Improved outcome of zygomycosis in patients with hematological diseases?
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.
Gleissner
B
B
Department of Hematology, Oncology and Transfusion Medicine, University Hospital Benjamin Franklin, Free University of Berlin, Germany. gleisner@zedat.fu-berlin.de
Schilling
A
A
Anagnostopolous
I
I
Siehl
I
I
Thiel
E
E
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D003131:Combined Modality Therapy; D003840:Deoxycholic Acid / Q000008:administration & dosage; D015521:Ethmoid Sinusitis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D008081:Liposomes; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications; D008297:Male; D015523:Maxillary Sinusitis / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D009089:Mucor / Q000302:isolation & purification; D009091:Mucormycosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D009101:Multiple Myeloma / Q000150:complications; D009668:Nose Diseases / Q000188:drug therapy / Q000382:microbiology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D016896:Treatment Outcome; D020096:Zygomycosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery
D000935:Antifungal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D003840:Deoxycholic Acid; D017964:Itraconazole; D000666:Amphotericin B; D007654:Ketoconazole