Background: Mucormycosis is an invasive fungal infection from non-septate fungi with high morbidity and mortality especially in uncontrolled diabetic patients and immunocompromised patients.

Objective: To review the epidemiology of mucormycosis between 2006 and 2016 to understand the trend of this infection and treatment success rate.

Materials and Methods: The present study collected inpatient records from the principal diagnosis of mucormycosis from medical records at a tertiary-care hospital, King Chulalongkorn Memorial Hospital, between 2006 and 2016. Thirty-six patients with mucormycosis were classified as proven, probable, and possible mucormycosis according to EORTC/MSG criteria.

Results: From the present study, 34 patients (94.4%) were classified as proven mucormycosis using histopathological evidence (27 patients, 79.4%) or both histopathological and microbiological evidence (7 patients, 20.6%). The rest were diagnosed as possible mucormycosis using clinical characteristics alone. The most common underlying disease for this infection was diabetes (61.1%). Paranasal sinuses (75%) were the main sites of infection. The most common causative agent was Rhizopus spp. (four out of seven isolates). The effective treatment of this infection, especially inside paranasal sinuses and lungs, was surgery (endoscopic sinuscope with debridement or lobectomy) with antifungal therapy (amphotericin B). Conventional amphotericin B was used mostly in the present study when some patients had to switch into liposomal amphotericin B (25%) or posaconazole (16.67%) because of side effects of amphotericin B. Acute kidney injury, the most common form of amphotericin B side effects, was observed in about 55.9% of the patients using conventional amphotericin B. The overall mortality rate was 30.6%.

Conclusion: The incidence of mucormycosis infection has not changed much during these ten years. The reason behind this may come from the under-diagnosis of this serious infection. The conventional culture method does not seem to be very helpful in this infection while histopathological evidence is still crucial for the diagnosis. For the early detection of this infection, the molecular approach, e.g., ITS-sequencing, could be implemented. The mortality rate of this infection in the present study is mostly depending on the response to conventional amphotericin B treatment. Therefore, liposomal amphotericin B and posaconazole are the alternative better options for invasive mucormycosis.

Keywords: Mucormycosis, Epidemiology, Thailand, King Chulalongkorn Memorial Hospital

Received 8 Feb 2019 | Revised 13 May | Accepted 16 May 2019