Factors associated with survival in diabetic patients with rhino-orbito-cerebral mucormycosis

Abstract

Abstract BACKGROUND. Mucormycosis is an emerging angioinvasive, potentially fatal infection caused by the ubiquitous filamentous fungi of the order Mucorales of the class Phycomycetes. They occur particularly in metabolically decompensated diabetic patients. OBJECTIVE. To evaluate the factors associated with survival in a group of diabetic patients with rhino-orbito-cerebral mucormycosis. MATERIAL AND METHODS. A case-control study of a series of cases from January 2013 to May 2020 was designed. Patients with diabetes mellitus and a diagnosis of rhino-orbito-cerebral mucormycosis were included. The clinical findings were considered, as well as age, gender, laboratory and radiological results, and mortality. For the statistical analysis, we used descriptive statistics, Mann Whitney U test. We considered a p-value equal to or less than 0.05 to indicate a statistically significant association or difference. Likewise, the odds ratio was used to determine the relative risk. RESULTS. 19 cases were included, with an average age of 60.8 years and female gender predominance. In 100% of the cases, nonseptate hyphae were identified in histopathological studies. We had a mortality of 7 (36.8%), where the rhino-orbital complications were the most frequent. The findings of CRP ≤23.1mm/L, an absolute neutrophil count ≥13.2 x1000 /µl and absence of bone erosion in the simple tomography, the rhino-orbital stage, could be related to greater survival. CONCLUSION. Our series presented mortality close to 40%. Age <64 years, CRP ≤23.1mm/L, absolute neutrophil count ≥13.2 x1000 /µl and absence of bone erosion in the simple tomography, rhino-orbital stage were associated with a better survival in our series.