Pulmonary Mucormycoses ; Review of Eight Cases

S Aïssi, A Ayadi-Kaddour, M Mlika, E Braham, A Zeddini, O Ismail, F El Mezni

Abstract


Zygomycosis, or mucormycosis is an emerging life-threatening angio-invasive infection caused by fungi of the class Zygomycetes, order Mucorales. The most common organisms causing mucormycosis belong to the genera Rhizopus, Lichtheimia, and Mucor. It usually occurs in immune-compromised patient. Pulmonary involvement can be seen in approximately 24% of cases.
We report eight cases of pulmonary mucormycoses. These patients were identified from Abderrahman Mami Hospital between 2001 and 2013. During this time, a review of the literature, has identified 80 cases.
There were 1 man and 7 women with an average age of 50 years (13– 72). Seven patients were diabetic, two cirrhotic and one with hematologic malignancy. The delays of the first consultation was 31.6 days. All of our patients had respiratory symptoms at diagnosis. The main clinical signs were cough (50%), hemoptysis (50%), chest pain (25%) and dyspnea (12,5%). Imaging revealed a pulmonary opacity often excavated. The diagnosis of mucormycosis is often confirmed by the histological examination (bronchial biopsy 75%, surgical resection 25%) with a post-mortem diagnosis in two cases. Sex patients underwent medical treatment with amphotericin B associated in five cases to a surgical resection. The outcome was fatal in 3 cases.
Pulmonary mucormycosis was a rare but fatal opportunistic fungal infection. Its incidence appears to have increased in recent years with high mortality (40–76%), and debilitating morbidity. Successful treatment was largely depends on timely diagnosis, reversal of the underlying predisposing factors, and early removal of infected tissue in conjunction with systemic antifungal agents.

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