Rhinocerebral mucormycosis in Taiwan

To understand the demographic as well as clinical characteristics, and outcomes of patients with rhinocerebral mucormycosis in Taiwan, we retrospectively analyzed patients with this disease admitted to Chang Gung Memorial Hospital-Kaohsiung from 1988 through 2000. The 21 patients included 8 men (28%) and 13 women (62%). The median age was 60 years (range, 34-82 years). Twenty patients (95%) had underlying diabetes mellitus. The most common clinical feature at admission was ocular lesions, followed by headache, nostril lesions, and consciousness disturbance. Fifteen (94%) of 16 patients who received combined surgical debridement and therapy with amphotericin B survived, while only 1 (20%) of the 5 patients who received amphotericin B alone survived (p=0.004). The diagnosis of rhinocerebral mucormycosis was delayed in 4 patients (19%). Of the 16 patients who survived, 1 (6%) had delayed diagnosis, while of the 5 patients who died, 3 (60%) had delayed diagnoses (p=0.028). This series disclosed a higher proportion of patients with rhinocerebral mucormycosis in Taiwan had underlying diabetes mellitus, and ocular lesions were more frequent than nostril lesions at the time of admission. These results highlight the importance of the timely initiation of a combination of aggressive surgical debridement and treatment with amphotericin B in patients with rhinocerebral mucormycosis. Considering the high rate of delayed diagnosis, improved clinician's awareness of mucormycosis is extremely important and is in urgent need in Taiwan.