Rhino-orbito-cerebral mucormycosis (ROCM) in eastern Iran: a six-year dual-center retrospective observational study of 329 patients.
7 affiliations
- 1Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- 2Department of Infectious Diseases and Tropical Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- 3Infectious Diseases Research Center, Birjand University of Medical Scieces, Birjand, Iran. [email protected].
- 4Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- 5Department of Statistics, Ferdowsi University of Mashhad, Mashhad, Iran.
- 6School of Nursing and Midwifery, Mashhad University of Medical Science, Mashhad, Iran.
- 7Department of Infectious Diseases and Tropical Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. [email protected].
Abstract
Background
Invasive mucormycosis is a rapidly progressive angioinvasive mycosis with high mortality. We aimed to describe epidemiology, presentation, diagnostics, antifungal utilization, in-hospital outcomes, sex-based descriptive differences, and available sociodemographic variables among patients managed at referral hospitals in eastern Iran.Methods
We conducted a retrospective observational study of all hospitalized rhino-orbito-cerebral mucormycosis (ROCM) cases at two tertiary hospitals in Mashhad, March 2018-March 2024. Inclusion required compatible clinical features plus pathological confirmation. Data were abstracted from charts, imaging archives, and pathology. Endoscopic, radiologic, and histopathologic findings; comorbidities; therapies; and in-hospital outcomes were summarized and compared using descriptive statistics.Results
Among 329 patients (52.9% male), median age was 53 years (IQR 31-59); 71.4% lived in urban areas and 23.7% required ICU care. Diabetes was present in 45.6% and immunosuppressive therapy in 51.1%. Endoscopy (n = 326) most often showed necrosis (54.3%) and crusting (37.4%). Across 571 imaging procedures, mucosal thickening (68.1%) and sinus opacification (67.8%) predominated; orbital involvement occurred in 13.7%. Of 495 biopsies, the nasal septum was the commonest site (22.8%); histology reported necrosis in 49.1% and angioinvasion in 4.6%. L-AmB was administered to 56.8% and deoxycholate to 28.6%; combination regimens were less frequent. Overall, in-hospital mortality was 30.4%; survival to discharge occurred in 58.7%. Standardized 6-week or 12-week mortality could not be calculated from the available retrospective records. Unadjusted survival varied across antifungal regimens, but dual and triple antifungal groups were small; therefore, these descriptive differences should not be interpreted as evidence of comparative efficacy or superiority of combination antifungal therapy.Conclusions
In this large retrospective cohort of referral-hospital ROCM, diagnosis commonly involved endoscopy, cross-sectional imaging, and tissue-based confirmation, and most patients received amphotericin B formulations with azole-containing combinations used in a minority. In-hospital mortality was 30.4%; however, lack of standardized severity staging, treatment-timing metrics, surgical debridement data, and antifungal dosing/duration precludes attributing outcomes to specific care processes. Observed differences between male and female patients in socioeconomic variables and regimen selection are descriptive and warrant evaluation in datasets with baseline severity and timing variables.
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BibTeX
@article{bakhshaee2026rhinoorbitocerebral,
title = {{Rhino-orbito-cerebral mucormycosis (ROCM) in eastern Iran: a six-year dual-center retrospective observational study of 329 patients.}},
author = {Mehdi Bakhshaee and Salman Banifazl and Arash Ziaee and Ali Tajik and Mehdi Jabbari Nooghabi and Imaneh Roshanzamir and Amin Bojdi and Hossein Alavi and Kiana Ketabi and Sarina Aeen and Mahnaz Arian},
journal = {BMC infectious diseases},
year = {2026},
month = jul,
doi = {10.1186/s12879-026-13860-z},
url = {https://europepmc.org/article/MED/42902156},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Rhino-orbito-cerebral mucormycosis (ROCM) in eastern Iran: a six-year dual-center retrospective observational study of 329 patients.
AU - Mehdi Bakhshaee
AU - Salman Banifazl
AU - Arash Ziaee
AU - Ali Tajik
AU - Mehdi Jabbari Nooghabi
AU - Imaneh Roshanzamir
AU - Amin Bojdi
AU - Hossein Alavi
AU - Kiana Ketabi
AU - Sarina Aeen
AU - Mahnaz Arian
PY - 2026
DA - 2026/07/01
JO - BMC infectious diseases
DO - 10.1186/s12879-026-13860-z
UR - https://europepmc.org/article/MED/42902156
AB - Background Invasive mucormycosis is a rapidly progressive angioinvasive mycosis with high mortality. We aimed to describe epidemiology, presentation, diagnostics, antifungal utilization, in-hospital outcomes, sex-based descriptive differences, and available sociodemographic variables among patients managed at referral hospitals in eastern Iran.Methods We conducted a retrospective observational study of all hospitalized rhino-orbito-cerebral mucormycosis (ROCM) cases at two tertiary hospitals in Mashhad, March 2018-March 2024. Inclusion required compatible clinical features plus pathological confirmation. Data were abstracted from charts, imaging archives, and pathology. Endoscopic, radiologic, and histopathologic findings; comorbidities; therapies; and in-hospital outcomes were summarized and compared using descriptive statistics.Results Among 329 patients (52.9% male), median age was 53 years (IQR 31-59); 71.4% lived in urban areas and 23.7% required ICU care. Diabetes was present in 45.6% and immunosuppressive therapy in 51.1%. Endoscopy (n = 326) most often showed necrosis (54.3%) and crusting (37.4%). Across 571 imaging procedures, mucosal thickening (68.1%) and sinus opacification (67.8%) predominated; orbital involvement occurred in 13.7%. Of 495 biopsies, the nasal septum was the commonest site (22.8%); histology reported necrosis in 49.1% and angioinvasion in 4.6%. L-AmB was administered to 56.8% and deoxycholate to 28.6%; combination regimens were less frequent. Overall, in-hospital mortality was 30.4%; survival to discharge occurred in 58.7%. Standardized 6-week or 12-week mortality could not be calculated from the available retrospective records. Unadjusted survival varied across antifungal regimens, but dual and triple antifungal groups were small; therefore, these descriptive differences should not be interpreted as evidence of comparative efficacy or superiority of combination antifungal therapy.Conclusions In this large retrospective cohort of referral-hospital ROCM, diagnosis commonly involved endoscopy, cross-sectional imaging, and tissue-based confirmation, and most patients received amphotericin B formulations with azole-containing combinations used in a minority. In-hospital mortality was 30.4%; however, lack of standardized severity staging, treatment-timing metrics, surgical debridement data, and antifungal dosing/duration precludes attributing outcomes to specific care processes. Observed differences between male and female patients in socioeconomic variables and regimen selection are descriptive and warrant evaluation in datasets with baseline severity and timing variables.
SN - 1471-2334
ER -