title: Mucormycoses in patients with hematologic malignancies: an emerging fungal infection.
abstract: 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.
authors.affiliation: Medical Center University of Tübingen, Hematology/Oncology Otfried-Müller Str. 10 , 72076 Tübingen; Germany. wolfgang.bethge@med.uni-tuebingen.de
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Bethge
authors.forename: Marc
authors.initials: M
authors.lastname: Schmalzing
authors.forename: Gernot
authors.initials: G
authors.lastname: Stuhler
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schumacher
authors.forename: Stefan-Martin
authors.initials: SM
authors.lastname: Kröber
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Holger
authors.initials: H
authors.lastname: Hebart
mesh_terms: 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
chemical_list: 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