Epidemiology

The incidence of mucormycosis is significantly lower than those of invasive Candida or Aspergillus infections, by about 10- to 50-fold.[3]​​

There is no national surveillance for mucormycosis in the US, making it difficult to determine exact case numbers and trends.[8]​ The estimated incidence in the US is about 1.7 cases per million per year, or 500 cases annually.​[3][9] In 2014, 1140 mucormycosis-related hospitalizations occurred in the US.[10]​​

This disease is more commonly encountered in the immunosuppressed population, but cases in immunocompetent hosts have been described with organisms in the order Entomophthorales.[11]​ The most vulnerable hosts are those with diabetes mellitus (with or without ketoacidosis), hematologic malignancies, solid organ or bone marrow transplants, history of corticosteroid use, and graft-versus-host disease.[4][12][13]​

Prematurity is a major underlying factor for acquiring the disease in neonates.[14]​ Gastrointestinal and cutaneous disease is more common in neonates than in older children and adults. Neonates are also at increased risk for disseminated disease. Overall mortality is 64% in neonates compared with 56% in children more than a month old and less than 18 years of age. Disseminated infection and age less than 12 months are independent risk factors for increased mortality.[15]

In adults, rhino-orbito-cerebral disease is the most common presentation (44% to 49%), followed by cutaneous (10% to 16%), pulmonary (10% to 11%), disseminated (6% to 11.6%), and gastrointestinal (2% to 11%).[16] Rhino-orbito-cerebral is more common in patients with diabetes, whereas pulmonary manifestation is more typical of patients with hematologic malignancies or transplants. The incidence in a study over a 10-year period among transplant recipients, per 1000 patients, was 0.4 to 0.5 in renal transplant recipients, 8 in heart transplant recipients, 4 to 6 in liver transplant recipients, and 13.7 to 14 in lung transplant recipients.[3]

Most cases of mucormycosis are sporadic, though rare outbreaks have occurred in healthcare settings, often linked to nonsterile products such as contaminated bandages, linens, drugs, and food.[4][17][18]​​​[19]​ Invasive procedures such as surgery, dental extractions, and tube insertions, as well as medical devices like insulin pumps, finger sticks, and ostomy bags, have also been implicated in transmission.[17]​ Outbreaks have also been reported following natural disasters, likely due to increased environmental exposure to fungal spores.[4][20]

Mucormycosis has been increasingly reported in patients with coronavirus disease 2019 (COVID-19), particularly in patients who have diabetes mellitus and have also received corticosteroids.[21][22][23]​​[24][25][26][27]

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