Objective: Fungal infections by Mucorales are rare, even in highly immunocompromized patients. Unless diagnosis can be made early, local invasive disease tends to progress with a poor prognosis. Initial symptoms are unspecific and an early high index of suspicion is crucial. We are interested in the epidemiology, microbiology, therapy and outcome of mucormycosis in our institution. Methods: University of Geneva Hospitals is a tertiary hospital with 1600 acute care beds and 40,000 admissions each year, containing all disciplines including several intensive care units and a transplantation centre. Retrospective analysis of all electronical and clinical databases from 1989 till 2004. All results containing Mucorales were analysed. Results: We identified 7 cases of infection: 2 bone marrow transplant patients, 1 liver transplantation patient, 1 renal transplantation patient, 1 patient with AIDS and 2 patients receiving high doses of steroids. Rhizopus and Absidia sp were the causative fungus agent in 3 cases each. Survival (3 of 7 patients) could only be achieved during local disease such as the involvement of the orbita, associated with early diagnosis, early and aggressive surgical therapy and specific antifungal treatment. Table 1 resumes the characteristics of the infection cases. In 35 cases the presence of mucormycosis were considered as colonisation since there was no invasive disease, no secondary prophylaxis, no specific surgical or antifungal treatment and no clinical importance reported in the records. The most prevalent body sites for colonisation were nasal sinuses and tracheal aspirates. Conclusion: Mucormycosis is a rare disease even in a tertiary hospital. Disseminated fungal infections have a poor prognosis and may evolve into multiorgan failure within a short period of time, whereas early recognized local infections can be successfully treated. In the presence of a severely immunocompromized host, a high index of suspicion remains mandatory. Physicians should be aware of the possibility of this fungal infection in order to begin a rapid diagnostic workup including aggressive surgical and antimycotic therapy with amphotericin B or posaconazole.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)