns closely with a review of cases in South America, 16 indicating that there may be dif- Surgery may not always be feasible and is generally restricted to patients with limited disease. In the opinion of the authors, antifungal prophylaxis is key to improve outcome in high-risk patients.…”

“…Our study summarises 303 cases from the literature and seven cases The median age of patients identified in this analysis (41 years) was in line with those reported in a global review and a review for South America (39 years and 40 years, respectively). 7,16 However, higher median ages have been identified in studies covering Europe (50-60 years) 5,6,23 and in another global study (49 years). 17 The proportion of males (58.4%) was largely consistent with the range observed in other studies (58-70%).…”

“…The dominance of diabetes and conditions associated with immunosuppression broadly aligns with reports from other regions including South America and India. 3,16,25 However, reports from Europe indicate haematological conditions as the predominant underlying pathology. 26,27 Regional differences raise the concern that other factors may influence the pathogenesis, diagnosis and treatment of mucormycosis.…”

“…3,16 Of note, rhino-sino-orbito-cerebral mucormycosis infections have been associated with diabetes mellitus in particular and, to a lesser extent, immunosuppression, trends that have been observed across multiple regions. 3,16 Given the worldwide increase in the number of patients who have diabetes mellitus or are immunosuppressed, 8,9 such infections have growing significance in clinical practice. This may be particularly relevant for the MENA region, which had the highest comparative prevalence of diabetes in the world in 2012.…”

“…14,15 Furthermore, geographic patterns and global differences in the underlying causes, manifestations and treatment of mucormycosis have been noted in data gathered in Europe, Asia and South America. [3][4][5]7,16,17 However, a review of cases across the Middle East and North Africa (MENA) is lacking. We have therefore collated and reviewed cases of mucormycosis from this region and herein summarise the key data from the cases identified.…”