Mucormycosis: Literature review and retrospective report of 15 cases from Portugal

Beatriz   Prista-Leao; Isabel   Abreu; Ana   Claudia Carvalho; Antonio   Sarmento; Lurdes   Santos

doi:10.18502/cmm.6.4.5437

Beatriz Prista-Leao Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
Isabel Abreu Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
Ana Claudia Carvalho Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
Antonio Sarmento Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
Lurdes Santos Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal

DOI: https://doi.org/10.18502/cmm.6.4.5437

Keywords: Immunosuppression Invasive fungal infections Mucormycosis

Abstract

Background and Purpose: Prevalence of mucormycosis is growing with the increase of the population at risk. Current recommendations for its management are mostly based on retrospective studies. 3 study aimed to present the cumulative experience of an Infectious Diseases Department from a Portuguese hospital in the management of mucormycosis and discuss the potential gaps in the diagnostic and therapeutic approaches of this infection.

Materials and Methods: For the purposes of the study, the electronic hospital database was searched for adult patients with mucormycosis from 1996 to 2019 based on the definition provided by the Consensus Definitions of Invasive Fungal Disease. Demographic, clinical, treatment, and outcome data were collected and compared to what had been described in the related literature.

Results: In total, 15 cases of mucormycosis were found, including 11 cases with sinus involvement (10 with central nervous system involvement), two pulmonary, and two gastrointestinal infections. Diabetes mellitus (n=7) and corticosteroid therapy (n=7) were frequent risk factors. Median duration of symptoms before the suspicion of diagnosis was 26 days (3-158). The diagnosis was confirmed in 12 patients mostly by histopathology (n=9); the culture was positive only once. Systemic antifungals and surgical debridement were the backbones of treatment; however, side effects, the need for therapeutic drug monitoring, and the anatomical location of lesions added complexity to management. Overall, seven patients died, two of them before the consideration of clinical suspicion.

Conclusion: More medications are becoming available for the treatment of mucormycosis. Nevertheless, we believe that its prognosis will only significantly change through the increase of awareness and reduction of the time to diagnosis. An effective multidisciplinary approach among surgeons, infectious diseases specialists, radiologists, microbiologists, and anatomopathologists is critical to the achievement of this goal.