Title : Mucormycosis in patients with diabetes mellitus: New data after the COVID-19 pandemic
Abstract:
Introduction: Mucormycosis is a severe disease with high mortality caused by fungi of the order Mucorales, mainly in immunocompromised patients. Uncontrolled diabetes mellitus is one of the risk factors for the development of the disease. The purpose of this study was to study background diseases, risk factors, etiology, clinical and diagnostic features, as well as methods and results of treatment of mucormycosis in patients with diabetes mellitus.
Materials and Methods: We observed from 2002 to 2024, 100 patients with mucormycosis and diabetes mellitus (aged 15 to 83 years). Mucormycosis was diagnosed and the effectiveness of antifungal therapy was evaluated based on criteria proposed by the European Organization for the Study and Treatment of Cancer (EORTC) and the Mycoses Study Group Education and Research Consortium (2019, 2020).
Results: During the period from 2002 to 2024, 100 patients with diabetes mellitus and mucormycosis were included in the research. The majority of patients were adults -97%, children – 3%. The median age of the patients was 59 years (Q1Q3 - 43.65). Men - 58%, women – 42%.
The main underlying diseases for mucormycosis were: - COVID-19 (83%) , steroid- associated diabetes mellitus (83%), coronary artery disease (66%) , overweight (BMI more than 30%) (37%), oncohematological diseases (3%), previous bacterial sinusitis (3%).
The main risk factors were:glycemic level in patients with mucormycosis averaged 17 mmol/l (Iu Q1Q3 - 11; 22) on the day of diagnosis (+/- 3 days), using of glucocorticosteroids (GCS) in patients with COVID-associated mucormycosis and diabetes mellitus in the average dose in terms of prednisone 1.5 mg/kg/day was noticed in 85% of patients,lymphocytopenia – 44%(in patients with COVID-associated mucormycosis and diabetes mellitus),15% (in patients with diabetes mellitus without COVID-19).
The most frequently diagnosed lesions were the paranasal sinuses (93%), orbital tissue (70%), central nervous system (37%), and skin (25%). Lung mucormycosis (8%) and kidney (1%) were less frequently diagnosed. Widespread mucormycosis with lesions of 2 or more anatomical structures (SNP and orbit, SNP and central nervous system, SNP and lungs) was observed in 48% of patients. The main causative agents of mucormycosis were: Rhizopus spp. (32%), Lichtheimia corymbifera (16%), Mucor spp. (8%).
The highest antimycotic therapy for mucormycosis was demonstrated: posaconazole (800 mg/day) – 69%, amphotericin B deoxycholate (1 mg/kg/day) - 59%, lipid forms of amphotericin B (3-5 mg/kg/day) – 18%, isavuconazole (600 mg in the first 2 days, then 200 mg per day) - 17%, lipid forms of amphotericin B (5 mg/kg /day) - 7%, echinocandins (caspofungin, micafungin) – 4%.
Surgical removal was performed in 97% of patients 1-3 days after diagnosis. The overall survival rate for 12 weeks in patients with diabetes mellitus complicated by mucormycosis is 80%, and for a year it is 75%.
An analysis of survival in patients without surgical treatment showed that despite treatment with antifungal drugs, survival is only 33% for 12 weeks.
Conclusions:
1. Diabetes mellitus is one of the most common background diseases.
2. Rhinocerebral mucormycosis is the main clinical form in patients with diabetes mellitus.
3. Rhizopus spp. the main causative agent of mucormycosis.
4. Combined antifungal therapy and surgical treatment improve survival rates.
