title: Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran.
abstract: BACKGROUND
  No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran.
  
  
  METHODS
  This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments.
  
  
  RESULTS
  Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay.
  
  
  CONCLUSIONS
  There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.
authors: Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Vida
authors: V
authors: Bozorgi
authors: Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Mahshid
authors: M
authors: Talebitaher
authors: Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Neda
authors: N
authors: Shalbaf
authors: Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Nima
authors: N
authors: Radmanesh
authors: Infectious disease department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Fatemeh
authors: F
authors: Nasri
authors: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Mohammad Mostafa
authors: MM
authors: Ansari-Ramandi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001927:Brain Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D003920:Diabetes Mellitus / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D020096:Zygomycosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Rhinocerebral zygomycosis; in-hospital mortality; morbidity