Objectives

To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality.

Methods

We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic profile, microbiology, predisposing factors, management and 90-day mortality were recorded; risk factors for mortality were analysed.

Results

We included 465 patients. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and posaconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappropriate in 7.6% (30/394) of the individuals. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival.

Conclusions

Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.

中文翻译：

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关于印度毛霉菌病的流行病学，危险因素，管理和结果的多中心观察性研究。

目标

描述毛霉菌病患者的流行病学，治疗和结果；并评估与死亡率相关的危险因素。

方法

我们进行了一项前瞻性观察研究，涉及来自印度12个中心的连续证实患有毛霉菌病的个人。记录人口统计资料，微生物学，诱发因素，管理和90天死亡率；分析了死亡的危险因素。

结果

我们纳入了465名患者。鼻眶毛霉菌病是最常见的表现（315 / 465，67.7％），其次是肺（62 / 465，13.3％），皮肤（49 / 465，10.5％）等。诱发因素包括糖尿病（342/465，73.5％），恶性肿瘤（42/465，9.0％），移植（36/465，7.7％）等。根霉菌种（231/290，79.7％）是最常见的，其次是变异阿朴藻（23/290，7.9％），以及几种稀有的毛cor鱼。62.2％（289/465）的参与者进行了手术治疗。两性霉素B是81.9％（381/465）的主要治疗方法，泊沙康唑被用作53（11.4％）个人的联合治疗。在7.6％（30/394）的个体中，抗真菌治疗是不合适的。90天死亡率为52％（242/465）。在多变量分析中，弥漫性和鼻眶（具有大脑延伸）的毛霉菌病，症状的持续时间较短，抗真菌治疗的持续时间较短以及使用两性霉素B脱氧胆酸盐（相对于脂质体）的治疗是死亡的独立危险因素。内科和外科手术相结合的治疗与更好的生存率相关。

结论

糖尿病是所有形式的毛霉菌病的主要诱因。手术和药物治疗相结合可带来更好的预后。毛霉菌病的治疗中出现了一些空白。研究中鉴定出的稀有毛霉菌有待进一步评估。