Rhinocerebral mucormycosis: A 15-year retrospective study in southern Spain.

Abstract

Background: Rhinocerebral mucormycosis (RCM) is a severe, rapidly progressing opportunistic fungal infection with a high mortality rate, primarily affecting immunocompromised patients with diabetes mellitus or haematological malignancies. Its incidence has increased in recent years, particularly since the SARS-CoV-2 pandemic, coinciding with population ageing and the growing prevalence of immunocompromised patients. Data regarding survival rates and the most effective diagnostic and therapeutic strategies in Spain are limited. This study analyses the clinical characteristics, risk factors, and prognosis of RCM at a tertiary care centre in southern Spain.

Material and methods: A retrospective study was conducted on 36 patients treated for RCM between 2009 and 2023. Clinical-epidemiological variables, history of immunosuppression, extent of infection, diagnostic and therapeutic management, and survival outcomes were evaluated. Statistical analysis was performed using chi-square tests and regression models (p<0.05).

Results: Males predominated (66.7%), with a mean age of 58 years (range 17-83). The primary risk factors were haematological malignancies (61.1%), solid tumours (16.6%), and uncontrolled diabetes mellitus (22.2%). The most common clinical presentation was orbital involvement (86.1%), followed by sinusitis (47.2%), neurological symptoms (36.1%), and palatal necrosis (25%). Imaging studies revealed pansinusitis in 97.2% of cases and periorbital/nasomaxillary cellulitis in 66.7%. Treatment consisted of combined antifungal therapy (liposomal amphotericin B/azoles) and management of the underlying disease. Twenty-seven patients (75%) underwent surgical intervention, including endoscopic sinus surgery, maxillectomy, or orbital exenteration. Overall mortality was 66.7% (24 deaths), which was significantly associated with advanced age and the absence of surgical treatment.

Conclusions: RCM is a rare but highly lethal infection in our setting. Early diagnosis and prompt combined treatment, involving multidisciplinary management and standardised protocols, are essential to improve outcomes. The main prognostic factors identified were age, control of immunosuppression, and timely surgical intervention. Further multicentre studies are needed to optimise treatment strategies.