Pulmonary Mucormycosis

Abstract

Pulmonary mucormycosis is relatively uncommon but an important opportunistic fungal infection in immunocompromised persons. The literature on the subject is sparse. We describe a recent case and review the literature to delineate the clinical characteristics of this infection. We searched the MEDLINE database for articles published in the English-language literature since 1970 and carefully analyzed 87 cases. The main risk factors were diabetes mellitus, hematologic cancers, renal insufficiency, and organ transplantation. Several patients had no apparent immune compromise. There was a predilection for involvement of the upper lobes. Air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. Fiberoptic bronchoscopy was a useful diagnostic method, and histopathologic examination was more sensitive than fungal cultures. The overall survival rate was 44%. Patients treated with a combined medical-surgical approach had a better outcome than patients who did not undergo surgery. Thus, this relatively rare but often fatal disease should be suspected in immunocompromised patients who fail to respond to antibacterial therapy. Early recognition and aggressive management are warranted to maximize chances for cure. Optimal therapy requires systemic antifungal therapy, surgical resection, and, when possible, control of the patient's underlying disease.

A Case of Pulmonary Mucormycosis Presenting with Endobronchial Involvement

“…Donahue et al (15) reported that there was susceptibility to endobronchial involvement in patients with diabetes. In a review conducted, it was reported that 85% of patients with endobronchial involvement had diabetes, as in our case (12). Hemoptysis is seen more in mucormycosis than bacterial pneumonias.…”

“…The most common causes of delayed diagnosis are the simultaneous existence of viral or bacterial infections, not suspecting the disease, and difficulty of reproduction of fungi with conventional techniques (6). While the most frequent pre-mortem diagnosis is made by bronchoscopy, the most common technique is transbronchial biopsy (12). Since there was also endobronchial involvement in our case, a mucosa biopsy was conducted.…”

“…The most important underlying disease in patients with mucormycosis is diabetes, since it reproduces in an acidic and glucose-rich medium (11). In the three large reviews published over the last 20 years, the most important underlying diseases in patients having received pulmonary mucormycosis were reported as diabetes mellitus (32%-56%) and hematologic malignancy (32%-37%) (6,12,13). It was reported that the majority of the patients with diabetes had type 2 diabetes (80%) and that there was a clinical picture of documented ketoacidosis in 48% of the patients with type 1 diabetes and 34% of the patients with type 2 diabetes (13).…”

Pulmonary Mucormycosis in the Setting of Chronic Obstructive Pulmonary Disease

“…Bronchoscopy is the most common method used to obtain tissue; about 40% of patients with this condition will have visible endobronchial lesions which may be biopsied [4]. Histopathological examination of infected tissue will reveal broad nonseptate hyphae with right angle branching that is more sensitive than culture (sensitivity of 93 vs. 49%) [4]. As mucorales may be a contaminant, the clinical significance of isolating the organism from sputum and bronchoalveolar lavage is problematic [5].…”

“…The overall outcome is poor, with overall survival about 44% [4]. When diagnosed early, there may be a higher potential for cure.…”