Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases.
BACKGROUND
Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients.


METHODS
We performed prospective surveillance of patients with zygomycosis (group A; n = 27) and compared them with contemporaneous patients with invasive aspergillosis (group B; n = 54) and with matched contemporaneous high-risk patients without fungal infection (group C; n = 54). We also performed molecular typing and in vitro susceptibility testing of Zygomycetes isolates.


RESULTS
Nearly all patients with zygomycosis either had leukemia (n = 14) or were allogeneic bone marrow transplant recipients (n = 13). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval [CI]], 2.76-38.97]; P = .001), diabetes (OR, 8.39 [95% CI, 2.04-34.35]; P = .003), and malnutrition (OR, 3.70 [95% CI, 1.03-13.27]; P = .045) were found to be independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85-108.15]; P = .0001) and sinusitis (OR, 76.72 [95% CI, 6.48-908.15]; P = .001) were the only factors that favored the diagnosis of zygomycosis.


CONCLUSIONS
Zygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition.
Kontoyiannis
Dimitrios P
DP
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. dkontoyi@mdanderson.org
Lionakis
Michail S
MS
Lewis
Russell E
RE
Chamilos
Georgios
G
Healy
Mimi
M
Perego
Cheryl
C
Safdar
Amar
A
Kantarjian
Hagop
H
Champlin
Richard
R
Walsh
Thomas J
TJ
Raad
Issam I
II
D018806:APACHE; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology / Q000382:microbiology; D001230:Aspergillus / Q000187:drug effects* / Q000502:physiology; D016022:Case-Control Studies; D016172:DNA Fingerprinting; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D012307:Risk Factors; D020096:Zygomycosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*
D000935:Antifungal Agents