Improving the Outcome of Patients Diagnosed with Rhino-orbito-cerebral Mucormycosis in the Last Two Decades: 97 Patients in Two Referral Centers in the Northeast of Iran

Abstract

Background: Mucormycosis is a rare and invasive fungal infection with high mortality. Early diagnosis and prompt initiation of appropriate treatment reduce mortality in mucormycosis cases. Objectives: This study examined the clinical symptoms and outcomes of hospitalized mucormycosis patients in two northeastern Iranian referral centers. Methods: This 7-year retrospective study reviewed mucormycosis patients hospitalized in the Imam Reza and Ghaem Hospitals of Mashhad University of Medical Sciences, which serve as educational, medical, and therapeutic referral centers. Inclusion criteria included positive pathology or mycology results, complete patient files, and clarity of patient outcomes. Demographics, underlying diseases, clinical symptoms, treatments, and outcomes were analyzed. Hospitalized mucormycosis patients' pathology information, files, and graphs were utilized to complete the checklist, and data were entered into SPSS v26. Results: The study included 97 patients, with 57 confirmed cases (58.76%). The disease was more common in men (31 cases; 54.4%), and the patients had an average age of 40.82 ± 19.45 years. Regarding seasonality, autumn showed a higher number of cases (28.1%). Malignancy (34 cases; 59.6%) was the most common underlying disease, followed by diabetes (20 cases; 35.1%). The most common symptoms among patients were fever (34 cases; 59.6%), facial swelling (28 cases; 49.1%), and nasal secretions (28 cases; 49.1%). Imaging revealed that the maxillary sinus was involved in almost all patients (55 cases; 96.5%). All confirmed patients underwent surgery as part of their treatment. The most common surgical procedure was ethmoidectomy (29 cases; 50.9%), followed by maxillectomy (19 cases; 33.3%) and sphenoidectomy (19 cases; 33.3%). All patients received amphotericin B, with the majority receiving the common novel Amphotericin B Deoxycholate (48 cases; 84.2%). The mortality rate in confirmed cases was 35%, with a significantly higher rate in ICU patients (P < 0.001). All patients who were undergoing dialysis and had an invasive fungal infection experienced mortality (3 cases; 100%). Extended drug treatment was associated with improved survival rates (OR = 0.920; (0.962 - 0.880) 95% CI; P > 0.001). Conclusions: The prognosis of mucormycosis has improved in the treatment centers studied due to early diagnosis, frequent surgical interventions, and increased availability of antifungal medications. Prioritizing mycological analysis and drug resistance research is crucial and should receive significant attention in future studies.