Characteristics of pulmonary mucormycosis and predictive risk factors for the outcome

Purpose Little is known about risk factors for the outcome of pulmonary mucormycosis. We summarized characteristics of this rare disease, and systemically explored risk factors for the outcome. Methods Ninety-two patients with pulmonary mucormycosis, including 12 patients at Peking Union Medical College Hospital and 80 patients published in 62 articles between 2006 and 2016, were retrospectively analyzed. Results The median age was 47.5 years, and the male to female ratio was 2.8:1. Hematological disorders, diabetes mellitus, renal insufficiency and organ transplantation were main underlying conditions. Twelve percent of patients had no underlying diseases. A predilection for involvement of upper lobes was noted, and thick-walled cavity was described in 37.0% of patients on chest computed tomography. Most of the patients were diagnosed by microscopic analysis (95.7%), mainly histopathology; and only a minority were diagnosed by culture of sterile materials (28.3%). The overall mortality rate was 30.4%. Four independent determinants were associated with a better prognosis: hemoptysis (adjusted OR 7.910; 95% CI 1.411-44.342), chronic onset (adjusted OR 25.269, 95% CI 1.654-385.993), treated with medicine (adjusted OR 53.896, 95% CI 3.072-945.561), and treated with surgery (adjusted OR 5.983, 95% CI 1.497-23.918). Conclusions Pulmonary mucormycosis is a rare infection with a high mortality. Invasive approach for histopathology and culture are crucial for a definite diagnosis. Acute onset patients had a poorer prognosis, and early treatment with antifungal therapy is imperative. Surgical approach is recommended in appropriate patients for a better outcome.