A systematic review of the therapeutic outcome of mucormycosis
L Shamithra M Sigera, David W Denning- Infectious Diseases
- Oncology
Abstract
Purpose
Mucormycosis is a potentially lethal mycosis. We reviewed peer-reviewed publications on mucormycosis to assess therapeutic outcomes.
Methods
A systematic literature search using Ovid MEDLINE and EMBASE databases to identified manuscripts describing human mucormycosis diagnosed according to EORTC/MSG criteria with therapeutic outcomes published from 2000 to 2022.
Results
From126 articles 10,335 patients were described, most from Asia (n = 6632, 66%). Diabetes was the most frequent underlying disease (n = 6188, 60%); 222 (2.1%) patients had none. The dominant clinical form was rhino-orbitocerebral (n = 7159, 69.3%) followed by pulmonary (n = 1062, 10.3%). Of 5364 patients with outcome data, amphotericin B monotherapy (n = 3749, mortality 31.5%) was most frequent, amphotericin B + azole (n = 843, mortality 6.6% (p < 0.0001)), amphotericin B followed by azole (n = 357, mortality 13.7% (p < 0.0001)), posaconazole only (n = 250, mortality 17.2% (p < 0.0001)) or isavuconazole alone (n = 65, mortality 24.6% (p = 0.24)). Duration and dose of antifungals varied widely. Documented outcomes from surgical resections in 149 patients found 47 of 125 died (37.6%) compared to 16 of 24 (66.7%) patients who did not undergo surgery (p = 0.008).
Conclusion
Mucormycosis is more frequently reported in Asia than in Europe, often linked to diabetes. Antifungal therapy usually with surgery, is frequently effective for mucormycosis.