The Epidemiological, Clinical, Mycological, and Pathological Features of Rhino-cerebral Mucormycosis: A Systematic Review

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until  December ۳۱st ۲۰۱۸. Data sources included  PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included ۲۸۷ articles corresponding to ۳۴۵ cases of CM. Out of the ۳۴۵ cases, ۲۰۶ (۶۰%) were male with a median age of ۴۴ years; ۱۳۰ (۳۸%) were reported from North America; ۸۷ (۲۵%) from Asia; and ۸۴ (۲۴%) from Europe. The median time from onset of symptoms to presentation was ۳-۷ days (۶۵/۳۴۵, ۶۵%). The highest mortality was observed among patients with diabetes mellitus (P=۰.۰۰۳). Debridement of infected brain tissue was associated with improved survival in CM cases (OR ۱.۵; ۹۵% CI ۰۱.۳-۱.۸; P<۰.۰۰۰۱). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR ۲.۰۹; ۹۵% CI ۱.۲-۳.۴; P=۰.۰۰۳). The combination of L-AMB and posaconazole (۱۲.۵%) was more effective than the monotherapy treatment of CM cases (P=۰.۰۰۹). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.

کلیدواژه ها:

Cerebral mucormycosis ، Diabetes Mellitus ، Invasive fungal infections