Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases

Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2005; 41(5):634-53. DOI: 10.1086/432579
Source: PubMed


Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease.
We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described.
The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively).
Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.

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Available from: Thomas J Walsh, Apr 03, 2015
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    • " poorly controlled diabetes mellitus , haema - tological malignancies and allogeneic stem cell transplan - tation , solid - organ transplant recipients and patients with other immunedeficiencies such as after high - dose steroid use , renal insufficiency and trauma secondary to accidents or major surgery and burns ( Petrikkos et al., 2012 , 2014 ; Roden et al . , 2005 ; Skiada et al . , 2011 ; Sun & Singh , 2011 ) . Mucormycosis of the maxillary sinus occurs following inhalation of sporangiospores of mucormycetes , molds that are ubiquitous in the environment , and may extend to the hard palate and develop into a painful necrotic ulcer - ation . Palatal ulceration may be the first clinical finding , "
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    ABSTRACT: Introduction: Mucormycosis is a rare fungal infection, with high morbidity and mortality. Palatal ulceration may suggest a number of differential diagnoses, one of which is rhinocerebral/craniofacial mucormycosis and for which it may be the first presenting clinical finding. We report a case of sinus mucormycosis in a patient with chronic myelomonocytic leukaemia-2 (CMML-2), now classified in the myelodysplastic/myeloproliferative neoplasms, presenting with dental painand palatal ulcer. Case presentation: A 72-year-old female with CMML-2 presented with pain of the left maxillary molar and a dark-brown necrotic ulcer with a white irregular border on the hard palate. Invasive fungal infection was included in the differential diagnosis. Computerized tomography disclosed inflammatory lesions in the left nasal, ethmoid and frontal sinuses. Histological examination of the ulcer showed fungal hyphae typical of agents of mucormycosis. Rhizopus arrhizus was isolated from the culture. Liposomal amphotericin B was introduced, combined with haematological support and maxillectomy. Mucormycosis was controlled, but the patient died of progressive acute myeloid leukaemia and multiple bacteraemias. A literature review of rhinocerebral mucormycosis with palatal involvement disclosed 109 cases; palatal involvement was present among other presenting signs in 34 patients and as the presenting sign leading to diagnosis in nine cases, including the present case. Six of the nine patients (66.6 %) survived the infection, compared with 43 of 101 (42.6 %) with other signs at presentation. Conclusion: Palatal ulcer may represent an early sign of sinus mucormycosis. Awareness by healthcare professionals is critical for the prompt diagnosis of this rapidly developing and lifethreatening infection.
    01/2015; 2(1):e000014-e000014. DOI:10.1099/jmmcr.0.000014
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    • "La mortalité globale d'une série de 18 cas de mucormycoses post-traumatiques en France de 2005 à 2007 était de 11 % [16]. L'évolution dépend du caractère extensif de l'infection et de la localisation du traumatisme [26]. Le risque de mortalité semble plus élevé en cas de traumatisme crânien en raison de la nécrose des tissus mous adjacents cérébraux [5]. "
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    ABSTRACT: Nous rapportons 3 observations de mucormycoses cutanées post-traumatiques à Lichtheimia corymbifera, dont 2 survenues après un traumatisme majeur en milieu agricole. La prise en charge des mucormycoses post-traumatiques repose sur une large excision des tissus infectés, associée à un traitement antifongique, prescrit le plus rapidement possible. L’amphotéricine B liposomale est le traitement recommandé en première ligne. Le posaconazole a été peu évalué. Nos trois patients ont bénéficié d’un débridement chirurgical associé à un traitement antifongique par amphotéricine B liposomale dans tous les cas, avec relais par posaconazole dans 2 cas. La durée du traitement antifongique n’est pas définie. Tous nos patients ont reçu un traitement de 5 semaines, avec une évolution favorable.
    Journal de Mycologie Médicale/Journal of Medical Mycology 11/2014; 24(4). DOI:10.1016/j.mycmed.2014.10.013 · 0.57 Impact Factor
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    • "Making an early diagnosis to facilitate rapid initiation of antifungal therapy, along with extensive and aggressive surgical debridement of involved tissues, is crucial for the management of mucormycosis [15]. Multiple studies have found surgery to be an independent variable for a favourable outcome in patients with mucormycosis [4] [5] [10]. The rapid progression of this infection should be explained to the treating surgical teams involved, who may otherwise be reluctant to perform extensive debridement. "
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    ABSTRACT: Mucormycosis is a severe fungal infection that largely affects immunocompromised individuals. It carries a high morbidity and mortality rate and is characterised by extensive angioinvasion and necrosis of host tissue. This case report details success in treating disseminated mucormycosis in a paediatric patient with an underlying haematological malignancy. Treatment included institution of combination antifungal therapy with liposomal amphotericin B and caspofungin, aggressive surgical debridement of infected tissue and reversal of underlying immunosuppression.
    Medical Mycology Case Reports 10/2014; 6(1). DOI:10.1016/j.mmcr.2014.08.002
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