title: Mucormycosis in Iran: a systematic review.
abstract: Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.
authors.affiliation: Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Afsane
authors.initials: A
authors.lastname: Vaezi
authors.affiliation: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Moazeni
authors.affiliation: Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Rahimi
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands.
authors.forename: Sybren
authors.initials: S
authors.lastname: de Hoog
authors.affiliation: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.|Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Badali
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D003881:Dermatomycoses / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D000072742:Invasive Fungal Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D007492:Iran / Q000453:epidemiology; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000235:genetics / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D012233:Rhizopus / Q000235:genetics / Q000302:isolation & purification; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Iran; Mucor; Mucormycosis; Rhizomucor; diabetes; systematic review