Mucormycosis—A clinicoepidemiological review of cases over 10 years

Abstract

Summary Background Limited data exist for epidemiology and outcomes of various agents causing mucormycosis in various clinical settings from developing countries like India. Objectives To study the epidemiology and outcomes of various agents causing mucormycosis in different clinical settings in a tertiary care hospital from South India. Patients and methods We reviewed details of 184 consecutive patients with culture‐proven mucormycosis with consistent clinical syndrome and supporting features from September 2005 to September 2015. Results The mean age of patients was 50.42 years; 70.97% were male. Unlike developed countries, R microsporus (29/184; 15.7%) and Apophysomyces elegans (20/184; 10.8%) also evolved as important pathogens in addition to R arrhizus in our setting. Paranasal sinuses (136/184; 73.9%) followed by musculoskeletal system (28/184; 15.2%) were the common areas of involvement. Apophysomyces elegans typically produced skin and musculoskeletal disease in immune‐competent individuals with trauma (12/20; 60%) and caused significantly lower mortality (P = 0.03). R microsporus was more common in patients with haematological conditions (25% vs 15.7%) and was less frequently a cause for sinusitis than R arrhizus (27.58% vs 10.9%). The overall mortality was 30.97%. Combination therapy with surgery and antifungals offered the best chance for cure. Conclusions Agents causing mucormycosis may have unique clinical and epidemiological characteristics.

Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019

“…Probability of overall survival in IM patients was 0.50 ± 0.11. This is a much better result than the results from studies performed a decade ago [5,16,17] and is comparable with recent reports [6,7,18]. Still, the outcome is much worse than in immunosuppressed patients infected with invasive aspergillosis or invasive candidiasis.…”

“…Mucormycetes (previously: Zygomycetes; recently proposed: Entomophthorales [4]) organisms are highly aggressive, filamentous, ubiquitous, fast-growing, broad aseptate fungi, which are unique among filamentous fungi because of their disproportionately high capacity to cause devastating disease in patients regardless of underlying conditions [5,6].…”

“…The activity of Mucormycetes is characterized by angioinvasion and tissue invasion, which leads to a rapid and progressive infection. The clinical presentations are pulmonary, gastrointestinal, soft tissue, paranasal (sino-orbital), and cerebral mucormycoses, with possible evolution into disseminated disease [6,7].…”

Epidemiology and Diagnosis of Mucormycosis: An Update

“…In contrast, the percentages from the European ECMM study were 17% [14], from Italy 18% [27], from France 23% [10] and from Lebanon 35% [31]. In the Indian publications, mucormycosis was the unmasking disease for diabetes mellitus in 12-31% of patients [5,11,22,38].…”

Mucormycosis Following Tooth Extraction in a Diabetic Patient: A Case Report

“…Treatment is based on systemic administration of amphotericin B and local irrigation, along with surgical debridement of necrotic tissue and the control of diabetes levels [16][17][18].…”