Zygomycosis in a Tertiary-Care Cancer Center in the Era of Aspergillus-active Antifungal Therapy: A Case-Control Observational Study of 27 Recent Cases

J Infect Dis. 2005 Apr 15;191(8):1350-60. doi: 10.1086/428780. Epub 2005 Mar 16.

Abstract

Background: Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients.

Methods: We performed prospective surveillance of patients with zygomycosis (group A; n = 27) and compared them with contemporaneous patients with invasive aspergillosis (group B; n = 54) and with matched contemporaneous high-risk patients without fungal infection (group C; n = 54). We also performed molecular typing and in vitro susceptibility testing of Zygomycetes isolates.

Results: Nearly all patients with zygomycosis either had leukemia (n = 14) or were allogeneic bone marrow transplant recipients (n = 13). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval [CI]], 2.76-38.97]; P = .001), diabetes (OR, 8.39 [95% CI, 2.04-34.35]; P = .003), and malnutrition (OR, 3.70 [95% CI, 1.03-13.27]; P = .045) were found to be independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85-108.15]; P = .0001) and sinusitis (OR, 76.72 [95% CI, 6.48-908.15]; P = .001) were the only factors that favored the diagnosis of zygomycosis.

Conclusions: Zygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Aspergillosis / epidemiology
  • Aspergillosis / microbiology
  • Aspergillus / drug effects*
  • Aspergillus / physiology
  • Case-Control Studies
  • DNA Fingerprinting
  • Drug Resistance, Fungal
  • Female
  • Humans
  • Leukemia / complications
  • Male
  • Middle Aged
  • Neoplasms*
  • Risk Factors
  • Zygomycosis / complications
  • Zygomycosis / diagnosis
  • Zygomycosis / epidemiology*
  • Zygomycosis / microbiology*

Substances

  • Antifungal Agents