Deciphering the association between adverse clinical outcome and patient co-morbidities in mucormycosis – a fourteen year study from South India

Abstract

Mucormycosis is an angioinvasive, fatal infection commonly seen in individuals with diabetes mellitus, malignancy and immunosuppression due to chemotherapy and steroids. The aim of this study was to identify the association between adverse clinical outcomes and patient co-morbidities in mucormycosis. Over a period of 14 years, clinical specimens positive for mucormycosis by fungal culture and histopathological examination were included in the study. Statistical analysis was performed to identify the association between adverse clinical outcome and patient demographics. Odds ratio with a 95% confidence interval was calculated to analyse the association between age, gender, diabetes mellitus, malignancy and adverse clinical outcome. p-value <0.05 was used to identify statistical significance. 63 patients with mucormycosis were identified in the study. Rhino-orbital-cerebral mucormycosis was seen in 70% of patients and Rhizopus (52.7%) was the most commonly isolated fungus. Antifungal therapy (92.06%) and surgery (68.25%) were the treatment modalities utilised with a mortality rate of 26.9%. No significant statistical correlation was found between age, gender, presence of diabetes mellitus, malignancy and adverse clinical outcome. Rhino-orbital cerebral mucormycosis due to Rhizopus spp was the most common clinical presentation seen in our setting. Combination of antifungal therapy and surgery is vital for clinical response. Diabetes mellitus and malignancy do not show a statistically significant association with the clinical outcome of mucormycosis. Rapid identification of mucormycosis helps in early diagnosis and initiation of antifungal therapy.