A retrospective analysis on mucormycosis in patients with hematological diseases: a single center experience from Turkey

Abstract

Aim: Mucormycosis is an acute, invasive, devastating and highly fatal fungal infection, affecting particularly immunocompromised patients; fortunately, it is rare. This study aimed to describe the attitude of mucormycosis in patients with a hematological disease, and to evaluate the risk factors associated with mortality.
 Material and Method: We retrospectively assessed the demographic and clinical data of patients who were diagnosed with mucormycosis in Erciyes University Hematology and Bone Marrow Transplantation Center, between 2010 and 2020. The study was included 34 patients with a history of either hematological malignancy or hematopoietic stem cell transplantation. 
 Results: Twenty-seven patients had proven infection, and the others had possible infection. The most frequent underlying disease was acute leukemia. Seven-teen patients had a history of allogeneic transplantation, and frequency of mucormycosis was 3.5% among allogeneic transplant recipients. The most frequent site of infection was the rhino-orbital region (85.3%). Forty-seven percent of patients presented with acute orbital symptoms. Fifteen patients were on a mucor-active antifungal (posaconazole and liposomal Amphotericin B) prophylaxis or treatment at the time of diagnosis. All patients received liposomal Amphotericin B and seven patients received posaconazole additionally as initial therapy. Surgical debridement was performed in 91.1% of patients. The two-year mucor-related mortality rate was 44.1%. The survival curves were significantly lower in patients with concomitant fungal pneumonia, allogeneic transplantation and also in patients who were receiving mucor-active antifungal drugs at the time of diagnosis.
 Conclusion: Mucormycosis remains a significant problem for hematology clinicians despite the expanding use of antifungal prophylaxis. Moreover, breakthrough infections indicate rising danger regarding resistant agents. We also highlight that, most of the patients receiving broad-spectrum antifungal prophylaxis are more fragile and more complicated patients, which put them at increased baseline risk for mucormycosis, and deserve more attention.