Clinical Features and Outcome of Mucormycosis Cases in A Tertiary Care Hospital: A 10-year Experience

Abstract

Objective: The study aimed to describe the clinical features and outcomes of mucormycosis and identify variables associated with in-hospital mortality.
Study Design: Retrospective observational study.
Place and Duration of Study: Rehman Medical Institute, Peshawar between 1st January 2015 and 31st December 2024.
Materials and Methods: The study included all histopathological confirmed cases of mucormycosis diagnosed during the study period. Demographic data, clinical and radiological features, treatment, and outcomes at discharge were retrieved from patient hospital records. Data were summarized as frequencies and percentages for categorical variables and as median (interquartile range) for continuous variables. Mann–Whitney U test
and Fisher's exact test were applied to do mortality analysis between two groups.
Results: Of 35 study participants, the median (IQR) age was 55(21) years, 68.6% (n=24) were male. Rhinoorbito-cerebral mucormycosis (ROCM) was the most common presentation in 94.2% (n=33). About 77.1% (n=27) of patients had diabetes mellitus (DM), 85.7% (n=23) had poor glycemic control. Surgical intervention was performed in 97.1% (n=34). About 20% (n=7) of patients required ICU care. The in-hospital mortality was 17.1% excluding patients who left against medical advice. ICU admission, intracranial extension, and septic shock were strongly associated with mortality (p < 0.001 each). Higher C -reactive protein (CRP) (49.26 vs 7.75
mg/L, p= 0.007), neutrophilia (87.8 vs 73.3%, p = 0.005) and HbA1c (13.9% Vs 11.4%. P= 0.03) were associated with high mortality.
Conclusion: Mucormycosis mostly affected middle aged adults with poorly controlled DM. ROCM was common with worse outcomes. Extensive organ involvement at presentation, high CRP, HbA1c levels, and neutrophil counts were associated with mortality.