Improved Outcome of Zygomycosis in Patients with Hematological Diseases?

Abstract

Zygomycosis is an opportunistic fungal infection that is increasingly reported in hematological patients. We describe 2 cases of successfully treated rhino-cerebral zygomycosis and give an overview of 120 patients from the literature with underlying hematological or oncological disorders. These data document the improved survival in sinus (15/17 patients surviving) and cutaneous (6/9 patients surviving) disease. Hematological patients with pulmonary (9/30 patients surviving) or disseminated (4/38 patients surviving) zygomycosis still have a poor prognosis. The clinical course of sinus-orbital involvement (4/11 patients surviving) follows sinus-cerebral (2/3 patients surviving) or cerebral (3/6 patients surviving) disease. Besides deoxycholate amphotericin B (AmB) (24/62 patients surviving), patients seem to benefit from liposomal amphotericin B (L-AmB) (10/16 patients surviving) or sequential AmB/L-AmB treatment (6/8 patients surviving). Alternative treatment options lead only in a few patients to success.

Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia

“…8 Two of our three patients, who underwent emergency surgery owing to hemoptysis, had zygomycosis. Although it is rarer than aspergillosis, zygomycosis carries a high mortality rate in hematology patients, [27][28][29] as is our experience. 30 Its rapid invasion is directly related to neutropenia; in this situation early diagnosis and aggressive treatment are imperative.…”

Disseminated mucormycosis: A sinister cause of neutropenic fever syndrome

“…The vasculotropic nature of the infection leads to angioinvasion and widespread tissue necrosis contributing to the fatality of disease. Indeed, pulmonary mucormycosis has a mortality of 76% that increases to more than 90% with dissemination (9).…”

Rhinocerebral mucormycosis: a case series

“…The rate of mortality of rhinoorbitalcerebral mucormycosis ranges from 30-69%. 17 Poor prognostic indicators are delay in treatment of more than 6 days, evidence of intracranial invasion, bilateral involvement, palate invasion and associated haematological malignancies. 18 In our study sites of mucormycosis in 10 patients were nose (10/10, 100%), sinus (8/10, 80%), orbit (7/10, 70%), cerebrum (05/10, 50%), tongue (02/10, 20%) and hard palate (02/10, 20%) as shown in Figure 1.…”