Journal Article

A Global Analysis of Mucormycosis in France: The RetroZygo Study (2005-2007)

Elie, C., Huerre, M., Lanternier, F., Garcia-Hermoso, D., Dannaoui, E., Dromer, F., Lortholary, O., Morizot, G., Bitar, D.

2012

Overview

Background. Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. Methods. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. Results. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) > 50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. Conclusions. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

• Publisher: Oxford University Press,Oxford University Press (OUP)
• Subject: Adolescent / Adult / Aged / Amphotericin B / Amphotericin B - therapeutic use / Antifungal Agents / Antifungal Agents - therapeutic use / Cerebellar Diseases / Cerebellar Diseases - complications / Cerebellar Diseases - microbiology / Cerebellar Diseases - pathology / Cerebellar Diseases - surgery / Child / Data Collection / Dermatomycoses / Dermatomycoses - complications / Dermatomycoses - drug therapy / Dermatomycoses - microbiology / Diabetes / Diabetes Mellitus / Diabetes Mellitus - microbiology / Epidemiology / Female / France / France - epidemiology / Fungal infections / Fungi / Hematologic Neoplasms / Hematologic Neoplasms - complications / Hematologic Neoplasms - microbiology / Hematology / Humans / Infections / Life Sciences / Lung / Lung - microbiology / Lung - pathology / Male / Microbiology and Parasitology / Middle Aged / Mortality / Mucormycosis / Mucormycosis - complications / Mucormycosis - drug therapy / Mucormycosis - epidemiology / Mucormycosis - microbiology / Mycology / Nonnative species / Prognosis / Proportional Hazards Models / Regression analysis / Retrospective Studies / Rhizopus / Rhizopus - pathogenicity / Risk Factors / Skin diseases / Survival Analysis / Transplantation / Treatment Outcome / Wounds and Injuries / Wounds and Injuries - complications / Wounds and Injuries - microbiology / Wounds and Injuries - surgery / Young Adult / Zygomycosis