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

Division of Infectious Diseases, The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
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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    • "For example, some fungi in the order Mucoracea are difficult to cultivate. In a review of 929 cases of mucormycosis reported between 1940 and 2003, only 50% were culture positive[17]. In the present study, the prevalence of A. flavus was 38.8%; another study in South east Asia found a prevalence of 44%[15], while in Europe, this percentage was reported to be higher (61.5%)[18]. "
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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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