Diabetes mellitus as the major risk factor for mucormycosis in Mexico: Epidemiology, diagnosis, and outcomes of reported cases
- 20 April 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in Medical Mycology
- Vol. 56 (1), 29-43
- https://doi.org/10.1093/mmy/myx017
Abstract
Mucormycosis is an emerging infectious disease with high rates of associated mortality and morbidity. Little is known about the characteristics of mucormycosis or entomophthoromycosis occurring in Mexico. A search strategy was performed of literature published in journals found in available databases and theses published online at Universidad Nacional Autónoma de México (UNAM) library website reporting clinical cases or clinical case series of mucormycosis and entomophthoromycosis occurring in Mexico between 1982 and 2016. Among the 418 cases identified, 72% were diabetic patients, and sinusitis accounted for 75% of the reported cases. Diabetes mellitus was not a risk factor for entomophthoromycosis. Mortality rate was 51% (125/244). Rhizopus species were the most frequent isolates (59%, 148/250). Amphotericin B deoxycholate was used in 89% of cases (204/227), while surgery and antifungal management as combined treatment was used in 90% (172/191). In diabetic individuals, this combined treatment approach was associated with a higher probability of survival (95% vs 66%, OR = 0.1, 95% CI, 0.02–0.43’ P = .002). The most common complications were associated with nephrotoxicity and prolonged hospitalization due to IV antifungal therapy. An algorithm is proposed to establish an early diagnosis of rhino-orbital cerebral (ROC) mucormycosis based on standardized identification of warning signs and symptoms and performing an early direct microbiological exam and histopathological identification through a multidisciplinary medical and surgical team. In summary, diabetes mellitus was the most common risk factor for mucormycosis in Mexico; combined antifungal therapy and surgery in ROC mucormycosis significantly improved survival.Keywords
This publication has 51 references indexed in Scilit:
- A Global Analysis of Mucormycosis in France: The RetroZygo Study (2005-2007)Clinical Infectious Diseases, 2012
- Antifungal Susceptibility and Phylogeny of Opportunistic Members of the Order MucoralesJournal of Clinical Microbiology, 2012
- Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007Clinical Microbiology & Infection, 2011
- How I treat mucormycosisBlood, 2011
- Zygomycosis in Two Hematologic CasesCase Reports in Infectious Diseases, 2011
- Cutaneous zygomycosis in immunocompetent patients in MexicoMycoses, 2009
- Multifaceted Determinants for Achieving Glycemic ControlDiabetes Care, 2009
- Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus GroupClinical Infectious Diseases, 2008
- The emergence of mucormycosis as an important opportunistic fungal infection: five cases presenting to a tertiary referral center for mycologyInternational Journal of Dermatology, 2007
- RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS WITH DIFFERENT CEREBRAL INVOLVEMENTS: INFARCT, HEMORRHAGE, AND OPHTHALMOPLEGIAInternational Journal of Neuroscience, 2007