Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients.
BACKGROUND
Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed.


METHODS
SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included.


RESULTS
Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57% (51 of 90). Overall mortality was 52.3% (46 of 88), and the mortality in patients with CNS disease was 73.5% (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95% CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95% CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease.


CONCLUSIONS
Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.
Sun
Hsin-Yun
HY
Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Forrest
Graeme
G
Gupta
Krishan L
KL
Aguado
Jose M
JM
Lortholary
Olivier
O
Julia
Marino Blanes
MB
Safdar
Nasia
N
Patel
Robin
R
Kusne
Shimon
S
Singh
Nina
N
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000382:microbiology; D015331:Cohort Studies; D003646:Debridement; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D012044:Regression Analysis; D012852:Sinusitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D020096:Zygomycosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
D000935:Antifungal Agents; D000666:Amphotericin B