ADVANCEMENTS IN THE DIAGNOSIS AND MANAGEMENT OF MUCORMYCOSIS IN PATIENTS WITH DIABETES MELLITUS: AN INTEGRATED APPROACH FROM INTERNAL MEDICINE AND DENTAL SCIENCES
DOI:
https://doi.org/10.70520/kjms.v19i1.857Keywords:
Mucormycosis, Diabetes Mellitus, rhino-orbital-cerebral, oral cavity, interdisciplinary care, systematic reviewAbstract
Background: Mucormycosis, a lethal opportunistic fungal infection, primarily affects immunocompromised patients, with diabetes mellitus (DM) as the leading risk factor due to immune impairment and metabolic disruption. The oral cavity serves as the main entry point in rhino-orbital-cerebral (ROC) cases, demanding integrated internal medicine and dental care.
Methods: This PRISMA 2020-compliant systematic review searched PubMed, Embase, Scopus, and Cochrane (January 2020–October 2025). Two independent reviewers screened 1,247 records, assessing 62 full-texts. We included 15 studies: systematic reviews, case reports, case series, and observational studies involving diabetic patients with mucormycosis. Quality assessment via A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and Newcastle-Ottawa Scale (NOS).
Results: From 15 included studies (5 systematic reviews; 10 primary studies), ROC involvement predominated in 70-86% of diabetic mucormycosis cases. The oral cavity served as entry point in 50–60% of ROC presentations. Rhizopus species dominated (68%); uncontrolled DM (glycated hemoglobin [HbA1c] >9%) conferred substantially elevated risk. Diagnostic advances included polymerase chain reaction (PCR) with bronchoalveolar lavage fluid (BALF) achieving 97.5% sensitivity (95% CI 83.7-99.7%), tissue 86.4% (95% CI 78.9-91.5%), and blood 81.6% (95% CI 70.1-89.4%).
Computed tomography (CT)/magnetic resonance imaging (MRI) showed predominant ethmoid (86%) and maxillary (79%) sinus involvement. Multimodal therapy (liposomal amphotericin B [L-AmB] 5–10 mg/kg plus surgical debridement) achieved 57-75% survival. Interdisciplinary consultation within 24 hours and glycemic control <180 mg/dL improved outcomes.
Conclusions: Integrated internal medicine–oral surgery collaboration optimizes outcomes. Dentists should maintain high suspicion for palatal lesions in diabetic patients; internists should incorporate oral cavity examination in routine diabetes care.
