Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021)

Ilad Alavi  Darazam; Abdolreza  Babamahmoodi; Mohammad Javad  Ebrahimi; Maral  Moafi; Nader Akbari  Dilmaghani; Masoud  Mardani; Shervin  Shokouhi; Farid Javandoust  Gharehbagh; Elmira Mahmoudi  Chalmiani; Meinoosh  Shabani; Farahnaz  Bidari; Elena  Jamali; Shahrokh  Khoshsirat; Mansoor  Shahriari; Shahram  Sabeti; Zahra  Rahmani; Seyed Ali  Mousavinejad; Kaveh  Ebrahimzadeh; Mohammad  Hallajnejad

doi:10.18502/ijph.v52i11.14046

Ilad Alavi Darazam Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Scienc-es, Tehran, Iran
Abdolreza Babamahmoodi Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Javad Ebrahimi Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Maral Moafi Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Nader Akbari Dilmaghani Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sci-ences, Tehran, Iran
Masoud Mardani Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Scienc-es, Tehran, Iran
Shervin Shokouhi Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Scienc-es, Tehran, Iran
Farid Javandoust Gharehbagh Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Elmira Mahmoudi Chalmiani Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Scienc-es, Tehran, Iran
Meinoosh Shabani Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Scienc-es, Tehran, Iran
Farahnaz Bidari Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Elena Jamali Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahrokh Khoshsirat Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sci-ences, Tehran, Iran
Mansoor Shahriari Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahram Sabeti Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Zahra Rahmani Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sci-ences, Tehran, Iran
Seyed Ali Mousavinejad Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Kaveh Ebrahimzadeh Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Hallajnejad Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijph.v52i11.14046

Keywords: Mucormycosis; Epidemiology; Diabetes mellitus; Corticosteroids; COVID-19

Abstract

Background: Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection

Methods: In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran

Results: The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era.

Conclusion: The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased.