Zygomycosis in Europe: Interim results of an epidemiologic survey

Skiada, A., Petrikkos, G., Pagano, L., Groll, A.H., Mitroussia-Ziouva, A., Dupont, B., Lass-Floerl6, C., Bouza7, E. Roilides8, E., Meis9, J.

Author address: 

1 University of Athens,, ATHENS, Greece 2University of Athens, 1st Department Prop.Med., ATHENS, Greece 3Universití  Cattolica S. Cuore, ROME, Italy 4University Children's Hospital, MUENSTER, Germany 5Hopital Necker, PARIS, France 6 Medizini


Aim: Zygomycosis has emerged as an increasingly important infection with a high mortality. The aim of this study was to analyze epidemiology, microbiology, treatment practices and outcome of zygomycosis in Europe. Material and methods: Seventeen European countries collaborate in the study. In each country, a national co-ordinator prospectively collected zygomycosis cases, recorded them on specially provided case report forms, which were then electronically sent to the study co-ordinator. The study started in January 2005 and is ongoing. Results: To date, 129 cases have been collected from 11 countries (Italy 47, Germany 20, Greece 18, France 15, Austria 9, Spain 6, Russia 5, Belgium 4, Finland 2, Norway 2, UK 1.). This is a preliminary analysis of the collected case reports. The mean age of the patients is 50 yrs (range 1-87) and 58% were male. Underlying conditions included haematological malignancies (46%), non-haematological malignancies (5%), bone marrow transplantation (7%), solid organ transplantation (5%), diabetes mellitus (12%), trauma (12%), burn (3%), others (8%) and no apparent risk factors (2%). 48% of the patients had received corticosteroids, and 46% had received antifungals prior to the diagnosis of zygomycosis (9% voriconazole, 7% voriconazole plus caspofungin, 4% only caspofungin, 14% fluconazole and 9% amphotericin B). The most frequent clinical presentations were pulmonary (28%), rhinocerebral (23%), sinus (10%), soft tissue (22%), heart (2%), bone (0.7%) and disseminated zygomycosis (8%). The isolated fungi were Mucor spp. (30 cases), Rhizopus spp. (21), Absidia corymbifera (17), Rhizomucor spp. (11), Cuninghamella spp. (4) and Acrophialophora fusispora (1). Eighty-three patients received amphotericin B (AMB), (66 liposomal AMB, 15 AMB- deoxycholate and 2 ABLC), 26 patients received posaconazole, 13 caspofungin and 5 voriconazole. The last two agents were given in combination with other antifungals. Among 102 cases analyzed, overall mortality was 50%. Conclusions: This is the first prospective study of zygomycosis in Europe and indeed worldwide. The most common predisposing factors are hematological malignancies and diabetes mellitus, while Mucor spp. are the most frequent causes. Despite various treatment regimens outcome is dismal in half cases. *and the ECMM Zygomycosis Study Group

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Full conference title: 

3rd Trends in Medical Mycology
    • TIMM 3rd (2011)