Mucormycosis natural history, complications and prognosis

Overview

In most cases, the prognosis of mucormycosis is poor and has varied mortality rates depending on its form and severity. In the rhinocerebral form, the mortality rate is between 30% and 70%, whereas disseminated mucormycosis presents with the highest mortality rate in an otherwise healthy patient, with a mortality rate of up to 100%. Patients with AIDS have a mortality rate of almost 100%. Possible complications of mucormycosis include the partial loss of neurological function, blindness and clotting of brain or lung vessels.

Natural History

If left untreated, mucormycosis can be fatal. The survival rate of immunosuppressed patients with rhino sinusal mucormycosis without cerebral involvement is between 50-80%, and only 10% if the infection spreads into the brain. In uncontrolled diabetes mellitus patients with ketoacidosis, who are diagnosed with rhino-orbital mucormycosis, cerebral spread of infection should be suspected, if there is no improvement after 24 hours since the beginning of treatment. In 70% of cases mucormycosis occurs in diabetics, and the percentage increases if there is concomitant immunosupression and comorbities.

Complications

• Patients with mucormycosis may develop the following complications:
  • Extensive necrosis
  • Fungemia leading to septic shock
  • Stroke
  • Paralysis
  • Ophthalmoplegia
  • Intracranial hemorrhage
  • Mediastinitis
  • Bronchial perforation
  • Pulmonary gangrene
  • Renal mucormycosis

Prognosis

• The overall survival rate of patients with mucormycosis is approximately 50%, although survival rates approaching up to 85% have been reported.
• Differences in prognosis are due to the various forms of the disease.
• Rhinocerebral mucormycosis has a higher survival rate than does pulmonary or disseminated mucormycosis because the rhinocerebral disease can frequently be diagnosed earlier and the most common underlying cause, diabetic ketoacidosis, can be treated readily.
• Pulmonary mucormycosis has a high mortality (around 65 percent at 1 year)
• Mortality in patients with disseminated disease approaches 100%, majorly due to surgical removal of infected tissues is not feasible and in part because these patients are usually most highly immunocompromised.