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

Abstract

Summary Background Regional differences in the underlying causes, manifestations and treatment of mucormycosis have been noted in studies covering Europe, Asia and South America. Objectives To review cases of mucormycosis across the Middle East and North Africa (MENA) region in order to identify epidemiological, treatment and outcome trends in this region. Patients/Methods Cases of proven or probable invasive mucormycosis from the region were identified from the FungiScope® database and the medical literature. For each case, information on underlying condition, site of infection, pathogenic species, therapeutic intervention, type of antifungal therapy and outcome were analysed. Results We identified 310 cases of mucormycosis in the MENA region. The number of reported cases increased by decade from 23 before 1990 to 127 in the 2010s. In this region, the most common underlying conditions associated with mucormycosis were diabetes mellitus (49.7%) and conditions associated with immunosuppression (46.5%). The majority of patients received treatment with antifungals (93.5%), with a large proportion treated with both antifungals and surgery (70.6%). Overall mortality rates decreased from 47.8% before 1990 to 32.3% in the 2010s. Conclusions The number of reported cases of mucormycosis in the MENA region has risen over the past few decades, in line with increases in the number of patients with underlying conditions associated with this infection. Although the majority of patients received treatment with antifungal therapies and/or surgery, the associated mortality rate remains high and there is a clear need for more effective prevention and treatment strategies in the MENA region.

Epidemiology and Diagnosis of Mucormycosis: An Update

“…In studies from Europe [ 10 , 14 , 27 ] the most common underlying disease was a hematological malignancy, while in India [ 5 , 11 , 20 , 29 ], Iran [ 29 , 31 ] and Mexico [ 12 ] it was diabetes mellitus. Diabetes was also the leading underlying condition in the study by Stemler et al in countries of the Middle East and North Africa [ 34 ].…”

Frequency of occurrence, seasonal variation and antifungal susceptibility of opportunistic Mucorales isolated from hospital soils in Iran

“…Mucormycosis is a life‐threatening severe progressive disease caused by Mucorales with more than 10,000 cases annually worldwide and an estimated mortality rate of approximately 30%‐90% 1 . In Iran, mucormycosis is a rare fungal infection; nevertheless, its incidence increased in the last decades 2‐4 . Diabetes mellitus, solid organ transplants, haematological malignancy and corticosteroid therapy are the risk factors for this infection 5,6 .…”

Mucormycosis: Literature review and retrospective report of 15 cases from Portugal

“…Mucormycosis is a rare invasive fungal disease responsible for significant morbidity and mortality in immunocompromised patients, especially those with haematological malignancies, hematopoietic stem cell transplant recipients, and patients who undergo chronic high-dose corticosteroid treatment [ 1 - 9 ]. Poorly controlled diabetes mellitus (DM) is also a major risk factor and frequently the most reported underlying condition of this infection [ 1 , 3 - 10 ].…”

“…It should also be noted that despite its rarity, it has been increasingly reported in recent years [ 4 , 8 - 10 ]. Improvement of the supportive care of immune-compromised patients with consequent higher survival rates, the use of effective antifungal agents against Candida spp or Aspergillus spp, new immunosuppressive therapies (e.g., chemotherapy or targeted cancer immunotherapy), higher awareness of this infection, and the availability of better diagnostic tools might have contributed to the rising incidence of invasive mucormycosis in the aforementioned at-risk patients [ 2 - 4 , 11 ].…”

“…Overall prognosis of mucormycosis remains remarkably poor, with an associated mortality rate of up to 80%, depending on the underlying conditions and presentation [ 1 , 4 , 6 , 10 , 11 ]. Delays in the clinical recognition of infection together with its aggressive nature and difficult management are important factors for the reported poor outcomes [ 4 , 5 , 12 - 14 ].…”