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Case Reports
. 2022 Feb;187(1):1-14.
doi: 10.1007/s11046-021-00607-4. Epub 2021 Dec 2.

Mucormycosis in Mainland China: A Systematic Review of Case Reports

Lin-Wei Wei  1   2   3   4 , Pei-Qiu Zhu  1   2   3   4 , Xiao-Qing Chen  1   2   3   4 , Jin Yu  5   6   7   8
Affiliations
Case Reports

Mucormycosis in Mainland China: A Systematic Review of Case Reports

Lin-Wei Wei et al. Mycopathologia. 2022 Feb.

Abstract

Background: Mucormycosis is a lethal fungal infection with increasing incidence. The epidemiology of mucormycosis in current mainland China has not been fully elucidated.

Objectives: To investigate the epidemiology, risk factors, manifestations, diagnosis, treatment and prognosis of mucormycosis in mainland China.

Methods: We searched for published mucormycosis case reports/series in mainland China in the PubMed, WanFang and China National Knowledge Infrastructure databases from January 2001 to July 2020. Cases of proven/probable mucormycosis were included.

Results: A total of 390 cases were included in this review. Most of the patients were male (61.3%), and diabetes was the most common predisposing factor (37.2%). Pulmonary mucormycosis (42.1%) was the most common form followed by cutaneous infection (21.0%). Of 390 patients, 24 died before therapy. Among the remaining 366 patients, 208 (56.8%) received antifungal drugs alone, 16 (4.4%) received surgery alone, and 142 (38.8%) received a combination of drugs and surgery, the mortality of the last group is much lower (34/142, 23.9%). The overall mortality was 37.2%. A multivariate analysis indicated that factors associated with increased mortality included corticosteroid use alone as immunosuppressive therapy, rhino-orbito-cerebral or disseminated mucormycosis (compared with pulmonary mucormycosis), and drug administration other than amphotericin B (AmB), posaconazole (POS) and itraconazole (ITR) (compared with the use of conventional AmB), while factors associated with decreased mortality included cutaneous mucormycosis and surgical therapy. Combination or sequential antifungal therapy of AmB and POS or ITR did not reduce mortality compared with conventional AmB monotherapy.

Conclusion: In mainland China, mucormycosis is a serious fungal infection with high mortality. Corticosteroid use, rhino-orbito-cerebral and disseminated mucormycosis were adverse prognostic factors. Antifungal therapy combined with surgery could improve the prognosis.

Keywords: Epidemiology; Mainland China; Mucormycosis; Systematic review; Treatment.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection. Abbreviations: CNKI, China National Knowledge Infrastructure
Fig. 2
Fig. 2
Number of published cases of mucormycosis in mainland China in each age group and corresponding mortality. Fisher's exact test: p = 0.544
Fig. 3
Fig. 3
Associations between predisposing factors and disease manifestations of mucormycosis in mainland China
Fig. 4
Fig. 4
Percentage of patients with mucormycosis in mainland China who received antifungal therapy and surgery and patients who died before treatment between 2001 and 2020
Fig. 5
Fig. 5
Proportion of antifungal drugs used in cases of mucormycosis in mainland China between 2001 and 2020
See this image and copyright information in PMC

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