The burden of mucormycosis in HIV-infected patients: A systematic review - 08/08/16
Summary |
Objectives |
Mucormycosis is an invasive fungal infection afflicting immunocompromised patients, causing a significant degree of morbidity and mortality. The purpose of the study was to provide a comprehensive analysis describing the epidemiology and outcome of mucormycosis in the scenario of HIV infection.
Methods |
We systematically searched PubMed for reports about mucormycosis associated with HIV. Eligible studies describe the predisposing factor, clinical form, treatment, and survival outcome.
Results |
We included 61 articles from 212 reviewed abstracts, corresponding to 67 cases. Patients were mostly men (68.2%) with a median CD4+ count of 47 [IQR 17–100] cells/mm3. Intravenous drug use (50%), neutropenia (29.7%) and corticosteroid use (25%) were the predominant associated factors. The main clinical forms were disseminated (20.9%), renal (19.4%), and rhino-cerebral (17.9%). Rhizopus (45.5%) and Lichtheimia spp (30.3%) were the main fungal isolates. Treatment consisted of antifungal therapy and surgery in 38.8%. Overall mortality rate was 52.2%, and varied with the site of infection: 92.9% for disseminated disease, 62.5% for cerebral disease, 60% for pulmonary infection, and 36.4% for cutaneous infection. Survival was worse for those who did not initiate antifungals (p = .04), who were antiretroviral naïve (p = .01), who were admitted to ICU (p = .003) or had disseminated disease (p = .007).
Conclusions |
Mucormycosis is a life-threatening infection in HIV patients and clinician should be aware of this co-infection in the differential diagnosis of HIV opportunistic infections.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Mucormycosis occurred in late-stage HIV infection. |
• | Intravenous drug use, neutropenia and corticosteroids were frequent associations. |
• | The main clinical forms were disseminated, renal, and rhino-cerebral. |
• | Disseminated disease and ICU admission were positive predictors of mortality, which was 52.2%. |
• | Combined use of antifungals and surgery increased survival. |
Keywords : Mucormycosis, HIV, AIDS, Dissemination, Mortality
Plan
Vol 73 - N° 3
P. 181-188 - septembre 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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