Unveiling mucormycosis in Brazil: Analysis of 298 cases using amphotericin B distribution data

Since mucormycosis is not a notifiable disease in Brazil, its true incidence is likely underestimated; this study aims to assess its prevalence and characterize its epidemiological, clinical, and laboratory features.

We conducted a retrospective observational study of patients with mucormycosis treated with lipid amphotericin B (AmB) across 156 public healthcare centers in Brazil from 2017 to 2023, using Ministry of Health data.

There were 305 AmB distributions for 298 patients: 230 (75 %) lipid complex (ABLC) and 75 (25 %) liposomal formulations (LAmB). The highest number of distributions occurred in 2021 (80/298, 27 %). The median age was 52 years (IQR 33-63), with 65 % male patients. The main comorbidity was diabetes mellitus (42 %), followed by oncohematologic conditions (25 %). Most cases presented with the rhinocerebral (ROC) form (66 %), followed by pulmonary (15 %) and gastrointestinal (5 %). The ROC form predominated among patients with diabetes and COVID-19 (>80 %), while the pulmonary form was more common in solid-organ transplant and HSCT patients (33 % and 27 %, respectively). Histopathology established the diagnosis in 64 % of cases, with Rhizopus spp. causing the majority of infections (31/53, 58 %). The mean AmB dose was 5 mg/kg/day (IQR 1-10.8). Patients with gastrointestinal forms were significantly younger (p = 0.007), and AmB doses did not differ significantly across clinical forms (p = 0.3).

This study details the Brazilian mucormycosis patient profile, highlighting predominant diabetes-associated cases, the shift from ABLC to LAmB use after 2021, the predominance of the ROC form, pulmonary involvement in immunosuppressed patients, and regional diagnostic disparities.