Ten-Year Experience on 601 Patients with Mucormycosis at Eight Tertiary Care Centers in Iran

Mucormycosis is a rare, destructive, and life-threatening angio-invasive fungal infection caused by fungi of the order Mucorales. This study highlights the urgent need for more extensive research in this regard. We aimed to assess the epidemiology of mucormycosis at eight tertiary-care centers in Iran over ten years (2010-2020).

In the current retrospective study, eligible patients were included based on positive histopathology and direct microscopy by potassium hydroxide (KOH). Data collection started on July 26, 2021, and included data from February 15, 2010, to May 16, 2020.

Diabetes mellitus was the chief underlying condition related to mucormycosis. Rhino-cerebral, rhino-sino, and rhino-sino-orbital infections were observed in 53.2%, 23.8%, and 23% of these patients. Among the 108 cases with a culture, Rhizopus species were the most prevalent, followed by Mucor species. Over half of the patients received surgery/antifungal treatment, with an overall antifungal prescribing rate of 66.7% of patients within the study period. However, surgery was associated with better clinical outcomes than surgery/antifungal treatment. The antifungals prescribed were mainly amphotericin B, posaconazole, and amphotericin-posaconazole. Most patients with mucormycosis infection were admitted in the summer. Overall mortality in the identified cases was 30.6%, with the highest mortality rate in patients diagnosed with pulmonary infection.

The current study is the largest single-country retrospective study on the topic, with 601 mucormycosis cases. It may uncover gaps in knowledge, develop recommendations for future studies, and clarify the clinical and epidemiological aspects of mucormycosis. However, future studies and clarification of mucormycosis's clinical and epidemiological aspects are highly recommended.