Mucormicosis y sus formas clínicas: serie de casos
Palabras clave:
mucormicosis, infecciones fúngicas invasoras, huésped inmunocomprometido
Resumen
La mucormicosis es una infección fúngica invasiva poco frecuente causada por hongos del orden Mucorales, que afecta principalmente a pacientes con factores predisponentes como diabetes mellitus o alguna inmunosupresión. Puede presentarse en diversas formas clínicas: rinocerebral, pulmonar, cutánea, gastrointestinal y diseminada.
Exponemos una serie de casos que fueron atendidos en un hospital universitario de tercer nivel en Paraguay, en un periodo de 10 meses y pretenden aportar a la literatura una descripción detallada de sus diferentes formas clínicas, de las estrategias terapéuticas implementadas, con el objetivo de favorecer el reconocimiento precoz de esta patología y con ello mejorar las tasas de sobrevida.
Citas
1. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin Infect Dis [Internet]. 2005 [cited 2025 Oct 28];41(5):634–53. Available from: https://scispace.com/pdf/epidemiology-and-outcome-of-zygomycosis-a-review-of-929-5d2xmysi26.pdf
2. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis [Internet]. 2019 [cited 2025 Oct 12];19(12):e405–21. Available from: https://pubmed.ncbi.nlm.nih.gov/31699664
3. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) [Internet]. 2020 [cited 2025 Oct 12];6(4):265. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7711598
4. Pomarada ME, Ramirez LI, Rea AE, Morales SD, Cohen RI, Karaben VE. Mucormicosis asociada a COVID-19. Revisión de la literatura para odontólogos. Rev Asoc Odontol Argent [Internet]. 2022 [citado 26 Oct 2025];110(2): e1100851. Disponible en: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S2683-72262022000200008&lng=es&nrm=iso&tlng=es
5. Centers for Disease Control and Prevention (CDC). Data and statistics on mucormycosis [Internet]. United States: CDC; 2024. [cited 2025 Oct 28]. Available from: https://www.cdc.gov/mucormycosis/data-research/index.html
6. Özbek L, Topçu U, Manay M, Esen BH, Bektas SN, Aydın S, et al. COVID-19–associated mucormycosis: a systematic review and meta-analysis of 958 cases. Clin Microbiol Infect [Internet]. 2023 [cited 2025 Oct 27];29(6):722-31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10008766/
7. Brown L, Tschiderer L, Alanio A, Barnes RA, Chen SC, Cogliati M, et al. The diagnosis of mucormycosis by PCR in patients at risk: a systematic review and meta-analysis. EClinicalMedicine. 2025 Feb 22;81:103115. doi: 10.1016/j.eclinm.2025.103115. Available from: https://pubmed.ncbi.nlm.nih.gov/40083443/
8. Suganya R, Malathi N, Karthikeyan V, Janagaraj VD. Mucormycosis: A brief review. J Pure Appl Microbiol [Internet]. 2019 [cited 2025 Oct 27];13(1):161–5. Available from: https://microbiologyjournal.org/mucormycosis-a-brief-review/
9. Montiel Jarolin D, Insaurralde S, Jarolin M, Sánchez L, García E. Mucurmicosis rinocerebral en un paciente con diabetes descompensada. Rev cient cienc salud [Internet]. 2023 [citado 12 Oct 2025]; 5:1–6. Disponible en: https://revistascientificas.upacifico.edu.py/index.php/PublicacionesUP_Salud/article/view/323
10. Hernández JL, Buckley CJ. Mucormycosis [Internet]. En: StatPearls. [cited 2025 Oct 14]. Treasure Island (FL): StatPearls Publishing LLC; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544364/
11. Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, Chen SCA. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect [Internet]. 2019 [cited 2025 Oct 28];25(1):26–34. Available from: https://pubmed.ncbi.nlm.nih.gov/30036666/
12. Safiia J, Díaz MA, Alshaker H, Atallah CJ, Sakr P, Moshovitis DG, Nawlo A, Franceschi AE, Liakos A, Koo S. Recent Advances in Diagnostic Approaches for Mucormycosis. J Fungi (Basel). 2024 Oct 19;10(10):727. doi: 10.3390/jof10100727. Available from: https://pubmed.ncbi.nlm.nih.gov/39452679/
13. Manrique-Castaño S, Velásquez-Trujillo LA, Ángel-Correa M, Bravo JH, Matta-Cortés L. Mucormicosis: un dulce enemigo, serie de casos. Biomédica [Internet]. 2024 [citado 27 Oct 2025];44(2):135–43. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/7120
