Decreased Natural Killer Cells in Mucormycosis

Mucormycosis is an invasive fungal infection associated with high morbidity and mortality rates. Previous in vitro studies have demonstrated functional abnormalities in natural killer (NK) cells; however, it remains unclear whether circulating NK cell counts are altered in affected patients.

To assess baseline NK cell counts and explore their clinical associations in patients with mucormycosis treated at a tertiary referral hospital in Mexico City.

We conducted a cross-sectional analytical study of hospitalized patients with active mucormycosis, as confirmed by direct tissue examination and culture, at the Hospital de Especialidades, Centro Médico Nacional Siglo XXI. From 2019-2024, we performed peripheral blood immunophenotyping and obtained sociodemographic, clinical, and biochemical data. Non-parametric tests were used to compare NK cell counts across clinical subgroups.

We included 34 patients (59% male; median age, 59 years). Rhino-orbital-cerebral mucormycosis was the most frequent presentation. The most common comorbidities were diabetes (85.3%), hypertension (64.7%), and chronic kidney disease (8.8%). Poor glycemic control (79.4%), prior corticosteroid use (38.2%), previous COVID-19 infection (26.5%), and solid cancer (5.9%) were the main risk factors. Compared with the reference range patients showed reduced NK cell counts (median 0.11 [IQR, 0.05-0.24] vs. 0.15-0.43 × 10³/µL). NK cell counts were not associated with mortality or prior COVID-19 infection.

Patients with mucormycosis show decreased circulating NK cell counts, suggesting immune dysregulation. These findings describe a distinct immunologic phenotype rather than a causal or prognostic marker.