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. 2023 Aug 3;9(8):824.
doi: 10.3390/jof9080824.

Mucormycosis: A 14-Year Retrospective Study from a Tertiary Care Center in Lebanon

Fatima Allaw  1 , Johnny Zakhour  1 , Sarah B Nahhal  1 , Karim Koussa  2 , Elio R Bitar  2 , Anthony Ghanem  3 , Martine Elbejjani  4 , Souha S Kanj  1   5
Affiliations

Mucormycosis: A 14-Year Retrospective Study from a Tertiary Care Center in Lebanon

Fatima Allaw et al. J Fungi (Basel). .

Abstract

Mucormycosis (MCM) is a serious invasive fungal disease (IFD) that is associated with high mortality, particularly in immunocompromised patients. A global surge in MCM cases was reported with the COVID-19 pandemic. We analyzed all recorded cases of MCM at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon, over 14 years. We aimed to identify the incidence, seasonal variation, clinical characteristics of the patients, and predictors of mortality. We conducted a retrospective chart review between 1 January 2008 and 1 January 2023. All patients with proven or probable MCM were included in the study. Proven or probable MCM was defined by positive histopathology and/or positive cultures. A total of 43 patients were identified as having MCM. Their median age was 53 years, and the majority were males (58.1%). Most of the cases were diagnosed in the autumn season. In total, 67.4% of the patients had hematological malignancies (HMs), and 34.9% had uncontrolled diabetes mellitus (DM). The most common site of involvement was rhino-orbital-cerebral MCM (ROCM) (74%). The annual cases of MCM per 100,000 patient days increased markedly during the years of the COVID-19 pandemic (from 0 to 4.4 cases/100,000 patient days to 7.5 cases/100,000 during 2020 and 2021). Liposomal amphotericin (Ampho) B was used as a first-line agent in most of the patients (86%). The median duration of total in-hospital antifungal therapy was 21 days and 51.2% of the patients received step-down therapy with azoles. Surgical debridement and isolated ROCM were significantly associated with survival (p-value: 0.02 and <0.001, respectively). All-cause mortality was 46.7%, with chronic renal disease being significantly associated with mortality (p-value < 0.05). The incidence of MCM has been increasing at our institution, particularly since the COVID-19 pandemic. Early diagnosis, treatment, and surgical debridement improve patient outcomes and overall survival.

Keywords: COVID-19; Lebanon; amphotericin B; diabetes mellitus; hematological malignancy; mucormycosis; rhino-orbital-cerebral mucormycosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Annual cases of mucormycosis per 100,000 patient days.
Figure 2
Figure 2
Monthly distribution of mucormycosis cases.
Figure 3
Figure 3
Kaplan–Meier survival plot for time from diagnosis to mortality according to surgery status.
See this image and copyright information in PMC

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