Mucormycosis in hematologic patients.
OBJECTIVE
To evaluate the clinical characteristics of patients affected by hematologic malignancies who developed mucormycosis and to ascertain the factors which influenced the outcome following mycotic infection.


METHODS
This was a retrospective study conducted over a 15-year period (1987-2001). The study included 59 patients with hematologic malignancies with a proven or probable mucormycosis admitted in 18 Hematology Divisions in tertiary care or university hospitals.


RESULTS
The most frequent sites of infection were lung (64%) and orbito-sinus-facial (24%); cerebral involvement observed in 19% of cases was always associated with other sites of infection. Antifungal treatment was empirically administered in 49 patients (83%); 7 patients underwent radical surgical debridement (12%). Therapy was successful for only 18 patients (37%). Forty-seven patients died within 3 months of the diagnosis of fungal infection: the cause of death was mucormycosis in 41 patients (87%) and progression of hematologic disease in 6 patients (13%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: male sex, amphotericin B treatment, neutrophil recovery from post-chemotherapy aplasia. At multivariate analysis, the only factor that significantly correlated with recovery from infection was the liposomal amphotericin B treatment.


CONCLUSIONS
Mucormycosis is a rare filamentous fungal infection that occurs most frequently in neutropenic patients with acute leukemia. It does not seem to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential in order to improve the prognosis in these patients.
Pagano
Livio
L
Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy. lpagano@rm.unicatt.it
Offidani
Massimo
M
Fianchi
Luana
L
Nosari
Annamaria
A
Candoni
Anna
A
Picardi
Marco
M
Dipartimento de Medicina Clinica-Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
Corvatta
Laura
L
D'Antonio
Domenico
D
Girmenia
Corrado
C
Martino
Pietro
P
Del Favero
Albano
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D004660:Encephalitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D007558:Italy / Q000453:epidemiology; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
D000935:Antifungal Agents; D014230:Triazoles; D000666:Amphotericin B