Title of article :
The Epidemiological, Clinical, Mycological, and Pathological Features of Rhino-cerebral Mucormycosis: A Systematic Review
Author/Authors :
Salehi ، Mohammadreza Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Mahmoudi ، Shahram Department of Parasitology and Mycology - School of Medicine - Iran University of Medical Sciences , Rezahosseini ، Omid Viro-immunology Research Unit, Department of Infectious Disease - University of Copenhagen , Hashemi ، Jamal Department of Medical Parasitology and Mycology - School of Public Health - Tehran University of Medical Sciences , Ahmadikia ، Kazem Department of Medical Parasitology and Mycology - School of Public Health - Tehran University of Medical Sciences , Aala ، Farzad Department of Parasitology and Mycology - Faculty of Medicine - Kurdistan University of Medical Sciences , Khajavirad ، Nasim Department of Internal Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Alijani ، Neda Department of Infectious Diseases - Shariati Hospital - Tehran University of Medical Sciences , Izadi ، Alireza Department of Medical Parasitology and Mycology - School of Public Health - Tehran University of Medical Sciences , Getso ، Muhammad Ibrahim Department of Medical Microbiology and Parasitology - College of Health Sciences - Bayero University , Abdollahi ، Alireza Department of Pathology - School of Medicine - Imam Khomeini Hospital Tehran University of Medical Sciences , Salami ، Arezoo Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Khatami ، Rana Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Adibimehr ، Alireza Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Hedayat Yaghoobi ، Mojtaba Department of Infectious Diseases - Alborz University of Medical Sciences , Sabahi ، Mohammadmahdi Student Research Committee - Hamadan University of Medical Sciences , Pazooki ، Behshad Department of Internal Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Yazdi ، Farhad Department of Infectious Diseases - Arak Social Security Organization Hospital , Zebardast ، Jayran Institute for Cognitive Science Studies , Seifi ، Arash Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Hasan Nezhad ، Malihe Department of Infectious Diseases and Tropical Medicine - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences , Mardani ، Masoud Infectious Disease and Tropical Medicine Research Center - Shahid Beheshti University of Medical Sciences , Khodavaisy ، Sadegh Department of Medical Parasitology and Mycology - School of Public Health - Tehran University of Medical Sciences
Abstract :
Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angio-invasive 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 37 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 01.31.8; P 0.0001). The use of liposomal amphotericin B (LAMB) was significantly associated with patients’ recovery (OR 2.09; 95% CI 1.23.4; P=0.003). The combination of LAMB 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.
Keywords :
Cerebral mucormycosis , Diabetes Mellitus , Invasive fungal infections
Journal title :
Iranian Journal of Pathology (IJP)
Journal title :
Iranian Journal of Pathology (IJP)
