Central nervous system mucormycosis in diabetic patients: clinical features, neuroimaging and outcomes from a tertiary care hospital in Bangladesh

Abstract

Background: Central nervous system (CNS) mucormycosis is a rare but life-threatening fungal infection that predominantly affects patients with uncontrolled diabetes mellitus. Data on its clinical characteristics, neuroimaging findings, management, and outcomes in Bangladesh remain limited. This study aimed to describe the clinical profile and outcomes of CNS mucormycosis in diabetic patients at a tertiary care hospital.

Methods: We conducted a retrospective cohort study of adult diabetic patients (e”18 years) with confirmed CNS mucormycosis admitted between 1 July 2021 and 30 June 2025. Data on demographics, comorbidities, clinical presentation, laboratory parameters, microbiological or histopathological findings, neuroimaging features, treatments, and outcomes were collected from medical records. Follow-up data up to three months after discharge were also analyzed.

Results: A total of 27 patients with CNS mucormycosis were included. Type 2 diabetes mellitus was present in 23 (85%), and type 1 diabetes mellitus in 4 (15%). Diabetic ketoacidosis occurred in 2 (7%), and chronic kidney disease in 7 (26%). HbA1c ranged from 9.5% to 16.4%, indicating poor glycemic control. The most frequent presenting symptoms were headache (24, 90%), fever (22, 82%), and periorbital swelling (21, 76%). Neurological features included ophthalmoplegia (14, 52%), cranial nerve palsy (11, 42%), and altered consciousness (4, 16%). Seizures and hemiplegia were less common (4, 16% and 3, 12%, respectively). Microbiological or histopathological confirmation was achieved in about half of the cases. MRI showed sinusitis (15, 56%), orbital extension/mass (13, 47%), cavernous sinus thrombosis (4, 16%), intracerebral space-occupying lesions (4, 14%), cerebral infarction (2, 8%), and skull base osteomyelitis (1, 3%). Treatment included conventional amphotericin B (13, 48%), liposomal amphotericin B (8, 30%), and posaconazole (6, 22%). Surgical interventions included functional endoscopic sinus surgery (11, 41%), maxillary/palatal debridement (3, 11%), and craniotomy (1, 4%). Hospital stay ranged from 13–28 days. In-hospital mortality was 52% (14/27). Among survivors, 8 (30%) had persistent neurological deficits at discharge. At three-month follow-up (n = 13), recurrence occurred in 6 (46%), persistent neurological deficits in 5 (38%), and complete recovery in 2 (15%).

Conclusions: CNS mucormycosis in diabetic patients is associated with high morbidity and mortality. Early diagnosis, prompt antifungal therapy, surgical intervention, and strict glycemic control are essential to improve outcomes. The high recurrence and neurological complication rates highlight the need for close follow-up in this high-risk population.

BIRDEM Med J 2026; 16(2): 58-64