Pulmonary mucormycosis - The last 30 years

Pulmonary mucormycosis is relatively uncommon but an important opportunisti c fungal infection in immunocompromised persons. The literature on the subj ect is sparse. We describe a recent case and review the literature to delin eate the clinical characteristics of this infection. We searched the MEDLIN E database for articles published in the English-language literature since 1970 and carefully analyzed 87 cases. The main risk factors were diabetes m ellitus, hematologic cancers, renal insufficiency, and organ transplantatio n. Several patients had no apparent immune compromise. There was a predilec tion for involvement of the upper lobes. Air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. Fi beroptic bronchoscopy was a useful diagnostic method, and histopathologic e xamination was more sensitive than fungal cultures. The overall survival ra te was 44%. Patients treated with a combined medical-surgical approach had a better outcome than patients who did not undergo surgery. Thus, this rela tively rare but often fatal disease should be suspected in immunocompromise d patients who fail to respond to antibacterial therapy. Early recognition and aggressive management are warranted to maximize chances for cure. Optim al therapy requires systemic antifungal therapy, surgical resection, and, w hen possible, control of the patient's underlying disease.