A global analysis of mucormycosis in France: the RetroZygo Study (2005-2007)

Clin Infect Dis. 2012 Feb;54 Suppl 1:S35-43. doi: 10.1093/cid/cir880.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Cerebellar Diseases / complications
  • Cerebellar Diseases / microbiology*
  • Cerebellar Diseases / pathology
  • Cerebellar Diseases / surgery
  • Child
  • Data Collection
  • Dermatomycoses / complications
  • Dermatomycoses / drug therapy
  • Dermatomycoses / microbiology
  • Diabetes Mellitus / microbiology
  • Female
  • France / epidemiology
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / microbiology
  • Humans
  • Lung / microbiology
  • Lung / pathology
  • Male
  • Middle Aged
  • Mucormycosis / complications
  • Mucormycosis / drug therapy
  • Mucormycosis / epidemiology*
  • Mucormycosis / microbiology
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Rhizopus / pathogenicity*
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • Wounds and Injuries / complications
  • Wounds and Injuries / microbiology
  • Wounds and Injuries / surgery
  • Young Adult

Substances

  • Antifungal Agents
  • liposomal amphotericin B
  • Amphotericin B