The clinical respiratory journal 2017 10 13() doi 10.1111/crj.12724
Tranchobronchial mucormycosis is a rare and invasive pulmonary mucormycosis involving the tracheobronchial tree.
at a 3500-bed tertiary care center.
This was a retroactive study of 12 cases of tranchobronchial mucormycosis diagnosed in our hospital, and 48 cases that were previously reported in the English literature.
Rhizopus was the predominant species of pathogen (66.7%). Primary bronchus was the most frequently involved location (38.2%), and upper lobes (51% of cases) were a predilection. Obstructive necrosis and mucosal necrosis were the most common pathological forms (40% and 34.5%, respectively). Fever (59.3%), cough (59.3%), dyspnea (40.7%), and hemoptysis (30.5%) were the most common symptoms. 51.4% patients had rales, 40% had moist rales, and 28.6% had negative physical findings. 95% patients had immunosuppressive diseases. Diabetes mellitus (66.7%), diabetes ketoacidosis (21.7%), corticosteroid therapy (20%), and kidney insufficiency (18.3%) were the most common predisposing factors. 13.2% had neutropenia which was mostly among the non-diabetic patients (p=0.006). 23.2% endobronchial lesion had imaging reports with 33.9% exhibiting single mass. 76.7% pathological diagnosis used the transbronchial biopsy. The most frequent antifungal therapies were intravenous amphotericin B (79.7%), surgery (33.3%), and surgery combined with amphotericin B therapy (28.3%). Overall in-hospital mortality was 52.5%, with hemoptysis (p=0.017), dyspnea at presentation (p=0.022), and angioinvasion (p=0.03) as independent risk prognostic factors. In contrast, surgery (p=0.003) was an independent protection prognostic factor.
Tranchobronchial mucormycosis is a rare but severe disease with high mortality because of its nonspecific clinical presentations and variable predisposing factors. This article is protected by copyright. All rights reserved.