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The Epidemiological, Clinical, Mycological, and Pathological Features of Rhino-Cerebral Mucormycosis: A Systematic Review Publisher



Salehi M1 ; Mahmoudi S2 ; Rezahosseini O3 ; Hashemi SJ4 ; Ahmadikia K4 ; Aala F5 ; Khajavirad N6 ; Alijani N7 ; Izadi A4 ; Getso MI4, 8 ; Abdollahi A9 ; Salami A1 ; Khatami SR1 ; Adibimehr A1 Show All Authors
Authors
  1. Salehi M1
  2. Mahmoudi S2
  3. Rezahosseini O3
  4. Hashemi SJ4
  5. Ahmadikia K4
  6. Aala F5
  7. Khajavirad N6
  8. Alijani N7
  9. Izadi A4
  10. Getso MI4, 8
  11. Abdollahi A9
  12. Salami A1
  13. Khatami SR1
  14. Adibimehr A1
  15. Yaghoobi MH10
  16. Sabahi M11
  17. Pazooki B6
  18. Yazdi F12
  19. Zebardast J13
  20. Saifi A1
  21. Nezhad MH1
  22. Mardani M14
  23. Khodavaisy S4
Show Affiliations
Authors Affiliations
  1. 1. Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Viro-immunology Research Unit, Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  4. 4. Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
  5. 5. Department of Parasitology and Mycology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
  6. 6. Internal Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano, Nigeria
  9. 9. Department of Pathology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  10. 10. Department of Infectious Diseases, Alborz University of Medical Sciences, Karaj, Iran
  11. 11. Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
  12. 12. Department of Infectious Diseases, Arak social Security Organization Hospital, Arak, Iran
  13. 13. Neurocognitive Science Special Linguistics, Institute for Cognitive Science Studies, Tehran, Iran
  14. 14. Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Iranian Journal of Pathology Published:2022


Abstract

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: Mucor, Zygomycetes, mucormycosis, cereb*, brain, central nervous system, and intracranial, separately and in combination until December 31st 2018. Data sources included PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients. © 2022, Iranian Society of Pathology. All rights reserved.
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