Mucormycosis in renal transplant recipients: predictors and outcome

Abstract

Mucormycosis, though uncommon, is associated with high mortality in transplant recipients. This study was conducted to assess the incidence and risk factors associated with mucor infection and its outcome. We retrospectively reviewed the hospital records for evidence of mucor infection in patients transplanted between January 2005 and December 2009 at the Department of Nephrology and Clinical Transplantation (IKDRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India. The patient demographics, symptoms, diagnostic techniques and outcomes were analyzed. Out of a total of 1,330 transplants, 16 patients (1.20%) had evidence of mucor infection, including 14 males and two females. The mean age of the patients was 43.8 years. The time interval between transplantation and disease onset varied greatly (range: 1 month to 7 years; median 13.8 months). The presenting symptoms were fever (87.5%), severe headache (56.2%), facial swelling (56.2%), watering of eyes (56.2%), cough (31.2%), respiratory distress (18.7%) and pain abdomen (12.5%). Suspected patients were evaluated by computerized tomographic (CT) scan/magnetic resonance imaging (MRI), bronchoalveolar lavage (BAL) and biopsy, and the diagnosis was confirmed by culture. Of the 16 patients studied, nine had rhinocerebral mucormycosis, five had pulmonary mucormycosis and one case each had infection at the graft anastmosis site and disseminated mucormycosis. Early and intensive treatment with liposomal amphotericin-B was instituted in all patients, and extensive debridement was performed in addition in 11 cases, and one patient was subjected to graft nephrectomy; 10 patients (62.5%) survived. Our study suggests that rhinocerebral is the most frequent site of mucormycosis and it can occur very early or late in the post-transplant period. Early diagnosis and combined surgical debridement and parenteral liposomal amphotericin-B along with reduction of immunosuppression improve the patient survival.