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

Abstract

Background and Purpose: Prevalence of mucormycosis is growing with the increase of the population at risk. Current recommendations for its management are mostly based on retrospective studies. 3 study aimed to present the cumulative experience of an Infectious Diseases Department from a Portuguese hospital in the management of mucormycosis and discuss the potential gaps in the diagnostic and therapeutic approaches of this infection.
 Materials and Methods: For the purposes of the study, the electronic hospital database was searched for adult patients with mucormycosis from 1996 to 2019 based on the definition provided by the Consensus Definitions of Invasive Fungal Disease. Demographic, clinical, treatment, and outcome data were collected and compared to what had been described in the related literature.
 Results: In total, 15 cases of mucormycosis were found, including 11 cases with sinus involvement (10 with central nervous system involvement), two pulmonary, and two gastrointestinal infections. Diabetes mellitus (n=7) and corticosteroid therapy (n=7) were frequent risk factors. Median duration of symptoms before the suspicion of diagnosis was 26 days (3-158). The diagnosis was confirmed in 12 patients mostly by histopathology (n=9); the culture was positive only once. Systemic antifungals and surgical debridement were the backbones of treatment; however, side effects, the need for therapeutic drug monitoring, and the anatomical location of lesions added complexity to management. Overall, seven patients died, two of them before the consideration of clinical suspicion.
 Conclusion: More medications are becoming available for the treatment of mucormycosis. Nevertheless, we believe that its prognosis will only significantly change through the increase of awareness and reduction of the time to diagnosis. An effective multidisciplinary approach among surgeons, infectious diseases specialists, radiologists, microbiologists, and anatomopathologists is critical to the achievement of this goal.

Clinical Manifestations of Pulmonary Mucormycosis in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation: A 21-Case Series Report and Literature Review

“…A previous study confirmed the value of quantitative polymerase chain reaction (qPCR) in BAL regarding earlier diagnosis in cases of PM [ 34 ]. Many ongoing studies focusing on noninvasive methods, such as qPCR for the detection of circulating deoxyribonucleic acid (DNA) in blood (plasma or serum) or urine, are beginning to show the value of early diagnosis and early treatment [ 35 , 36 ].…”

Cutaneous mucormycosis in a young immunocompetent trauma patient: a case report

“…NF can be a monomicrobial or polymicrobial disease. The most common etiological agents are bacteria such as Streptococcus pyogenes, however it can also be caused by fungi like those of the Mucorales order [3][4][5] . urine, leading to the added diagnosis of pneumonia and urinary tract infection.…”

“…Ceftazidime was stopped, and meropenem, clindamycin and vancomycin were initiated as prevention against methicillin-resistant S. aureus (MRSA) and gram-negative agents. We were not able to control the infection with medical They cause a rare and opportunistic fungal infection, named primary cutaneous mucormycosis [4,5] . Mucormycosis mostly affects immunocompromised hosts, and produces serious lesions with cutaneous necrosis, thrombosis and vascular invasion leading to systemic infection and a poor prognosis [4,5] .…”

“…We were not able to control the infection with medical They cause a rare and opportunistic fungal infection, named primary cutaneous mucormycosis [4,5] . Mucormycosis mostly affects immunocompromised hosts, and produces serious lesions with cutaneous necrosis, thrombosis and vascular invasion leading to systemic infection and a poor prognosis [4,5] . Tissue examination by histopathology and culture confirms the fungal infection [4,5] .…”

“…Mucormycosis mostly affects immunocompromised hosts, and produces serious lesions with cutaneous necrosis, thrombosis and vascular invasion leading to systemic infection and a poor prognosis [4,5] . Tissue examination by histopathology and culture confirms the fungal infection [4,5] . Treatment includes antifungal therapies and surgical debridement [4,5] .…”