Khalid Rameesha, Khanum Iffat, Habib Kiren, Ali Akbar Shoukat, Farooqi Joveria, Iqbal Nousheen, Ejaz Taymmia, Jabeen Kauser, Irfan Muhammad
Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University, Karachi, Pakistan.
Section of Infectious Diseases, Department of Medicine, The Aga Khan University, Karachi, Pakistan.
Ther Adv Infect Dis. 2024 May 6;11:20499361241251744. doi: 10.1177/20499361241251744. eCollection 2024 Jan-Dec.
Pulmonary mucormycosis is a rare but rapidly progressive fatal disease. Limited data exist on the outcomes and factors associated with poor prognosis of pulmonary mucormycosis. The objective of this study was to evaluate clinical characteristics, factors associated with mortality, and outcomes of pulmonary mucormycosis at a tertiary care hospital in Pakistan.
This was a retrospective observational study conducted at a tertiary care hospital in Karachi, Pakistan. Medical records of hospitalized patients diagnosed with proven or probable pulmonary mucormycosis between January 2018 and December 2022 were reviewed. Univariate and regression analyses were performed to identify factors associated with mortality.
Fifty-three pulmonary mucormycosis patients (69.8% male) were included, with mean age of 51.19 ± 21.65 years. Diabetes mellitus was the most common comorbidity [ = 26 (49.1%)]. Chronic lung diseases were present in [ = 5 (9.4%)], and [ = 16 (30.2%)] had concurrent coronavirus disease 2019 (COVID-19) pneumonia. The predominant isolated Mucorales were [ = 32 (60.3%)] and species [ = 9 (17%)]. Main radiological findings included consolidation [ = 39 (73.6%)] and nodules [ = 14 (26.4%)]. Amphotericin B deoxycholate was prescribed in [ = 38 (71.7%)], and [ = 14 (26.4%)] of patients received combined medical and surgical treatment. The median [interquartile range (IQR)] hospital stay was 15.0 (10.0-21.5) days. Intensive care unit (ICU) care was required in [ = 30 (56.6%)] patients, with 26 (49.1%) needing mechanical ventilation. Overall mortality was seen in 29 (54.7%) patients. Significantly higher mortality was found among patients requiring mechanical ventilation 20/29 (69%, = 0.002). Immunosuppression ( = 0.042), thrombocytopenia ( = 0.004), and mechanical ventilation ( = 0.018) were identified as risk factors for mortality on multivariable analysis.
This study provides essential insights into the clinical characteristics, outcomes, and mortality factors associated with pulmonary mucormycosis. The mortality rate was high (54.7%), particularly in patients with immunosuppression, thrombocytopenia, and those who required mechanical ventilation.
肺毛霉病是一种罕见但进展迅速的致命疾病。关于肺毛霉病预后不良的结局和相关因素的数据有限。本研究的目的是评估巴基斯坦一家三级医疗医院中肺毛霉病的临床特征、与死亡率相关的因素及结局。
这是一项在巴基斯坦卡拉奇一家三级医疗医院进行的回顾性观察研究。回顾了2018年1月至2022年12月期间确诊为确诊或疑似肺毛霉病的住院患者的病历。进行单因素和回归分析以确定与死亡率相关的因素。
纳入了53例肺毛霉病患者（69.8%为男性），平均年龄为51.19±21.65岁。糖尿病是最常见的合并症[26例（49.1%）]。慢性肺部疾病患者有5例（9.4%），16例（30.2%）同时患有2019冠状病毒病（COVID-19）肺炎。分离出的主要毛霉目真菌为32例（60.3%）和9例（17%）。主要影像学表现包括实变39例（73.6%）和结节14例（26.4%）。38例（71.7%）患者使用了去氧胆酸两性霉素B，14例（26.4%）患者接受了药物和手术联合治疗。中位住院时间[四分位间距（IQR）]为15.0（10.0 - 21.5）天。30例（56.6%）患者需要重症监护病房（ICU）护理，其中26例（49.1%）需要机械通气。29例（54.7%）患者出现总体死亡。在需要机械通气的患者中死亡率显著更高，为20/29（69%，P = 0.002）。多变量分析确定免疫抑制（P = 0.042）、血小板减少（P = 0.004）和机械通气（P = 0.018）为死亡的危险因素。
本研究为肺毛霉病的临床特征、结局及死亡率相关因素提供了重要见解。死亡率很高（54.7%），尤其是在免疫抑制、血小板减少以及需要机械通气的患者中。