14. Xipell M, Losno RA, Garcia-Vidal C, Rovira M, Alejo-Cancho I, Puig de la Bellacasa J, et al. Características clínicas y evolución de los pacientes diagnosticados de mucormicosis en un hospital de tercer nivel (2012-2016). Rev Iberoam Micol [Internet]. 2018 [citado 28 Oct 2025];35(3):162–6. Disponible en: https://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-pdf-S1130140618300445
15. Dailey Garnes NJM, Kontoyiannis DP. Mucormycosis: update on clinical presentation, diagnosis, and treatment. Curr Opin Infect Dis. 2023 Dec 1;36(6):427-435. doi: 10.1097/QCO.0000000000000976. Available from: https://pubmed.ncbi.nlm.nih.gov/37732771/
16. Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. Mucormicosis diseminadas en pacientes sin inmunodeficiencias: una enfermedad que también existe. Rev Iberoam Micol [Internet]. 2015 [citado 27 Oct 2025];32(2):63–70. Disponible en: https://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-pdf-S1130140614000631
17. Lanternier F, Dannaoui E, Morizot G, Elie C, Garcia-Hermoso D, Huerre M, et al. A global analysis of mucormycosis in France: The RetroZygo study (2005–2007). Clin Infect Dis [Internet]. 2012 [cited 2025 Oct 28];54(suppl_1):S35–43. Available from: https://www.researchgate.net/publication/221749688_A_Global_Analysis_of_Mucormycosis_in_France_The_RetroZygo_Study_2005-2007
18. Regupathy J, Rajendran P, Kumar V, Shanmugam S. Is pulmonary mycoses shadowed by tuberculosis? Mandate to hit the bull’s eye—an Indian perspective. Pathogens [Internet]. 2025 [cited 2025 Oct 28];14(5):435. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12113956/
19. Plowes Hernández O, Prado Calleros HM, Soberón Marmissolle Daguerre GS, Sadek González A. Rhino-Orbito-Cerebral Mucormycosis. Management Strategies to Avoid or Limit Intracraneal Affection and Improve Survival. Acta Otorrinolaringol Esp [Internet]. 2015 [cited 2025 Oct 27];66(6):348–52. Available from: https://www.researchgate.net/publication/277817396_Rhino-Orbito-Cerebral_Mucormycosis_Management_Strategies_to_Avoid_or_Limit_Intracraneal_Affection_and_Improve_Survival
20. Alqarihi A, Kontoyiannis DP, Ibrahim AS. Mucormycosis in 2023: an update on pathogenesis and management. Front Cell Infect Microbiol. 2023 Sep 21;13:1254919. doi: 10.3389/fcimb.2023.1254919. Available from: https://pubmed.ncbi.nlm.nih.gov/37808914/
21. Martín Gómez MT, Salavert Lletí M. Mucormicosis: perspectiva de manejo actual y de futuro. Rev Iberoam Micol [Internet]. 2021 [citado 28 Oct 2025];38(2):91–100. Available from: https://www.sciencedirect.com/science/article/pii/S1130140621000292?via%3Dihub
2. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis [Internet]. 2019 [cited 2025 Oct 12];19(12):e405–21. Available from: https://pubmed.ncbi.nlm.nih.gov/31699664
3. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) [Internet]. 2020 [cited 2025 Oct 12];6(4):265. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7711598
4. Pomarada ME, Ramirez LI, Rea AE, Morales SD, Cohen RI, Karaben VE. Mucormicosis asociada a COVID-19. Revisión de la literatura para odontólogos. Rev Asoc Odontol Argent [Internet]. 2022 [citado 26 Oct 2025];110(2): e1100851. Disponible en: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S2683-72262022000200008&lng=es&nrm=iso&tlng=es
5. Centers for Disease Control and Prevention (CDC). Data and statistics on mucormycosis [Internet]. United States: CDC; 2024. [cited 2025 Oct 28]. Available from: https://www.cdc.gov/mucormycosis/data-research/index.html
6. Özbek L, Topçu U, Manay M, Esen BH, Bektas SN, Aydın S, et al. COVID-19–associated mucormycosis: a systematic review and meta-analysis of 958 cases. Clin Microbiol Infect [Internet]. 2023 [cited 2025 Oct 27];29(6):722-31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10008766/
7. Brown L, Tschiderer L, Alanio A, Barnes RA, Chen SC, Cogliati M, et al. The diagnosis of mucormycosis by PCR in patients at risk: a systematic review and meta-analysis. EClinicalMedicine. 2025 Feb 22;81:103115. doi: 10.1016/j.eclinm.2025.103115. Available from: https://pubmed.ncbi.nlm.nih.gov/40083443/
