Didehdar Mojtaba, Chegini Zahra, Khoshbayan Amin, Moradabadi Alireza, Shariati Aref
Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran.
Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Front Med (Lausanne). 2022 Aug 24;9:983612. doi: 10.3389/fmed.2022.983612. eCollection 2022.
Renal mucormycosis (RM) is a rare presentation of invasive mucormycosis with a high mortality rate. There is no single systematic review of the literature that indicates the different clinical aspects of RM.
A systematic search of PubMed/Medline was performed to collect individual case reports of RM in patients of all ages published between 2010 and April 2022.
Seventy-one individual cases were detected through PubMed bibliographic database searches, with a final assessment performed on 60 patients with RM. India and Asia had the largest number of reported cases, with 30 (50%) and 42 (70%) reports, respectively. Also, 74 and 26% of the patients with a mean age of 33 years were male and female, respectively. RM showed 44% mortality rate in the analyzed cases. Immunosuppressive agent therapy followed by tissue transplantation (kidney and liver) and diabetes were the most remarkable risk factors in patients. Nevertheless, 22% of the patients were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in eight adult patients with an 87% mortality rate. The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases. In 55% of the patients, histopathologic examination alone was sufficient to diagnose RM, whereas molecular methods and culture were used in only 18 and 35% of patients, respectively. Surgery alone, surgery plus anti-infection therapy, and anti-infection therapy alone were used in 12, 60, and 13% of patients, respectively. Furthermore, 15% of the patients died before any treatment.
The early diagnosis of RM is necessary. In this regard, the use of molecular-based diagnostic assays can help identify the fungus at the genus and species levels and use an appropriate treatment in the shortest possible amount of time. Because of the increase in antibiotic resistance in recent years, determining microbial susceptibility tests can lead to the better infection management. Additionally, withdrawal of immunosuppressant, appropriate surgical intervention, and antifungal therapy are the main factors associated with a successful outcome in RM.
肾毛霉病（RM）是侵袭性毛霉病的一种罕见表现，死亡率很高。目前尚无对文献的单一系统综述表明RM的不同临床特征。
对PubMed/Medline进行系统检索，以收集2010年至2022年4月期间发表的各年龄段RM患者的个案报告。
通过PubMed文献数据库检索发现71例个案，最终对60例RM患者进行了评估。印度和亚洲报告的病例数最多，分别为30例（50%）和42例（70%）。此外，平均年龄为33岁的患者中，男性和女性分别占74%和26%。在分析的病例中，RM的死亡率为44%。免疫抑制剂治疗、组织移植（肾脏和肝脏）以及糖尿病是患者中最显著的危险因素。然而，22%的患者免疫功能正常，无明显基础疾病。8例成年患者检测出新型冠状病毒肺炎阳性，死亡率为87%。最常见的感染症状是发热、胁腹痛和少尿；此外，57%的病例报告为孤立性RM。55%的患者仅通过组织病理学检查就足以诊断RM，而分子方法和培养分别仅用于18%和35%的患者。仅手术治疗、手术加抗感染治疗和仅抗感染治疗分别用于12%、60%和13%的患者。此外，15%的患者在接受任何治疗前死亡。
RM的早期诊断很有必要。在这方面，使用基于分子的诊断检测方法有助于在属和种水平上鉴定真菌，并在尽可能短的时间内进行适当治疗。由于近年来抗生素耐药性增加，确定微生物药敏试验可实现更好的感染管理。此外，停用免疫抑制剂、适当的手术干预和抗真菌治疗是RM治疗成功的主要相关因素。
