title: A global analysis of mucormycosis in France: the RetroZygo Study (2005-2007).
abstract: BACKGROUND
  Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood.
  
  
  METHODS
  Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model.
  
  
  RESULTS
  A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival.
  
  
  CONCLUSIONS
  This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.
authors.affiliation: Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, 25 rue du Dr Roux, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lanternier
authors.forename: E
authors.initials: E
authors.lastname: Dannaoui
authors.forename: G
authors.initials: G
authors.lastname: Morizot
authors.forename: C
authors.initials: C
authors.lastname: Elie
authors.forename: D
authors.initials: D
authors.lastname: Garcia-Hermoso
authors.forename: M
authors.initials: M
authors.lastname: Huerre
authors.forename: D
authors.initials: D
authors.lastname: Bitar
authors.forename: F
authors.initials: F
authors.lastname: Dromer
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002526:Cerebellar Diseases / Q000150:complications / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D002648:Child; D003625:Data Collection; D003881:Dermatomycoses / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D003920:Diabetes Mellitus / Q000382:microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012233:Rhizopus / Q000472:pathogenicity*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000382:microbiology / Q000601:surgery; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B