Delaying diagnostic procedure significantly increases mortality in patients with invasive mucormycosis

Abstract

Summary Invasive mucormycosis is an uncommon but increasing life‐threatening fungal infection. The present study investigated clinical characteristics and mortality among patients diagnosed as invasive mucormycosis infection. We retrospectively reviewed a total of 24 histologically proven cases of invasive mucormycosis at two tertiary care referral hospitals between November 2005 and February 2014. Overall survival was 50% (n = 12). The time between onset of symptom and diagnostic procedure proved to be associated with mortality (P = 0.009). In addition, preexisting renal failure and thrombocytopenia demonstrated trends toward a poor outcome in our study (P = 0.089 and 0.065, respectively). On multivariate regression analysis, delayed diagnostic procedure (more than 16 days after the onset of symptoms) was an independent predictor of mortality (OR= 12.34, 95% CI, 1.43–10.64; P = 0.022). Mucormycosis is a destructive fungal infection that is associated with high mortality rates, ranging from 40% to 100% depending on the form of disease. When a clinician suspects invasive mucormycosis infection, an early diagnostic procedure performed within 16 days from the onset of symptom and early initiation of antifungal therapy will lead to successful management of this highly fatal disease.

The cost-effectiveness of isavuconazole compared to the standard of care in the treatment of patients with invasive fungal infection prior to differential pathogen diagnosis in the United Kingdom

“…For example, IA and mucormycosis disease progression is rapid and, particularly with disseminated infection, often results in death 6,7 , with mortality rates ranging from 88-100% 6,8 . Furthermore, mortality rates for IA and mucormycosis can increase by at least 2-fold if antifungal coverage is delayed by 6-10 days 9,10 . Management of IA and mucormycosis is also associated with lengthy hospital stays 11,12 , which further increases the clinical and economic burden on patients and healthcare institutions, respectively.…”

Comparative genome-wide analysis of extracellular small RNAs from the mucormycosis pathogen Rhizopus delemar

“…The signs and symptoms of mucormycosis are non-specific and definitive diagnosis requires direct examination of specimens and culturing of the organism. These processes are time-consuming and limited in sensitivity 8 , 9 . The resulting delay in diagnosis and implementation of effective treatment during a critical window of time contributes to the high rate of tragic mucormycosis mortalities and underscores the urgent need for a rapid, sensitive diagnostic method.…”

Phylogenetic analysis reveals two genotypes of the emerging fungus Mucor indicus, an opportunistic human pathogen in immunocompromised patients

“…The time between the onset of symptoms and diagnostic procedures has been shown to be associated with the likelihood of mortality. 28 The most likely portal of entry in the present patient was the lung. CT features of pulmonary mucormycosis in solid-organ transplant recipients include consolidation or mass-like lesions, nodules, or cavities in approximately 25% of patients.…”