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Gastrointestinal and Intra-Abdominal Mucormycosis in Non-Haematological Patients—A Comprehensive Review

Summary

This review examines a serious but rare fungal infection called mucormycosis that affects the stomach and intestines. The infection most commonly occurs in patients with diabetes, those who have received organ transplants, or those in intensive care units. Diagnosis can be difficult because symptoms are non-specific, but prompt treatment with antifungal medications and surgery when possible significantly improves survival rates. Early recognition and rapid diagnosis are critical for patients to have the best outcomes.

Background

Gastrointestinal and intra-abdominal mucormycosis are less frequent than pulmonary and rhino-orbito-cerebral forms but highly lethal. These infections are caused by fungi of the order Mucorales and occur primarily in debilitated patients. Diagnosis remains challenging due to non-specific clinical presentations.

Objective

To comprehensively review epidemiological, clinical, and therapeutic characteristics of gastrointestinal and intra-abdominal mucormycosis in non-haematological and non-neonatal patients. The review aimed to identify predisposing conditions, clinical presentations, diagnostic methods, and treatment outcomes.

Results

Fifty-three percent of cases were from India and USA. Diabetes, solid organ transplant, ICU admission, and corticosteroid use were main predisposing factors. The stomach was most commonly affected (53.8%). Diagnosis relied on histology (93.8%), mycology (38.8%), and molecular methods (9.9%). Overall 90-day mortality was 52.9%, lower with amphotericin B treatment combined with or without surgery.

Conclusion

Early suspicion and prompt treatment with amphotericin B and surgical intervention when feasible improve outcomes. GI and IA mucormycosis should be suspected in ICU patients with ventilation/nasogastric tubes receiving corticosteroids presenting with abdominal pain, distension, and GI bleeding. Rapid mycological diagnosis including direct examination, culture, and Mucorales qPCR is essential.
  • Published in:Journal of Fungi,
  • Study Type:Comprehensive Review,
  • Source: PMID: 40278118, DOI: 10.3390/jof11040298
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