8. Suganya R, Malathi N, Karthikeyan V, Janagaraj VD. Mucormycosis: A brief review. J Pure Appl Microbiol [Internet]. 2019 [cited 2025 Oct 27];13(1):161–5. Available from: https://microbiologyjournal.org/mucormycosis-a-brief-review/
9. Montiel Jarolin D, Insaurralde S, Jarolin M, Sánchez L, García E. Mucurmicosis rinocerebral en un paciente con diabetes descompensada. Rev cient cienc salud [Internet]. 2023 [citado 12 Oct 2025]; 5:1–6. Disponible en: https://revistascientificas.upacifico.edu.py/index.php/PublicacionesUP_Salud/article/view/323
10. Hernández JL, Buckley CJ. Mucormycosis [Internet]. En: StatPearls. [cited 2025 Oct 14]. Treasure Island (FL): StatPearls Publishing LLC; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544364/
11. Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, Chen SCA. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect [Internet]. 2019 [cited 2025 Oct 28];25(1):26–34. Available from: https://pubmed.ncbi.nlm.nih.gov/30036666/
12. Safiia J, Díaz MA, Alshaker H, Atallah CJ, Sakr P, Moshovitis DG, Nawlo A, Franceschi AE, Liakos A, Koo S. Recent Advances in Diagnostic Approaches for Mucormycosis. J Fungi (Basel). 2024 Oct 19;10(10):727. doi: 10.3390/jof10100727. Available from: https://pubmed.ncbi.nlm.nih.gov/39452679/
13. Manrique-Castaño S, Velásquez-Trujillo LA, Ángel-Correa M, Bravo JH, Matta-Cortés L. Mucormicosis: un dulce enemigo, serie de casos. Biomédica [Internet]. 2024 [citado 27 Oct 2025];44(2):135–43. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/7120
14. Xipell M, Losno RA, Garcia-Vidal C, Rovira M, Alejo-Cancho I, Puig de la Bellacasa J, et al. Características clínicas y evolución de los pacientes diagnosticados de mucormicosis en un hospital de tercer nivel (2012-2016). Rev Iberoam Micol [Internet]. 2018 [citado 28 Oct 2025];35(3):162–6. Disponible en: https://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-pdf-S1130140618300445
15. Dailey Garnes NJM, Kontoyiannis DP. Mucormycosis: update on clinical presentation, diagnosis, and treatment. Curr Opin Infect Dis. 2023 Dec 1;36(6):427-435. doi: 10.1097/QCO.0000000000000976. Available from: https://pubmed.ncbi.nlm.nih.gov/37732771/
16. Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. Mucormicosis diseminadas en pacientes sin inmunodeficiencias: una enfermedad que también existe. Rev Iberoam Micol [Internet]. 2015 [citado 27 Oct 2025];32(2):63–70. Disponible en: https://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-pdf-S1130140614000631
17. Lanternier F, Dannaoui E, Morizot G, Elie C, Garcia-Hermoso D, Huerre M, et al. A global analysis of mucormycosis in France: The RetroZygo study (2005–2007). Clin Infect Dis [Internet]. 2012 [cited 2025 Oct 28];54(suppl_1):S35–43. Available from: https://www.researchgate.net/publication/221749688_A_Global_Analysis_of_Mucormycosis_in_France_The_RetroZygo_Study_2005-2007
18. Regupathy J, Rajendran P, Kumar V, Shanmugam S. Is pulmonary mycoses shadowed by tuberculosis? Mandate to hit the bull’s eye—an Indian perspective. Pathogens [Internet]. 2025 [cited 2025 Oct 28];14(5):435. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12113956/
19. Plowes Hernández O, Prado Calleros HM, Soberón Marmissolle Daguerre GS, Sadek González A. Rhino-Orbito-Cerebral Mucormycosis. Management Strategies to Avoid or Limit Intracraneal Affection and Improve Survival. Acta Otorrinolaringol Esp [Internet]. 2015 [cited 2025 Oct 27];66(6):348–52. Available from: https://www.researchgate.net/publication/277817396_Rhino-Orbito-Cerebral_Mucormycosis_Management_Strategies_to_Avoid_or_Limit_Intracraneal_Affection_and_Improve_Survival
20. Alqarihi A, Kontoyiannis DP, Ibrahim AS. Mucormycosis in 2023: an update on pathogenesis and management. Front Cell Infect Microbiol. 2023 Sep 21;13:1254919. doi: 10.3389/fcimb.2023.1254919. Available from: https://pubmed.ncbi.nlm.nih.gov/37808914/
21. Martín Gómez MT, Salavert Lletí M. Mucormicosis: perspectiva de manejo actual y de futuro. Rev Iberoam Micol [Internet]. 2021 [citado 28 Oct 2025];38(2):91–100. Available from: https://www.sciencedirect.com/science/article/pii/S1130140621000292?via%3Dihub
