Pulmonary mucormycosis: two cases report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SONG Min ¹ , JIANG Shenghua ² , LIU Yan ² , SU Na ¹ ,  JIANG Luning ²

1. Jining Medical College, Jining, Shandong 272067, P.R.China;
2. Department of Respiratory Medicine, Affiliated Hospital of Jining Medical College, Jining, Shandong 272029, P.R.China;

Corresponding author：

JIANG Luning, Email: w13001786181@126.com

Keywords：

Pulmonary mucormycosis; Clinical features; Treatment

DOI：

10.7507/1671-6205.201607021

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Objective To improve the knowledge of pulmonary mucormycosis through summarizing the clinical features and treatment of the disease. Methods A retrospective analysis was conducted on two cases of mucormycosis. The literature review was carried out with " pulmonary mucormycosis” as the research terms respectively in CNKI and Pubmed database. Search time ranged from January 2000 to June 2016. Results The first case was a 61-year-old male patient complained of cough, expectoration and dyspnea for 5 days. Chest computerized tomography (CT) showed lung nodules in the right upper lobe and bronchial cut off sign of apical bronchus. The patient received bronchoscopic examination and pathological findings indicated mucormycosis. Amphotericin B was recommended for the treatment. The patient recovered after treatment and was discharged. The second case was a 44-year-old female patient admitted to our hospital due to cough accompanied with expectoration and fever for over 10 days. Chest CT scan showed multiple double-pulmonary circular nodules and cavities with different sizes and clear boundary. The maximum cavity diameter was about 1.8cm, and the density of soft tissue was found in the part of the cavity. The patient received CT-guided percutaneous lung biopsy and pathological findings indicated fungal hyphae which was accorded with mucor infection. The patient received amphotericin B, voriconazole and posaconazole treatment, but with bad curative effect. She gave up therapy and died one week later after discharged. A total of 6 literatures were reviewed in above-mentioned databases. The clinical manifestations were nonspecific and the patients were likely to accompany with other diseases. The duration from the onset of symptoms to exact diagnosis was 37.5 days. Chest CT scan and pathological examination played important roles in the diagnosis of mucormycosis. Proper antifungal treatment could improve the prognosis. Conclusions Mucormycosis is a rare invasive fungal disease with high mortality. The clinical manifestations are nonspecific. Early diagnosis and appropriate treatment contribute to better prognosis.

Citation： SONG Min, JIANG Shenghua, LIU Yan, SU Na, JIANG Luning. Pulmonary mucormycosis: two cases report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(2): 122-126. doi: 10.7507/1671-6205.201607021 Copy

1.	杨士芳, 吴健. 老年男性肺毛霉菌病 1 例. 中华老年多器官疾病杂志, 2011, 10(6): 550-552.
2.	Long B, Koyfman A. Mucormycosis: what emergency physicians need to know?. Am J Emerg Med, 2015, 33(12): 1823-1825.
3.	刘治军, 许小毛, 李燕明, 等. 对 1 例罕见肺毛霉菌病的确诊过程和伏立康唑有效治疗的回顾分析. 中国药学杂志, 2010, 45(15): 1187-1189.
4.	徐钦星, 任振义, 王利民, 等. 累及气道的肺毛霉菌病 1 例. 南京医科大学学报(自然科学版), 2010, 30(10): 1522-1524.
5.	刘海蔚, 傅世华, 陈翩.糖尿病合并毛霉菌病二例报道. 中国糖尿病杂志, 2015, 23(2): 174-177.
6.	宗围, 文诗伟, 孙鲁华.肺毛霉菌病 1 例并文献复习.临床肺科杂志, 2015, 20(4): 775-776.
7.	Wang XM, Guo LC, Xue SL, et al. Pulmonary mucormycosis: a case report and review of the literature. Oncol Lett, 2016, 11(5): 3049-3053.
8.	Walsh TJ, Gamaletsou MN, McGinnis MR, et al. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis, 2012, 54 Suppl 1: S55-s60.
9.	Vaezi A, Moazeni M, Rahimi MT, et al. Mucormycosis in Iran: a systematic review. Mycoses, 2016, 59(7): 402-415.
10.	Dube P, Saroa R, Palta S. Coinfection in intensive care unit with pulmonary tuberculosis and mucormycosis: a clinical dilemma. Indian J Crit Care Med, 2016, 20(3): 191-193.
11.	Danion F, Aguilar C, Catherinot E, et al. Mucormycosis: new developments into a persistently devastating infection. Semin Respir Crit Care Med, 2015, 36(5): 692-705.
12.	McAdams HP, Rosado de Christenson M, Strollo DC, et al. Pulmonary mucormycosis: radiologic findings in 32 cases. Am J Roentgenol, 1997, 168(6): 1541-1548.
13.	Jung J, Kim MY, Lee HJ, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect, 2015, 21(7): 684.
14.	Cornely OA, Arikan-Akdagli S, Dannaoui E, et al. ESCMID and ECMM joint clinical guide lines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect, 2014, 20 Suppl 3: 5-26.
15.	Chitasombat MN, Kontoyiannis DP. Treatment of mucormycosis in transplant patients: role of surgery and of old and new antifungal agents. Curr Opin Infect Dis, 2016, 29(4): 340-345.
16.	Ville S, Talarmin JP, Gaultier-Lintia A, et al. Disseminated mucormycosis with cerebral involvement owing to rhizopus microsporus in a kidney recipient treated with combined liposomal amphotericin B and posaconazole therapy. Exp Clin Transplant, 2016, 14(1): 96-99.
17.	Kim JH, Williams K. Posaconazole salvage treatment for invasive fungal infection. Mycopathologia, 2014, 178(3-4): 259-265.
18.	Astellas: FDA Advisory Committee Briefing Document: Isavuconium - Invasive Aspergillosis and Invasive Mucormycosis. Available from: http://www.fda.gov/downloads.
19.	Graves B, Morrissey CO, Wei A, et al. Isavuconazole as salvage therapy for mucormycosis. Med Mycol Case Rep, 2016, 11: 36-39.
20.	Miceli MH, Kauffman CA. A new broad-spectrum triazole antifungal agent. Clin Infect Dis, 2015, 61(10): 1558-1565.
21.	Afolayan O, Copeland H, Hargrove R, et al. Successful treatment of invasive pulmonary mucormycosis in an immunocompromised patient. Ann Thorac Surg, 2016, 101(4): e117-e119.
22.	Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis, 2008, 47(4): 503-509.

