Cerebral mucormycosis: a national study (France, 2005-2020)

Author:

CD de La Porte1*, CP Provost2, AS Serris1, AC Coste3, MB Bougnoux4, RB Herbrecht5, VB Bru6, FA Ader7, FP Persat8, EC Canet9, FM Morio10, BD Denis11, AA Alanio12, LL Lelièvre13, SC Cassaing14, RS Sonneville15, LM Millon16, OL Lortholary1, ON Naggara2, FL Lanternier1, French Cerebral Mucormycosis Study Group

Author address:

1Department of Infectious Diseases, Necker University Hospital (AP-HP), Paris, France

2Department of Radiology, Sainte-Anne University Hospital, Paris, France

3Department of Internal Medicine, Brest University Hospital, Brest, France

4Department of Mycology, Necker University Hospital (AP-HP), Paris, France

5Department of Haematology, Strasbourg Cancer Institute, Strasbourg, France

6Department of Mycology, Strasbourg University Hospital, Strasbourg, France

7Department of Infectious Diseases, Croix-Rousse University Hospital, Lyon, France

8Department of Mycology, Croix-Rousse University Hospital, Lyon, France

9Intensive Care Unit, Nantes University Hospital, Nantes, France

10Department of Mycology, Nantes University Hospital, Nantes, France

11Department of Infectious Diseases, Saint-Louis University Hospital (AP-HP), Paris, France

12Department of Mycology, Saint-Louis University Hospital (AP-HP), Paris, France

13Department of Internal Medicine, Toulouse University Hospital, Toulouse, France

14Department of Mycology, Toulouse University Hospital, Toulouse, France

15Intensive Care Unit, Bichat Claude-Bernard University Hospital, Paris, France

16Department of Mycology, Besançon University Hospital, Besançon, France

Full conference title:

10th Advances Against Aspergillosis and Mucormycosis

Date: 2 February 2022

Abstract:

Purpose:

Previous studies on central nervous system (CNS) mucormycosis consist in case reports or small series of patients. The aim of this study is to guide clinicians by providing precise data on the clinical, radiological and biological characteristics of these infections according to the patients’ background, as CNS mucormycosis requires prompt diagnosis and treatment.

 

Methods:

We conducted a retrospective, multicentric, observational study in 24 French hospitals. All patients diagnosed with proven, probable or putative CNS mucormycosis from 2005 to 2020 -according to modified EORTC criteria – were included.

 

Results:

We enrolled 42 patients (21 proven, 17 probable and 4 putative CNS mucormycosis). Their median age was 60 years [IQR=49-64] and 69% were men. Twenty-eight (67%) had a disseminated infection due to haematogenous dissemination, while 14 (33%) had rhino-orbito-cerebral mucormycosis (ROCM). The main three underlying diseases were haematological malignancies (n=27), solid organ transplants (n=8) and diabetes mellitus (n=3). There was no significant difference between haematogenous dissemination and ROCM in terms of underlying diseases, but among 3 patients who had no identified risk factor, all had ROCM (p=0.01). Frequently observed clinical signs included fever (74%) and impaired consciousness (49%). However, 28% of patients had normal neurological examination. At diagnosis, lymphopenia, hypoalbuminemia and neutropenia (<1000/mm3) were observed in 87%, 75% and 58% of patients, respectively. In addition, cerebrospinal fluid (CSF) analysis in 14 patients revealed 4 meningitis and 7 increased protein levels. Mucorales’ PCR was positive in the sera of 87% (14/16) of the patients for whom it was measured and in 50% (2/4) of the analyzed CSF. Cerebral imaging was reviewed for 26 patients. Abscesses were present in 12 patients, meningitis in 9 patients, ventriculitis in 1 and encephalitis in 9. Large vessel disease was present in 8 patients and small vessel disease in 10, while venous thrombosis was reported in 4 patients and cavernous sinus infiltration in 4. Patients with disseminated infection often had abscesses, microvascular lesions or macrovascular lesions (63%; 38% and 56%, respectively), while meningitis and cavernous sinus infiltrations were particularly common in ROCM (83 and 43% of patients). Overall one-month mortality reached 68% (including 16 patients (40%) who died within the first week after diagnosis). In univariate analysis, death at one month was significantly associated with haematogenous dissemination (OR=12.94) and neutropenia at diagnosis (OR=5.33). Neurosurgery was performed in 4 patients and tended to be associated with decreased one-month mortality, but this result was not statistically significant (p=0.06) and one severe complication was reported (bleeding).

 

Conclusion:

This study emphasizes that CNS mucormycosis is rapidly fatal, especially in case of hematogenous dissemination and neutropenia. Thus, CNS infection should be tracked when invasive mucormycosis is identified or suspected. Normal clinical examination should not exclude the diagnosis: CSF analysis and imaging of the brain should be performed when possible.

Abstract Number: 14

Conference Year: 2022

Link to conference website: https://aaam2022.org/

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