Comparative Prognosis of Fungal Balls Versus Invasive Pulmonary Mucormycosis

Jiayu Wang,1– 4 Naishu Xie,1– 4 Rui Zhao,1– 4 Huihui Zeng,1– 4 Yan Chen1– 4 1Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People’s Republic of China; 3Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, Hunan, People’s Republic of China; 4Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Huihui Zeng, Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, People’s Republic of China, Email [email protected] Yan Chen, Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, People’s Republic of China, Email [email protected]: Pulmonary mucormycosis is recognized as a highly fatal invasive fungal infection. However, clinical observations have demonstrated unexpectedly favorable outcomes in some patients. This study aimed to compare the clinical presentation, management, and prognosis between patients with fungal balls and invasive pulmonary mucormycosis.Methods: This observational study included patients diagnosed with pulmonary mucormycosis at the Second Xiangya Hospital of Central South University between 2007 and 2023. Based on imaging characteristics, the patients were divided into invasive pulmonary mucormycosis and fungal balls groups, and the underlying diseases, clinical manifestations, diagnostic method, treatment, and prognosis were analyzed.Results: Compared to invasive pulmonary mucormycosis patients, pulmonary mucormycosis patients with fungal balls had fewer systemic underlying diseases, such as diabetes, immunosuppression, and more pre-existing lung diseases like bronchiectasis (82.4%) and tuberculosis (64.7%). They exhibited milder symptoms, mainly cough and sputum, with lower CRP and ESR levels. Pulmonary mucormycosis patients with fungal balls typically involved a single upper lobe, while invasive pulmonary mucormycosis patients often had bilateral lung involvement. Ten pulmonary mucormycosis patients with fungal balls treated surgically without antifungal therapy still had favorable prognoses than those with invasive disease.Conclusion: Compared to invasive pulmonary mucormycosis patients, pulmonary mucormycosis patients with fungal balls exhibit milder clinical symptoms and more favorable prognosis. Surgical intervention might play a critical role in the management of pulmonary mucormycosis patients.Keywords: pulmonary mucormycosis, fungal balls, infection, favorable prognosis