Global Cutaneous Mucormycosis: A Systematic Review

Area of Science:

• Mycology
• Infectious Diseases
• Dermatology

Background:

• Cutaneous mucormycosis is the third most frequent clinical form of mucormycosis.
• Early diagnosis is crucial for improved patient outcomes.
• Understanding epidemiology, presentation, diagnosis, and treatment is vital.

Purpose of the Study:

• To systematically review the epidemiology, clinical presentation, diagnosis, and treatment of cutaneous mucormycosis.
• To analyze cases published between 1958 and 2021.
• To identify trends and risk factors associated with the disease.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Inclusion of 693 cases from 485 articles across 46 countries.
• Data analysis of publication dates, geographical distribution, risk factors, transmission, clinical presentation, causative agents, and treatment outcomes.

Main Results:

• Most cases originated from North America and Asia.
• Diabetes mellitus and hematological malignancies were common risk factors, but 39.6% had no identified underlying disease.
• Trauma was the most frequent transmission route (54%), with 15.6% being healthcare-associated.
• Rhizopus spp. was prevalent in the Americas and Europe, while Apophysomyces spp. predominated in Asia.
• Combined antifungal (primarily amphotericin B) and surgical treatment resulted in significantly lower mortality (29.6%).

Conclusions:

• Cutaneous mucormycosis presents diverse clinical features and risk factors.
• Geographical variations exist in the predominant fungal genera.
• A multimodal treatment approach combining antifungals and surgery is associated with improved survival rates.