title: [Mucormycosis: retrospective evaluation of 12 cases].
abstract: Mucormycosis is a rare and often fatal invasive fungal infection. Disseminated or pulmonary forms are common in patients with immune deficiency while rhinocerebral form is common in diabetes mellitus. The aim of this study was to evaluate retrospectively the adult mucormycosis cases which were followed up in our hospital between 2007-2010. The cases were evaluated in terms of demographic characteristics, underlying diseases, laboratory, clinical and treatment results. A total of 12 mucormycosis cases (6 were male; age range: 18-74 years; mean age: 50.83 ± 18.27 years) were evaluated. Ten of the 12 cases had definitive diagnosis of invasive fungal infection according to EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria whereas two had possible mucormycosis. Six cases had rhinoorbital, four had rhinocerabral, one had pulmonary and one had rhinocerebral and pulmonary mucormycosis. Fever (n= 10; 83%), edema in face (n= 8; 67%) and eyes (n= 6; 50%) were the most common symptoms and findings. Mycologic culture was performed in ten cases and was found positive in five cases (four cases had Rhizopus spp. one case had Mucor). In two cases direct microscopy revealed mycelium but culture did not yield any pathogen. Two cases had concomitant Aspergillus spp. growth. Overall mortality rate was determined as 50% (6/12). All of the cases received antifungal therapy (liposomal amphotericin B and posaconazole or itraconazole), however, surgical intervention was applied to five cases. Mean duration of antifungal treatment was 60.8 ± 47.4 days. Mortality rate was lower in cases who received concomitant surgical therapy, but the difference was not found statistically significant (2/5 vs. 4/7, p> 0.05). Hematologic diseases (n= 6) and diabetes mellitus (n= 3) were the most common underlying diseases in mucormycosis cases. Voriconazole prophylaxis applied to three cases with hematologic diseases was detected as a risk factor. Development of mucormycosis in those cases who were under voriconazole prophylaxis, deserves attention. Since this is the largest 3-years series of adult mucormycosis cases reported from a single center and includes the first cases treated with posaconazole, the results of this evaluation may aid to the management of patients with mucormycosis.
authors.affiliation: Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey.
authors.forename: Bilgin
authors.initials: B
authors.lastname: Arda
authors.forename: Aytaç
authors.initials: A
authors.lastname: Erdem
authors.forename: Oğuz Reşat
authors.initials: OR
authors.lastname: Sipahi
authors.forename: Meltem
authors.initials: M
authors.lastname: Işıkgöz Taşbakan
authors.forename: Hüsnü
authors.initials: H
authors.lastname: Pullukçu
authors.forename: Mehmet Sezai
authors.initials: MS
authors.lastname: Taşbakan
authors.forename: Naim
authors.initials: N
authors.lastname: Ceylan
authors.forename: Dilek Yeşim
authors.initials: DY
authors.lastname: Metin
authors.forename: Raşit
authors.initials: R
authors.lastname: Midilli
authors.forename: Tansu
authors.initials: T
authors.lastname: Yamazhan
authors.forename: Sercan
authors.initials: S
authors.lastname: Ulusoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001927:Brain Diseases / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D009668:Nose Diseases / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D009916:Orbital Diseases / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole