Mucormycosis in Iran: a systematic review

Abstract

Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.

Cutaneous mucormycosis in an acute lymphoblastic leukemia child during bone marrow suppression: A case report

“…Risk factors of mucormycosis infection include diabetes, acidosis, malignancy, organ transplantation, granulocyte deficiency, glucocorticoid use, AIDS, trauma, malnutrition, and usage of deferoxamine [6,[12][13][14]. Mucormycosis infection could also be found in patients with normal immune function, especially those with trauma or skin damage [15].…”

Rhinocerebral Mucormycosis: Clinical Outcome, Diagnosis, Treatment – Review of the Literature

“…The most common form is the rhinocerebral one [3,[8][9][10] and it is found in 44-49% of all detected zygomycosis. Retrospective analysis of 98 cases made by Vaezi et al [11] showed that rhinocerebral form, characterized by the highest mortality rate was detected most frequently in the gathered data (about 48.9% of all clinical subtypes of rhinocerebral zygomycosis). For comparison: the sinonasal -7.1% and sinonasaloorbital -6.1% forms were not often found.…”

“…At least 25% is a group with severe trauma [13]. Vaezi et al [11] also indicates that diabetes is the most common predisposing factor (47.9%), while the second one are organ or bone marrow diseases -22.4%. Different statistics were presented by ECMM study group.…”

“…Mortality rate of mucormycosis is very high, estimated at 40.8-50% [11,16], while some fungal forms are associated with even a one hundred percent mortality rate [13]. The very high risk of death is related with the rhinocerebral form estimated at even 62.5% [7].…”

Diagnostic difficulty identifying Apophysomyces trapeziformis septic arthritis in a patient with multiple myeloma

“…These infections can be quite devastating, causing complications such as tissue necrosis and necrotizing fasciitis, especially in immunocompromised individuals (Neblett Fanfair et al , 2012). There is substantial morbidity and mortality associated with these infections (Vaezi et al , 2016). …”