Outcomes of early anti-fungal therapy with aggressive surgical resection in pulmonary mucormycosis

OBJECTIVES: The standard management protocols are lacking in the management of pulmonary mucormycosis (PM). The present study aims at reporting our clinical experience and proposing an algorithm for the management of PM. MATERIALS AND METHODS: This is a retrospective analysis of a prospectively maintained database at a dedicated thoracic surgical unit in New Delhi, India, over 7 years. An analysis of demographic characteristics and perioperative variables including complications was carried out. Various parameters were analyzed to assess the factors affecting mortality after surgical intervention. RESULTS: Out of total 19 patients, 15 were males (78.9%) and 4 females (21.1%), with a mean age of 43.8 years (range, 19–72 years). Chronic kidney disease (status postrenal transplant on immunosuppressant therapy) was the most common predisposing factor in 11 patients (57.8%). All patients were initially started on antifungal therapy, and after 7–8 days, the response was assessed by computed tomography scan of the chest, and based on that, 15 patients (78.9%) were operated (surgical group) and the rest 4 (21.1%) were not (nonsurgical group). In the surgical group, lobectomy was required in 12 (80%) and pneumonectomy in 3 patients (20%). Postoperative complications occurred in 5 patients (33.3%). There were 3 perioperative deaths (within 90 days of surgery) (20%). Poor Eastern Cooperative Oncology Group performance status (>2) and longer duration of symptoms (>2 weeks) were independent predictors of mortality after surgery. The survivors in the surgical group are doing well. However, all four patients in the nonsurgical group died due to disease progression. CONCLUSION: After few days of initiation of antifungal therapy, aggressive surgical resection must be performed (wherever feasible) to improve survival outcome in patients with PM.