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Clin Microbiol Infect. 2019 Jan;25(1):26-34. doi: 10.1016/j.cmi.2018.07.011. Epub 2018 Jul 21.

The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports.

Author information

1
Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia.
2
Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW, Australia; Marie Bashir Institute for Biosecurity and Emerging Infections, The University of Sydney, Sydney, NSW, Australia.
3
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
4
National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.
5
Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia; Pharmacy Department, Ballarat Health Services, Ballarat, VIC, Australia; The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
6
Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW, Australia; Marie Bashir Institute for Biosecurity and Emerging Infections, The University of Sydney, Sydney, NSW, Australia. Electronic address: Sharon.Chen@health.nsw.gov.au.

Abstract

BACKGROUND:

The epidemiology of mucormycosis in the era of modern diagnostics is relatively under-explored.

OBJECTIVES:

To examine the contemporary epidemiology, clinical manifestations, diagnosis and causative pathogens of mucormycosis.

DATA SOURCES:

Ovid MEDLINE and Ovid EMBASE from January 2000 to January 2017.

STUDY ELIGIBILITY CRITERIA:

Published case reports/series of proven/probable mucormycosis.

PARTICIPANTS:

Patients ≥18 years old.

METHODS:

Patient characteristics, disease manifestations and causative pathogens were summarized descriptively. Categorical variables were assessed by chi-square test or Fischer's exact test, and continuous variables by the Wilcoxon-Mann-Whitney or Kruskal-Wallis test. Risk factors for the different clinical manifestations of mucormycosis were identified using multivariate logistic regression.

RESULTS:

Initial database searches identified 3619 articles of which 600 (851 individual patient cases) were included in the final analysis. Diabetes mellitus was the commonest underlying condition (340/851, 40%) and was an independent risk for rhino-orbital-cerebral mucormycosis (odds ratio (OR) 2.49; 95% CI 1.77-3.54; p < 0.001). Underlying haematological malignancy was associated with disseminated infection (OR 3.86; 95% CI 1.78-8.37; p 0.001), whereas previous solid organ transplantation was associated with pulmonary (OR 3.19; 95% CI 1.50-6.82; p 0.003), gastrointestinal (OR 4.47; 95% CI 1.69-11.80; p 0.003), or disseminated (OR 4.20; 95% CI 1.68-10.46; p 0.002) mucormycosis. Eight genera (24 species) of Mucorales organisms were identified in 447/851 (53%) cases, of which Rhizopus spp. (213/447, 48%) was the most common. Compared with other genera, Rhizopus spp. was predominantly observed in patients with rhino-orbital-cerebral mucormycosis (75/213, 35% versus 34/234, 15%; p < 0.001). Death was reported in 389/851 (46%) patients. Mortality associated with Cunninghamella infections was significantly higher than those caused by other Mucorales (23/30, 71% versus 185/417, 44%; p < 0.001). However, Cunninghamella spp. were isolated primarily in patients with pulmonary (17/30, 57%) or disseminated disease (10/30, 33%).

CONCLUSIONS:

Findings from the current review have helped ascertain the association between various manifestations of mucormycosis, their respective predisposing factors and causative organisms.

KEYWORDS:

Diagnosis; Epidemiology; Mucorales; Mucormycosis; Systematic review

PMID:
30036666
DOI:
10.1016/j.cmi.2018.07.011

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