title: Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007.
abstract: Zygomycosis is an important emerging fungal infection, associated with high morbidity and mortality. The Working Group on Zygomycosis of the European Confederation of Medical Mycology (ECMM) prospectively collected cases of proven and probable zygomycosis in 13 European countries occurring between 2005 and 2007. Cases were recorded by a standardized case report form, entered into an electronic database and analysed descriptively and by logistic regression analysis. During the study period, 230 cases fulfilled pre-set criteria for eligibility. The median age of the patients was 50 years (range, 1 month to 87 years); 60% were men. Underlying conditions included haematological malignancies (44%), trauma (15%), haematopoietic stem cell transplantation (9%) and diabetes mellitus (9%). The most common manifestations of zygomycosis were pulmonary (30%), rhinocerebral (27%), soft tissue (26%) and disseminated disease (15%). Diagnosis was made by both histology and culture in 108 cases (44%). Among 172 cases with cultures, Rhizopus spp. (34%), Mucor spp. (19%) and Lichtheimia (formerly Absidia) spp. (19%) were most commonly identified. Thirty-nine per cent of patients received amphotericin B formulations, 7% posaconazole and 21% received both agents; 15% of patients received no antifungal therapy. Total mortality in the entire cohort was 47%. On multivariate analysis, factors associated with survival were trauma as an underlying condition (p 0.019), treatment with amphotericin B (p 0.006) and surgery (p <0.001); factors associated with death were higher age (p 0.005) and the administration of caspofungin prior to diagnosis (p 0.011). In conclusion, zygomycosis remains a highly lethal disease. Administration of amphotericin B and surgery, where feasible, significantly improve survival.
authors.affiliation: 1st Department of Propaedeutic Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Skiada
authors.forename: L
authors.initials: L
authors.lastname: Pagano
authors.forename: A
authors.initials: A
authors.lastname: Groll
authors.forename: S
authors.initials: S
authors.lastname: Zimmerli
authors.forename: B
authors.initials: B
authors.lastname: Dupont
authors.forename: K
authors.initials: K
authors.lastname: Lagrou
authors.forename: C
authors.initials: C
authors.lastname: Lass-Florl
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: N
authors.initials: N
authors.lastname: Klimko
authors.forename: P
authors.initials: P
authors.lastname: Gaustad
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.forename: P
authors.initials: P
authors.lastname: Hamal
authors.forename: M
authors.initials: M
authors.lastname: Akova
authors.forename: J F
authors.initials: JF
authors.lastname: Meis
authors.forename: J-L
authors.initials: JL
authors.lastname: Rodriguez-Tudela
authors.forename: E
authors.initials: E
authors.lastname: Roilides
authors.forename: A
authors.initials: A
authors.lastname: Mitrousia-Ziouva
authors.forename: G
authors.initials: G
authors.lastname: Petrikkos
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications; D005060:Europe / Q000453:epidemiology; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult; D020096:Zygomycosis / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000935:Antifungal Agents