title: Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature.
abstract: Zygomycetes are ubiquitous fungi that can cause invasive disease associated with high mortality. We report 10 solid organ transplant recipients with zygomycosis (incidence 2 per 1000) and reviewed 106 cases in the English-language literature. These included renal (n = 73), heart (n = 16), lung (n = 4), heart/lung (n = 2), liver (n = 19) and kidney/pancreas (n = 2) transplant recipients. All patients were receiving immunosuppression and the vast majority steroids. The clinical presentation included rhino-sino-orbital (n = 20), rhinocerebral (n = 16), pulmonary (n = 28), gastrointestinal (n = 13), cutaneous (n = 18), renal (n = 6) and disseminated disease (n = 15). Most frequently isolated genera were Rhizopus (73%) followed by Mucor (13%). The overall mortality was 49%. While rhino-sino-orbital disease had the best prognosis, rhinocerebral disease had high mortality (93%) comparable to disseminated disease. A favorable outcome was associated with limited, surgically accessible disease and early surgical intervention along with amphotericin B administration.
authors.affiliation: Department of Medicine, Univeristy of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA.
authors.forename: N G
authors.initials: NG
authors.lastname: Almyroudis
authors.forename: D A
authors.initials: DA
authors.lastname: Sutton
authors.forename: P
authors.initials: P
authors.lastname: Linden
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: S
authors.initials: S
authors.lastname: Kusne
mesh_terms: D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D016377:Organ Transplantation; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications; D015996:Survival Rate; D020096:Zygomycosis / Q000453:epidemiology*