Zygomycoses in patients with acute leukaemia

Abstract

Zygomycoses are rare invasive mould infections which mainly occur in immunocompromised patients, especially during prolonged neutropenia. The high mortality rate is due to a high failure rate of both intravital diagnosis and treatment. Exact diagnosis requires microscopic examination and proof by culture. The treatment consists of amphotericin B and surgical debridement. We report four recent cases of zygomycosis among 89 patients with intensively treated acute leukaemia at our institution. Three cases were breakthrough infections since the patients were under voriconazole treatment prior to diagnosis of zygomycosis. Only one patient had premortal diagnosis (paranasal sinus infection) and showed clinical response with amphotericin B and surgical debridement. A review of the literature of these emerging fungal infections is given and is focused on patients with acute leukaemia. In addition, the importance of autopsy as a tool for quality control and epidemiological studies is pointed out.

Breakthrough disseminated zygomycosis induced massive gastrointestinal bleeding in a patient with acute myeloid leukemia receiving micafungin

“…seldom, if ever, involve the gastrointestinal tract; gastrointestinal zygomycosis is rare but is occasionally found in patients with severe malnutrition or after intensive chemotherapy. 1,5,7 Zygomycetes probably enter the host via the mouth, invade the gastrointestinal mucosa, with the development of an ulcer and at times stricture, and enter the circulation from the ulcer in cases of disseminated disease. 8 Therefore, gastrointestinal manifestations such as abdominal pain, hematemesis, or melena are more likely to indicate zygomycosis than aspergillosis.…”

“…1,4 Additional risk factors include diabetes mellitus; metabolic acidosis; intravenous drug use; iron overload; malnutrition; prior therapy with broad-spectrum antibiotics (including antimycotic therapy with voriconazole or micafungin, as mentioned below), corticosteroids, and deferoxamine; and male sex. [1][2][3][4][5] The primary site of infection at the time of initial diagnosis varies with the underlying disease. 4 Neutropenic patients are at high risk of developing pulmonary infections or disseminated disease, and all of these manifestations are associated with high mortality.…”

“…6 Moreover, cultures from autopsy or surgical specimens have insuffi cient sensitivity; these specimens are positive in only 52% and 30% of cases, respectively. 5 Hence, the most sensitive diagnostic procedure for zygomycosis is the identifi cation of the organism in the tissue by histopathology. Although zygomycosis may sometimes be confused with invasive aspergillosis, even histopathologically, it can be diagnosed quite accurately by careful observation.…”

Synthesis and in vitro and in vivo Antifungal Activity of the Hydroxy Metabolites of Saperconazole

“…Despite many cases of invasive candidiasis and aspergillosis, there has been an increased incidence of infections due to other molds such as Scedosporium apiospermum, Fusarium spp., and Zygomycetes, Rhizopus and Mucor spp. [9][10][11] Therefore, effective therapeutic agents to treat all these infections must have a very broad spectrum of activity. Over the past few decades itraconazole, [12][13][14] fluconazole, [15] ketoconazole, [16] and intravenous or liposomal amphotericin B [17] have been used to treat SFI, and all these agents have their limitations with regard to spectrum, safety, or ease of administration.…”

“…[1][2][3][4][5][6][7][8][9][10] The number of various fungi that have been involved in SFI is large and still growing. Despite many cases of invasive candidiasis and aspergillosis, there has been an increased incidence of infections due to other molds such as Scedosporium apiospermum, Fusarium spp., and Zygomycetes, Rhizopus and Mucor spp.…”