Zygomycosis is a rapidly-progressive invasive
fungal disease with high mortality rates. Mucor, Rhizopus, Rhizomucor and Absidia species classified in Mucorales order, are the main causative agents of
zygomycosis. Uncontrolled diabetes,
hematologic malignancies, long term
corticosteroid use and immunosuppressive therapies are the main predisposing factors for
mucormycosis. In this study, we aimed to evaluate the
mucormycosis cases from Turkey published in national and international databases in the last 17 years by means of age, gender, co-morbidities, signs and symptoms, diagnostic methods, therapeutic modalities, and mortality rate by pooling analysis. In our study, two national (http://uvt.ulakbim.gov.tr, http://www.turkmedline.net) and two international (www.ncbi.nlm.nih.gov, http://apps.webofknowledge.com) databases were used. A total of 64 manuscript (34 from national and 30 from international databases) published between 1995 and 2012, which were eligible for the study criteria and accessible as full text were included in the study. A total of 151
mucormycosis patients (71 female, 80 male; mean age: 45.4 ± 21.4 years) from these studies, with definitive diagnosis of
invasive fungal infections according to the criteria of European Organization for Research and Treatment of
Cancer (EORTC) have been evaluated. Of 151 patients 91 (60%) were diagnosed as rhinocerebral, 42 (%27.8) were sinoorbital, 7 (4.6%) were pulmonary, 6 (3.9%) were disseminated, 3 (1.9%) were skin, and 2 (1.3%) were gastrointestinal mycormycosis. The most common symptoms and signs were; swelling of eye and face (n= 95, 63%),
fever (n= 72, 48%),
nasal obstruction (n= 60, 40%),
headache (n= 58, 38%) and opthtalmoplegia (n= 48, 32%). The most common co-morbidity was diabetes (49%) followed by
hematological malignancies (39.7%). Mycological cultures were performed for 82 patients, and fungal growth were detected in the clinical specimens of 51 cases. The distribution of strains isolated in culture were as follows: Mucor spp. (n= 19, 37.2%), Rhizopus spp. (n= 13, 25.5%), Zygomycetes (n= 9, 17.6%), Rhizopus oryzae (n= 4, 7.8%), Rhizopus spp. + yeast (n= 3, 5.9%), Rhizomucor spp. (n= 2, 3.9%) and Rhizosporium spp. (n= 1, 1.9%). In 133 patients, histopathological investigation and in 126 patients radiological examinations were performed for diagnosis. Both surgical
debridement and antifungal
therapy were employed in 115 patients. Four patients had received only surgical
debridement and 30 only antifungal
therapies. Classical
amphotericin B (
AMP-B)
therapy for 77 cases, liposomal
AMP-B for 60 cases, liposomal
AMP-B +
posaconazole for six cases and
lipid complex
AMP-B for two cases have been started as antifungal
therapies. Total mortality rate was detected as 54.3% (82/151). In conclusion, despite new diagnostic tools and therapeutic agents, mortality rates in
mucormycosis are still very high. For the management,
mucormycosis should be considered early in risky patients, and surgical
debridement together with effective antifungal
therapy should be applied as soon as possible.