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      Outcome of mucormycosis after treatment: report of five cases

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          Abstract

          Mucormycoses are serious infections caused by filamentous fungi of the order Mucorales. They occur most often in immunocompromised patients. We report five cases of mucormycosis in patients hospitalized in the Infectious Diseases Department in Sousse – Tunisia between 2000 and 2013. They were 4 males and one female, mean age 60 years. Three patients were diabetic and one patient had acute leukemia. The locations of mucormycosis were rhinocerebral, rhino-orbital, auricular, pulmonary and cutaneous. The Mucorales isolated were Rhizopus arrhizus in 3 cases and Lichteimia in 2 cases. All patients were treated with amphotericin B and 2 patients had, in addition, surgical debridement. Two patients died and 2 kept peripheral facial paralysis.

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          Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis.

          Dimitrios Kontoyiannis, Edwin Lewis, Georgios Chamilos (2008)
          Zygomycosis is an emerging opportunistic mycosis among immunocompromised patients with a particularly poor prognosis. We analyzed the impact of delaying effective amphotericin B-based therapy on outcome among 70 consecutive patients with hematologic malignancy who had zygomycosis in our institution during the period 1989-2006. We used classification and regression tree analysis to identify the mortality breakpoint between early and delayed treatment. Delayed amphotericin B-based therapy (i.e., initiating treatment >/=6 days after diagnosis) resulted in a 2-fold increase in mortality rate at 12 weeks after diagnosis, compared with early treatment (82.9% vs. 48.6%); this remained constant across the years of the study and was an independent predictor of poor outcome (odds ratio, 8.1; 95% confidence interval, 1.7-38.2; P = .008) in multivariate analysis. Active malignancy (P = .003) and monocytopenia (P =.01) at the time of diagnosis of infection were also independently associated with a poor outcome, whereas salvage posaconazole-based therapy (P=.01) and neutrophil recovery (P = .009) were predictive of a favorable outcome. Because discriminating between zygomycosis and aspergillosis in a timely fashion is difficult, the pursuit of aggressive diagnostic strategies and prompt initiation of antifungal agents with activity against Zygomycetes should be considered for patients with hematological malignancy who are at an increased risk for zygomycosis.
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            Survival factors in rhino-orbital-cerebral mucormycosis

            Robert A. Yohai, John Bullock, Andy A. Aziz … (1994)
            Article 0 comments Cited 61 times – based on 0 reviews     Review now
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              Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy.

              P Yarnold, Francisco J. Parada, J McKoy … (2007)
              Zygomycosis is increasingly reported as a cause of life-threatening fungal infections. A higher proportion of cases reported over the last decades have been in cancer patients, with or without hematopoietic stem cell transplantation (HSCT). The new anti-fungal agent voriconazole is a recently identified risk factor for developing zygomycosis. We reviewed the clinical characteristics and outcomes of a large cohort of cancer patients who developed zygomycosis after exposure to voriconazole. Health care professionals at 13 large cancer centers provided clinical information on cancer patients with zygomycosis and prior exposure to voriconazole. Criteria for inclusion were 5 days or more of voriconazole use and diagnostic confirmation with tissue or histology. Fifty-eight cases were identified among patients with hematologic malignancies, 62% including patients who underwent a HSCT procedure. Fifty-six patients received voriconazole for primary or secondary prophylaxis against fungal infection. In addition to prior exposure to voriconazole, patients also had several of the previously established risk factors for zygomycosis. Amphotericin B was the most commonly prescribed anti-fungal therapy. Overall mortality was 73%. We conclude that zygomycosis after exposure to voriconazole is a recently described entity that is frequently fatal, despite treatment with currently available anti-fungal agents and surgery.
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                Author and article information

                Contributors
                A. Letaief
                Journal
                Journal ID (nlm-ta): New Microbes New Infect
                Journal ID (iso-abbrev): New Microbes New Infect
                Title: New Microbes and New Infections
                Publisher: Elsevier
                ISSN (Electronic): 2052-2975
                Publication date PMC-release: 27 December 2014
                Publication date Collection: July 2015
                Publication date (Electronic): 27 December 2014
                Volume: 6
                Pages: 49-52
                Affiliations
                [1) ]Service de Maladies Infectieuses, CHU Farhat Hached, Sousse, Tunisie
                [2) ]Laboratoire de Parasitologie – Mycologie, CHU Farhat Hached, Sousse, Tunisie
                Author notes
                [∗ ] Corresponding author: Docteur Amel Letaief, Service de Maladies Infectieuses. CHU Farhat Hached, 4000, Sousse, Tunisie. Tel.: +216 73102556; fax: +216 73102516 amel.letaief@ 123456famso.rnu.tn
                Article
                Publisher ID: S2052-2975(14)00015-8
                DOI: 10.1016/j.nmni.2014.12.002
                PMC ID: 4484545
                PubMed ID: 26137308
                SO-VID: 66a5e714-04d0-425f-ab11-3a2a69518feb
                Copyright © © 2015 New Microbes and New Infections published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                Date received : 18 August 2014
                Date revision received : 1 December 2014
                Date accepted : 9 December 2014
                Categories
                Subject: Original Article

                Keywords: amphotericin b,diabetes,lichteimia corymbifera,mucormycosis,rhizopus arrhizus
                Data availability:
                Keywords: amphotericin b, diabetes, lichteimia corymbifera, mucormycosis, rhizopus arrhizus

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