title: Pulmonary mucormycosis: clinical features and outcomes.
abstract: OBJECTIVE
  Mucormycosis encompasses a group of opportunistic fungal infections caused by Zygomycetes, order Mucorales. Mucormycosis can manifest as rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, and disseminated infections. Pulmonary mucormycosis is the second most common presentation. This manuscript characterizes the demographics, clinical presentation, diagnostic procedures, radiologic findings, therapeutic interventions, and outcome in pulmonary mucormycosis.
  
  
  METHODS
  We retrospectively reviewed clinical data of 35 patients with pulmonary mucormycosis from 2000 to 2015. Microbiologic diagnosis was based on positive culture from a sterile site or findings on histopathology consistent with mucormycosis. Independent predictors of 28-day mortality were assessed using logistic regression. Survival curves were estimated using Kaplan-Meier method.
  
  
  RESULTS
  There was male predominance with a mean age of 55 ± 15 years. Analysis of predisposing conditions revealed the prevailing presence of malignancy. Sixty-six percent of patients were receiving immunosuppressive agents. Common presenting clinical findings were fever, neutropenia, dyspnea, and cough. Radiologic findings included pleural effusion and nodules. All patients received medical therapy and 43% underwent additional surgical intervention. Twenty eight day mortality was 29% with concurrent bacteremia found as the sole independent predictor. Similar survival from pulmonary mucormycosis was noted over time.
  
  
  CONCLUSIONS
  Pulmonary mucormycosis is an opportunistic angioinvasive fungal infection. Physicians must have a high level of suspicion in immunocompromised patients with fever and respiratory symptoms refractory to antibiotics. A low threshold should be had for performing an invasive procedure to gain reliable diagnosis, as early, aggressive medical and surgical interventions are needed for successful treatment.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
authors.forename: Erica
authors.identifier: http://orcid.org/0000-0002-0024-4086
authors.initials: E
authors.lastname: Lin
authors.affiliation: Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. moua.teng@mayo.edu.
authors.forename: Teng
authors.initials: T
authors.lastname: Moua
authors.affiliation: Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Limper
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009091:Mucormycosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Fungal infection; Pulmonary mucormycosis