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.