Objectives
Mucormycosis is an invasive fungal infection from non-septate fungi with high morbidity and mortality especially in uncontrolled diabetic patients and immunocompromised patients. The objective of this study is to review the epidemiology of this infection from 2006 to 2016 to understand the trend of this infection and treatment success rate.
Methods
This study collected inpatient records from the principal diagnosis of mucormycosis from medical records at a tertiary-care hospital, King Chulalongkorn Memorial Hospital, from 2006 to 2016. These thirty-six patients with mucormycosis were classified as proven, probable, and possible mucormycosis according to EORTC/MSG criteria.
Results
From this study, thirty-three patients (91.7%) were classified as
proven mucormycosis using histopathological evidence (thirty-one patients, 93.9%) or both histopathological and microbiological evidence (two patients, 6.1%). The rest three patients were diagnosed as possible mucormycosis using clinical characteristics alone. The most common underlying disease for this infection was diabetes (61.1%) while the following underlying diseases were hematological malignancies (leukemia, lymphoma) (25%), other immunodeficiency diseases (AIDS, CMI defects) (11.1%), structure defects (lung cavity) (2.8%). Paranasal sinuses (75%) and lungs (22%) were the main sites of infection. This study showed that only two patients with hematological malignancies had the microbiological evidence from positive fungal cultures inside paranasal sinuses as Mucor spp. In addition, there were three patients that had histopathological evidence of Aspergillus spp. co-infections inside their lungs. The effective treatment of this infection, especially inside paranasal sinuses and lungs, was surgery (endoscopic sinuscope with debridement or lobectomy) with antifungal therapy (amphotericin B). Conventional amphotericin B was used mostly in this study when some patients had to switch into liposomal amphotericin B (25%) or posaconazole (16.67%) because of side effects of amphotericin B. Acute kidney injury, the most common form of amphotericin B side effects, was observed about 55.9% from patients using conventional amphotericin B. The overall mortality rate was 30.6 percent. 
Conclusion
In Thailand, both diabetic patients and immunocompromised patients are increasing; however, the incidence of mucormycosis infection has not changed much during these ten years. The reason behind this may come from the under-diagnosis of this serious infection. The conventional culture method does not seem to be very helpful in this infection while histopathological evidence is still crucial for the diagnosis. For early detection of this infection, the molecular approach, e.g. ITS-sequencing, could be implemented. The mortality rate of this infection in this study is mostly depending on the response to conventional amphotericin B treatment. Therefore, liposomal amphotericin B and posaconazole are the alternative better options if the patients do not respond to conventional amphotericin B.

Epidemiology of Mucormycosis in a Thai Tertiary-Care Hospital, King Chulalongkorn Memorial Hospital, Bangkok, during 2006-2016