Clinical characteristics of pulmonary mucormycosis
Objective To analyze the clinical data of patients with pulmonary mucormycosis,and to explore the clinical characteristics and diagnosis and treatment protocol of pulmonary mucormycosis.Methods Thirty-three patients with pulmonary mucormycosis were diagnosed and treated in Luohe Central Hospital from January 2021 to April 2023.The clinical data as clinical symptoms,laboratory tests,imaging examinations,etiological diagnosis,treatment protocol and prognosis were recorded.Results Among these 33 patients,the clinical symptoms were fever in 24 patients,cough in 33,and hemoptysis in 18.The underlying diseases were diabetes mellitus in 19 patients,solid organ transplantation in 6,blood disease in 5,and chronic kidney disease in 3.One patient had no underlying disease.Twenty-three patients were complicated with viral infection.The C-reactive protein was 48.1(8.5,108.0)mg/L,the erythrocyte sedimentation rate was(57.5±27.9)mm/h,and there were no blood routine,liver function or renal function abnormalities.Chest CT images of these 33 patients were diverse and multiple signs coexisting,with consolidation in 26 patients,cavity in 16,airway stenosis in 15,pleural effusion in 13,mediastinal and hilar lymph node enlargement in 11,pulmonary ground-glass shadow in 4,pulmonary nodule in 2,"reversed halo sign"in 2,and bronchitis in 1;and multiple lobe involvement in 31 and single lobe involvement in 2.The positive rate of metagenomic next-generation sequencing in the diagnosis of pulmonary mucormycosis(86.7％)was higher than that of smear microscopy(24.2％),fungal culture(15.2％)and histopathology(50.0％)(x2=24.649,P＜0.001;x2=32.156,P＜0.001;x2=8.314,P=0.004),was higher of histopathology than that of smear microscopy and fungal culture(x2=3.873,P=0.049;x2=7.771,P=0.005),and showed no significant difference between the smear microscopy and fungal culture results(x2=0.862,P=0.353).Among these 33 patients,25 were treated with antifungal drugs alone,including amphotericin B monotherapy in 2,posaconazole or esaconazole monotherapy in 6,and amphotericin B combined with posaconazole or esaconazole in 17;7 were treated with surgery combined with antifungal drugs,including posaconazole monotherapy in 1 and amphotericin B combined with posaconazole in 6;1 abandoned treatment.Among 8 patients receiving monotherapy,7 were improved and discharged,and among 17 patients receiving multi-drug combination therapy,14 were improved and discharged.There was no significant difference in the response rate between monotherapy(87.5％)and multi-drug combination therapy(82.4％)(P＞0.999)(Fisher's Exact Test).Among 25 patients receiving antifungal drugs alone,21 were improved and discharged,and 4 died;and among 7 patients treated with surgery combined with antifungal drugs,6 were improved and discharged,and 1 died.There was no significant difference in response rate between antifungal therapy alone(84.0％)and surgery combined with antifungal therapy(85.7％)(P＞0.999)(Fisher's Exact Test).Conclusions Pulmonary mucormycosis tends to occur in immunocompromised populations.Clinical symptoms,laboratory tests and imaging examinations lack specificity,and the positive rate of conventional microbiological diagnostic methods is low.Histopathology and metagenomic next-generation sequencing are helpful to improve the diagnostic positive rate.Monotherapy,multi-drug combination therapy,and surgery combined with antifungal drugs can be selected according to the patients'conditions.
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