Mucormycosis in Turkey

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SONE Study Group.Materials and MethodsA structured survey form was filled out by 9 centers.ResultsThe number of mucormycosis cases varied: 3 centers (33%) reported 11-15 cases, 2 centers (22%) reported 1-5 cases and other 2 (22%) reported 6-10 cases, 1 center reported 16-20 cases and 1 more than 20 cases. Of these, 6 centers have both solid organ and hematopoietic stem cell transplantation. Men represent the majority of cases reported by 89% of centers. The prevalence of mucormycosis is particularly high in spring (44%) and autumn (33%). Rhinocerebral mucormycosis was identified in the majority of cases (89%) whereas only 1 center reported cutaneous form principally. Six centers (67%) identified Rhizopus species at the species level. The majority of diagnosis of mucormycosis was based on histopathology results (78%). Molecular methods were not used for identification. The most common underlying diseases was diabetes mellitus (78%). Hematological malignancies reported secondly from 4 centers (44%). Two centers (22%) reported mucormycosis cases occurring in either solid organ or hematopoietic stem cell transplant recipients. Headache (44%), fever (33%), sinus involvement (33%), edema and pain in the affected eyelid (33%) were the most frequently encountered signs and symptoms of infection. Cutaneous lesion, visual loss, proptosis and lethargy reported rarely. Liposomal amphotericin B was the treatment of choice by all centers. Although all combined both antifungal therapy and surgical intervention, early surgery within 48 hours was reported from only 5 centers (56%). 5 centers had a mortality rate of 21-50%, 2 had 10-20% and 2 had 51-80%.DiscussionClimate affects infection prevalence: mucormycosis is commonly reported in tropical and subtropical climates during autumn. In Turkey, mucormycosis is often reported in spring and autumn because of the highest airborne spore concentrations in the Middle East (1,2,3). As in accordance with previous studies, diabetes was the most common underlying disease and the rhinocerebral form was the most common form of mucormycosis (1,2,3). Despite antifungal therapy with liposomal amphotericin B and surgical intervention, mortality rates were higher.ConclusionMucormycosis is a life-threatening invasive fungal infection especially in immunocompromised patients. Molecular identification is needed for the accurate and specific diagnosis of Mucorales species.References1. Cornely OA, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014;20 Suppl 3:5-26.2. Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses 2016; 59(7): 402-15.3. Al-Ajam MR, et al. Mucormycosis in the Eastern Mediterranean: a seasonal disease. Epidemiol Infect 2006; 134(2): 341-6.

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