Zygomycosis in the 1990s in a tertiary-care cancer center.
Twenty-four patients with cancer met predetermined criteria for a diagnosis of zygomycosis over a 10-year period at our institution. All had hematologic malignancy, and most had either neutropenia or steroid use as a risk factor. Pulmonary involvement mimicking invasive aspergillosis was the most common presentation, and dissemination was seen in 58% of patients on whom autopsies were performed. Three-fourths of the patients with pulmonary zygomycosis had pathogenic microorganisms other than zygomycetes isolated from respiratory specimens. The sensitivity of cultures in detecting zygomycetes from respiratory specimens was low. A culture positive for zygomycetes was typically a preterminal finding in the fatal, acute cases. Two-thirds of the patients died. Favorable outcome seemed to correlate with lack of pulmonary involvement, surgical debridement, neutrophil recovery, and a cumulative total amphotericin B dose of 2000 mg. Therapy with high-dose amphotericin B, combined with aggressive surgery and immune reconstitution, offers the best chance for survival of cancer patients with zygomycosis.
Kontoyiannis
D P
DP
Department of Internal Medicine Specialties, Section of Infectious Diseases, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. dkontoyi@notes.mdacc.tmc.edu
Wessel
V C
VC
Bodey
G P
GP
Rolston
K V
KV
D002173:Cancer Care Facilities; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D009090:Mucorales / Q000145:classification / Q000302:isolation & purification*; D009091:Mucormycosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors