Authors
Y F Guo, Q Y Zhan, L N Huang
Published in
Zhonghua nei ke za zhi. Volume 65. Issue 7. Pages 734-742. Jul 01, 2026.
Abstract
Objective: To summarize the clinical characteristics, diagnostic and therapeutic strategies, and prognostic factors in patients with pulmonary mucormycosis. Methods: The patients with pulmonary mucormycosis admitted to the Department of Respiratory and Critical Care Medicine and the Lung Transplantation Department of China-Japan Friendship Hospital from January 2016 to March 2023 were retrospectively evaluated. High-risk factors, clinical manifestations, imaging findings, microbiological tests, therapeutic interventions, and clinical outcomes were analyzed, and variables were compared between survivors and non-survivors. Intergroup statistical analyses were performed using the chi-squared test, or Fisher's exact test, etc. Results: Of the 47 patients (21 confirmed, 26 clinically diagnosed), 32 (68.1%) were male, and the mean age of the cohort was (48±17) years. High-risk factors were present in 87.2% (41/47) of patients, primarily diabetes mellitus (53.2%, 25/47) and immunosuppression (42.6%, 20/47); 53.2% (25/47) had a history of voriconazole exposure. Hemoptysis occurred in 57.4% (27/47) of patients, of whom 17.0% (8/47) experienced massive hemoptysis; 48.9%(23/47) required interventional or surgical management. Chest CT scans revealed large consolidative opacities (70.2%, 33/47) and thick-walled cavities (48.9%, 23/47), and contrast-enhanced CT identified vascular involvement. The positive rate for lower respiratory tract fungal culture was only 17.1% (6/35), and that of smear microscopy was 18.2% (6/33), whereas the positive rate of metagenomic next-generation sequencing (mNGS) reached 76.0% (19/25), with mNGS of bronchoalveolar lavage fluid reaching 85.0% (17/20). Overall, 34.0% (16/47) of patients were diagnosed exclusively via mNGS. Conventional amphotericin B formulations were administered to 68.1% (32/47) of patients (including 10 who received liposomal amphotericin B); these formulations were associated with an adverse drug reaction rate of 86.7% (26/30), which contributed to only 40.7% (11/27) of these treated patients receiving a full therapeutic dose. Azoles were administered to 91.5% (43/47) of patients (15 received azoles alone), and among those treated with posaconazole, 88.0% (22/25) achieved target plasma concentrations; 48.9% (23/47) received combination therapy consisting of an amphotericin B formulation plus an azole. The survival rate among patients who underwent surgical intervention combined with antifungal therapy was 11/12, which was higher than that of patients who received antifungal therapy alone (28/35). Compared with survivors, non-survivors demonstrated significantly higher incidences of dyspnea (8/8 vs. 14/39, P=0.001), uncontrolled fever (6/8 vs. 12/39, P=0.027), pleural effusion (8/8 vs. 17/39, P=0.003), atelectasis (5/8 vs. 6/39, P=0.016), and severe complications (7/8 vs. 13/39, P=0.015). Furthermore, a significantly lower proportion of non-survivors received adequate antifungal dosing (1/8 vs. 21/39, P=0.037). Conclusions: Pulmonary mucormycosis predominantly occurs in high-risk populations such as those with diabetes mellitus or immunosuppression. Hemoptysis is a prominent clinical manifestation, while imaging findings commonly include large areas of consolidation, thick-walled cavities, and signs of vascular invasion. Early execution of contrast-enhanced chest CT, along with bronchoscopy with bronchoalveolar lavage fluid mNGS, improves the diagnostic yield. Adequate antifungal therapy combined with aggressive surgical intervention may contribute to improved prognosis. Severe complications, dyspnea, uncontrolled fever, pleural effusion, atelectasis, and inadequate antifungal treatment are associated with a poor prognosis, underscoring the need for early recognition and management.
PMID:
42427046
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.
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