1. 杨士芳, 吴健. 老年男性肺毛霉菌病 1 例. 中华老年多器官疾病杂志, 2011, 10(6): 550-552.
2. Long B, Koyfman A. Mucormycosis: what emergency physicians need to know?. Am J Emerg Med, 2015, 33(12): 1823-1825.
3. 刘治军, 许小毛, 李燕明, 等. 对 1 例罕见肺毛霉菌病的确诊过程和伏立康唑有效治疗的回顾分析. 中国药学杂志, 2010, 45(15): 1187-1189.
4. 徐钦星, 任振义, 王利民, 等. 累及气道的肺毛霉菌病 1 例. 南京医科大学学报(自然科学版), 2010, 30(10): 1522-1524.
5. 刘海蔚, 傅世华, 陈翩.糖尿病合并毛霉菌病二例报道. 中国糖尿病杂志, 2015, 23(2): 174-177.
6. 宗围, 文诗伟, 孙鲁华.肺毛霉菌病 1 例并文献复习.临床肺科杂志, 2015, 20(4): 775-776.
7. Wang XM, Guo LC, Xue SL, et al. Pulmonary mucormycosis: a case report and review of the literature. Oncol Lett, 2016, 11(5): 3049-3053.
8. Walsh TJ, Gamaletsou MN, McGinnis MR, et al. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis, 2012, 54 Suppl 1: S55-s60.
9. Vaezi A, Moazeni M, Rahimi MT, et al. Mucormycosis in Iran: a systematic review. Mycoses, 2016, 59(7): 402-415.
10. Dube P, Saroa R, Palta S. Coinfection in intensive care unit with pulmonary tuberculosis and mucormycosis: a clinical dilemma. Indian J Crit Care Med, 2016, 20(3): 191-193.
11. Danion F, Aguilar C, Catherinot E, et al. Mucormycosis: new developments into a persistently devastating infection. Semin Respir Crit Care Med, 2015, 36(5): 692-705.
12. McAdams HP, Rosado de Christenson M, Strollo DC, et al. Pulmonary mucormycosis: radiologic findings in 32 cases. Am J Roentgenol, 1997, 168(6): 1541-1548.
13. Jung J, Kim MY, Lee HJ, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect, 2015, 21(7): 684.
14. Cornely OA, Arikan-Akdagli S, Dannaoui E, et al. ESCMID and ECMM joint clinical guide lines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect, 2014, 20 Suppl 3: 5-26.
15. Chitasombat MN, Kontoyiannis DP. Treatment of mucormycosis in transplant patients: role of surgery and of old and new antifungal agents. Curr Opin Infect Dis, 2016, 29(4): 340-345.
16. Ville S, Talarmin JP, Gaultier-Lintia A, et al. Disseminated mucormycosis with cerebral involvement owing to rhizopus microsporus in a kidney recipient treated with combined liposomal amphotericin B and posaconazole therapy. Exp Clin Transplant, 2016, 14(1): 96-99.
17. Kim JH, Williams K. Posaconazole salvage treatment for invasive fungal infection. Mycopathologia, 2014, 178(3-4): 259-265.
18. Astellas: FDA Advisory Committee Briefing Document: Isavuconium - Invasive Aspergillosis and Invasive Mucormycosis. Available from: http://www.fda.gov/downloads.
19. Graves B, Morrissey CO, Wei A, et al. Isavuconazole as salvage therapy for mucormycosis. Med Mycol Case Rep, 2016, 11: 36-39.
20. Miceli MH, Kauffman CA. A new broad-spectrum triazole antifungal agent. Clin Infect Dis, 2015, 61(10): 1558-1565.
21. Afolayan O, Copeland H, Hargrove R, et al. Successful treatment of invasive pulmonary mucormycosis in an immunocompromised patient. Ann Thorac Surg, 2016, 101(4): e117-e119.
22. Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis, 2008, 47(4): 503-509.

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