Characteristics of pulmonary mucormycosis and predictive risk factors for the outcome

Abstract

Purpose: Little is known about risk factors for the outcome of pulmonary mucormycosis. We summarized characteristics of this rare disease, and systemically explored risk factors for the outcome.

Methods: Ninety-two patients with pulmonary mucormycosis, including 12 patients at Peking Union Medical College Hospital and 80 patients published in 62 articles between 2006 and 2016, were retrospectively analyzed.

Results: The median age was 47.5 years, and the male to female ratio was 2.8:1. Hematological disorders, diabetes mellitus, renal insufficiency and organ transplantation were main underlying conditions. Twelve percent of patients had no underlying diseases. A predilection for involvement of upper lobes was noted, and thick-walled cavity was described in 37.0% of patients on chest computed tomography. Most of the patients were diagnosed by microscopic analysis (95.7%), mainly histopathology; and only a minority were diagnosed by culture of sterile materials (28.3%). The overall mortality rate was 30.4%. Four independent determinants were associated with a better prognosis: hemoptysis (adjusted OR 7.910; 95% CI 1.411-44.342), chronic onset (adjusted OR 25.269, 95% CI 1.654-385.993), treated with medicine (adjusted OR 53.896, 95% CI 3.072-945.561), and treated with surgery (adjusted OR 5.983, 95% CI 1.497-23.918).

Conclusions: Pulmonary mucormycosis is a rare infection with a high mortality. Invasive approach for histopathology and culture are crucial for a definite diagnosis. Acute onset patients had a poorer prognosis, and early treatment with antifungal therapy is imperative. Surgical approach is recommended in appropriate patients for a better outcome.

Keywords: Amphotericin B; Computed tomography; Lung; Mucormycosis; Surgery.