Impact of risk factors in craniofacial mucormycosis

Abstract

Background: Craniofacial mucormycosis is a highly lethal infectious disease. This study aims to assess and analyze multiple variables, including clinical, socioeconomic, and biochemical markers, to identify and examine risk factors for mortality associated with this mycotic infection.

Material and methods: A retrospective analysis was conducted on 38 patients who sought medical attention at the Otolaryngology and Head and Neck Surgery Division of a tertiary-level hospital in Monterrey, Mexico. A broad range of variables was analyzed: clinical features, including the extent of mucormycosis infection; socioeconomic factors such as monthly income, marital status, geographical residence, educational level, and insurance status; as well as biochemical markers, including glucose levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and immune cell counts, specifically neutrophils (NEU) and lymphocytes (LYM). Statistical analysis was conducted using SPSS v26. Risk factors for mortality were evaluated using Cox regression. Overall survival (OS) was assessed with the Kaplan-Meier method. The Fisher's exact test and the Chi-square test were used for categorical variables. For median comparisons, the Student's t-test and Mann-Whitney U test were applied; with normality assessed using the Shapiro-Wilk test. A p-value <0.05 was considered statistically significant.

Results: Mucormycosis was associated with higher mortality in men (p=0.032). The disease primarily affected the paranasal sinuses (p=0.021) and was associated with increased mortality when involving the orbit (p=0.035). Additionally, compromised lymphocyte counts (LYM) (p=0.034) and lower educational levels (p=0.009) were associated with higher mortality. Individuals residing in rural areas also exhibited an elevated risk of mortality (p =0.023).

Conclusions: Prevention strategies should focus on high-risk groups to reduce the mortality rate of craniofacial mucormycosis, particularly targeting men and individuals residing in rural areas. Special emphasis should be placed on those without education or health insurance. Early diagnosis and appropriate management are crucial for improving outcomes.

Figure 1

(Left) Purplish mucous lesion of left hemipalate with necrosis; (Right) Coronal section of MRI demonstrating involvement of mucormycosis infection of left ethmoid sinus, lateral wall of nose, maxillary sinus, floor and medial wall of the left orbit.

Figure 2

(Left) Histopathological image showing lymphocytes and epithelioid cells conforming a granuloma with a non-septate hypha in its center. PAS 40x. (Right) Necrotic tissue associated to a non-septate, irregular, thick hyphae. PAS 40x.