Zygomycosis in a Tertiary-Care Cancer Center in the Era of Aspergillus-Active Antifungal Therapy: A Case-Control Observational Study of 27 Recent Cases
Author:
Dimitrios P. Kontoyiannis, Michail S. Lionakis, Russell E. Lewis, Georgios Chamilos, Mimi Healy, Cheryl Perego, Amar Safdar, Hagop Kantarjian, Richard Champlin, Thomas J. Walsh, and Issam I. Raad
Date: 21 April 2005
Abstract:
Background. Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients.Methods. We performed prospective surveillance of patients with zygomycosis (group A; ) and compared np27 them with contemporaneous patients with invasive aspergillosis (group B; ) and with matched contempo- np54 raneous high-risk patients without fungal infection (group C; ). We also performed molecular typing and in np54vitro susceptibility testing of Zygomycetes isolates.Results. Nearly all patients with zygomycosis either had leukemia ( ) or were allogeneic bone marrow np14 transplant recipients ( ). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different np13molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval {CI}], 2.76-38.97]; ), diabetes (OR, 8.39 Pp.001[95% CI, 2.04-34.35]; ), and malnutrition (OR, 3.70 [95% CI, 1.03-13.27]; ) were found to be Pp.003 Pp.045 independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85-108.15]; ) Pp.0001and sinusitis (OR, 76.72 [95% CI, 6.48-908.15]; ) were the only factors that favored the diagnosis of Pp.001zygomycosis.Conclusions. Zygomycosis should be considered in immunosuppressed patients who develop sinusitis whilereceiving VRC prophylaxis, especially those with diabetes and malnutrition.
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