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Palomba E, Colaneri M, Azzarà C, Fava M, Maccaro A, Renisi G, Viero G, Kaur H, Chakrabarti A, Gori A, Lombardi A, Bandera A. Epidemiology, Clinical Manifestations, and Outcome of Mucormycosis in Solid Organ Transplant Recipients: A Systematic Review of Reported Cases. Open Forum Infect Dis 2024; 11:ofae043. [PMID: 38887489 PMCID: PMC11181195 DOI: 10.1093/ofid/ofae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/20/2024] Open
Abstract
Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTRs). We systematically reviewed 183 cases occurring in SOTRs, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%), and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7% of cases reported within 100 days of transplantation and 20.6% occurring at least 1 year after transplant. The 90-day and 1-year mortality rates were 36.3% and 63.4%, respectively. Disseminated disease had the highest mortality at both time points (75% and 93%). Treatment with >3 immunosuppressive drugs showed a significant impact on 90-day mortality (odds ratio [OR], 2.33; 95% CI, 1.02-5.66; P = .0493), as did a disseminated disease manifestation (OR, 8.23; 95% CI, 2.20-36.71; P = .0027) and the presence of diabetes (OR, 2.35; 95% CI, 1.01-5.65; P = .0497). Notably, prophylaxis was administered to 12 cases with amphotericin B. Further investigations are needed to validate these findings and to evaluate the potential implementation of prophylactic regimens in SOTRs at high risk.
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Affiliation(s)
- Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Cecilia Azzarà
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Fava
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Renisi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Viero
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Institution and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Infectious Disease and Microbiology, Doodhadhari Burfani Hospital and Research Institute, Haridwar, India
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Rudramurthy SM, Aggarwal A, Chakrabarti A. Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports. Mycopathologia 2023; 188:755-763. [PMID: 37501018 DOI: 10.1007/s11046-023-00775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Ashutosh Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Moreira J, Varon A, Galhardo MC, Santos F, Lyra M, Castro R, Oliveira R, Lamas CC. The burden of mucormycosis in HIV-infected patients: A systematic review. J Infect 2016; 73:181-8. [PMID: 27394402 DOI: 10.1016/j.jinf.2016.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mucormycosis is an invasive fungal infection afflicting immunocompromised patients, causing a significant degree of morbidity and mortality. The purpose of the study was to provide a comprehensive analysis describing the epidemiology and outcome of mucormycosis in the scenario of HIV infection. METHODS We systematically searched PubMed for reports about mucormycosis associated with HIV. Eligible studies describe the predisposing factor, clinical form, treatment, and survival outcome. RESULTS We included 61 articles from 212 reviewed abstracts, corresponding to 67 cases. Patients were mostly men (68.2%) with a median CD4(+) count of 47 [IQR 17-100] cells/mm(3). Intravenous drug use (50%), neutropenia (29.7%) and corticosteroid use (25%) were the predominant associated factors. The main clinical forms were disseminated (20.9%), renal (19.4%), and rhino-cerebral (17.9%). Rhizopus (45.5%) and Lichtheimia spp (30.3%) were the main fungal isolates. Treatment consisted of antifungal therapy and surgery in 38.8%. Overall mortality rate was 52.2%, and varied with the site of infection: 92.9% for disseminated disease, 62.5% for cerebral disease, 60% for pulmonary infection, and 36.4% for cutaneous infection. Survival was worse for those who did not initiate antifungals (p = .04), who were antiretroviral naïve (p = .01), who were admitted to ICU (p = .003) or had disseminated disease (p = .007). CONCLUSIONS Mucormycosis is a life-threatening infection in HIV patients and clinician should be aware of this co-infection in the differential diagnosis of HIV opportunistic infections.
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Affiliation(s)
- José Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
| | - Andrea Varon
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Clara Galhardo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fabio Santos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Marcelo Lyra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Rodolfo Castro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Raquel Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Unigranrio, Infectious Disease Department, Rio de Janeiro, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
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Patel A, Bishburg E, Nagarakanti S. Mucormycosis in an HIV-infected renal transplant patient: A case report and review of the literature. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:74-8. [PMID: 24587853 PMCID: PMC3936948 DOI: 10.12659/ajcr.890026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/02/2013] [Indexed: 01/08/2023]
Abstract
Patient: Female, 15 Final Diagnosis: Mucormycosis Symptoms: Lower extremity swelling • respiratory failure • short of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Ami Patel
- Division of Infectious Diseases, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
| | - Eliahu Bishburg
- Division of Infectious Diseases, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
| | - Sandhya Nagarakanti
- Division of Infectious Diseases, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
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Sarrami AH, Setareh M, Izadinejad M, Afshar-Moghaddam N, Baradaran-Mahdavi MM, Meidani M. Fatal disseminated mucormycosis in an immunocompotent patient: a case report and literature review. Int J Prev Med 2013; 4:1468-71. [PMID: 24498504 PMCID: PMC3898454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 09/18/2013] [Indexed: 10/25/2022] Open
Abstract
Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64-year-old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients.
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Affiliation(s)
- Amir Hossein Sarrami
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | | | - Mohsen Meidani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Dr. Mohsen Meidani, Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Rocha MFG, Lima DT, Brilhante RSN, Cordeiro RA, Monteiro AJ, Teixeira CEC, Ribeiro JF, Castelo-Branco DSCM, Sidrim JJC. Glucose and lactose as cryoprotectants for fungal strains immobilised in sodium alginate: an emphasis on the conservation of the zygomycetesRhizopusandMucor. Mycoses 2012; 56:321-6. [DOI: 10.1111/myc.12030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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