Mucormycoses in patients with hematologic malignancies: an emerging fungal infection.
OBJECTIVE
Mucormycoses are seen with an increasing incidence in immunocompromised patients. Most common presentations are rhinocerebral and pulmonary. We here report the experience of a single center with mucormycoses in patients with hematologic malignancies.


RESULTS
Mucormycoses were diagnosed in six patients, (median age of 52 years; range, 26-74) treated between 2001-2004. Diagnoses included acute myeloid leukemia (AML) (n=3), acute lymphoblastic leukemia (n=1), chronic lymphocytic leukemia (n=1) and multiple myeloma (n=1). Mucormycosis was diagnosed in the neutropenic state following allogeneic hematopoietic cell transplantation (n=3) or intense chemotherapy (n=3). Sites of infections were rhinocerebral, facial and pulmonary involvement in one patient each and disseminated mucormycosis in three patients. The diagnosis was established by computed tomography followed by surgical interventions and histological diagnosis in 4 patients and post-mortem in two patients. Species identified were Rhizopus (n=3), Rhizomucor (n=2) and Absidia (n=1). Treatment responses were best if surgical resection was followed by aggressive antifungal chemotherapy. Five of six 6 patients died, all of complications of mucormycosis or their underlying disease. Only one patient with facial mucormycosis is still alive.


CONCLUSIONS
This experience demonstrates that patient with mucormycoses have a high mortality rate and early recognition followed by aggressive surgical debridement, high dose antifungal therapy and attempts to correct the underlying immunocompromised state are crucial in the treatment of this fatal infection.
Bethge
Wolfgang A
WA
Medical Center University of Tübingen, Hematology/Oncology Otfried-Müller Str. 10 , 72076 Tübingen; Germany. wolfgang.bethge@med.uni-tuebingen.de
Schmalzing
Marc
M
Stuhler
Gernot
G
Schumacher
Ulrike
U
Kröber
Stefan-Martin
SM
Horger
Marius
M
Einsele
Hermann
H
Kanz
Lothar
L
Hebart
Holger
H
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D021821:Communicable Diseases, Emerging; D003881:Dermatomycoses / Q000188:drug therapy / Q000601:surgery; D004198:Disease Susceptibility; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use; D012852:Sinusitis / Q000188:drug therapy / Q000401:mortality; D019172:Transplantation Conditioning / Q000009:adverse effects; D014230:Triazoles / Q000627:therapeutic use; D014781:Viscera / Q000382:microbiology; D065819:Voriconazole
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D017964:Itraconazole; C101425:posaconazole; D000666:Amphotericin B; D015725:Fluconazole; D065819:Voriconazole