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Published on: January 12, 2019
[Clinical features and outcome in patients with mucormycosis in a tertiary hospital (2012-2016)]
Marc Xipell1, Ricardo Arturo Losno2, Carolina Garcia-Vidal1
1Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, España.
Background:
The most common presentation of mucormycosis in the past was the nasosinusal involvement in patients with diabetic ketoacidosis. However, in the last few years, new groups of patients with risk of mucormycosis have emerged.
Aims And Methods:
Retrospective analysis of the characteristics, treatment and evolution of patients with mucormycosis in a tertiary hospital in the years 2012-2016.
Results:
Of the 12 patients included in the study, 7 had a haematological disease as a predisposing factor, most of them (6 patients) related to transplantation of haematopoietic progenitors. Only one patient had diabetic ketoacidosis. Seven out of the twelve patients were receiving an antifungal treatment at the onset of symptoms, and 9 patients had received them three months before. The clinical presentation was rhinosinusal (16.6%), localised lung disease (33.3%), and musculoskeletal (25%) and disseminated disease (25%). Surgical debridement was performed on 8 patients. Combination therapy with amphotericin B and posaconazole was received by 6 patients (16% mortality), and 4 patients were treated with amphotericin B alone (50% mortality), with an overall mortality of 41%. The mortality of patients with pulmonary involvement was 71%, increasing to 100% in the case of disseminated disease. None of the patients with only musculoskeletal involvement died.
Conclusions:
Mucormycosis has a high mortality rate, especially the pulmonary forms. Musculoskeletal involvement had a better prognosis. The main group at risk was that of patients with haematopoietic stem cell transplantation. Combination therapy had better results than monotherapy, although more experience is needed to define the most appropriate treatment.
Insights
Mucormycosis is a serious fungal infection with high mortality, particularly pulmonary forms. Hematopoietic stem cell transplant patients are at high risk, and combination antifungal therapy shows promise.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Mucormycosis traditionally affected patients with diabetic ketoacidosis.
- Recent years show emerging risk groups for mucormycosis.
- Hematological diseases, particularly post-hematopoietic progenitor transplantation, are now a significant risk factor.
Purpose of the Study:
- To analyze the characteristics of mucormycosis patients.
- To evaluate treatment strategies and outcomes.
- To assess the evolution of mucormycosis in a tertiary hospital from 2012-2016.
Main Methods:
- Retrospective analysis of 12 mucormycosis patients.
- Review of patient demographics, predisposing factors, clinical presentation, and treatments.
- Assessment of treatment efficacy and mortality rates.
Main Results:
- Hematopoietic stem cell transplantation was the primary risk factor (6/7 patients).
- Clinical presentations included rhinosinusitis, pulmonary, musculoskeletal, and disseminated disease.
- Combination therapy (amphotericin B and posaconazole) showed lower mortality (16%) compared to monotherapy (50%).
- Overall mortality was 41%, with pulmonary (71%) and disseminated (100%) forms being most fatal.
Conclusions:
- Mucormycosis carries a high mortality rate, especially pulmonary and disseminated forms.
- Musculoskeletal mucormycosis demonstrated a better prognosis.
- Hematopoietic stem cell transplant recipients represent a key at-risk population.
- Combination antifungal therapy appears more effective than monotherapy, warranting further investigation.
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