Background: Zygomycosis is an infrequent yet significant fungal infection most commonly found in patients with underlying immunocomprised states such as diabetes mellitus, renal failure, stem cell and solid organ transplantation. With the advent of the lipid amphitericin B (L-ab) products which allows treatment with higher doses of therapy with less toxicity with aggressive surgical debridment. We review the outcomes of this therapy at our institution. Method: This is a retrospective chart review from 1999-2004 of all biopsy proven invasive zygomycosis at the University of Maryland Medicial Center (UMMC) that received at least 1 dose of L-ab greater than 5mg/kg in their care. Risk factors, surgical interventions, nephrotoxicity and survival status at 6 months were also collected. Results: There were 16 proven cases: 9 had diabetes mellitus, 4 had underlying hematologic malignancy, 7 had solid organ transplantation (6 renal transplant, 1 lung transplant) and 2 had complicated major surgery only. Sites involved were 5 sinonasal, 4 cutaneous/soft tissue, 5 pulmonary and 2 blood stream infections. 10/16 went for surgical debridement, with 8 dying. The overall attributable mortality with treatment with high dose L-ab was 62.5%. No difference was seen in outcomes from site or underlying disease process. 5/8 (62.5%) survived receiving doses of L-ab at 10 mg/kg, compared to 1/8 (13%) at 5- 7.5 mg/kg. Nephrotoxicity was similar at the higher doses than lower doses. Conclusion: High doses L-ab at levels of 10 mg/kg early in the treatment of invasive zygomycosis appears to be effective in decreasing mortality. Surgical intervention appears to be a poor prognostic indicator, indication advanced disease. In patients who at high risk for invasive zygomycosis infection, the early diagnosis and initiation treatment with high dose L-ab at least 10 mg/kg may have a beneficial impact on survival.
Full conference title:
15th Annual Focus on Fungal Infections
- FFI 15th (2005)