1. Zygomycosis in Italy: A survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)
- Author
-
Alessandro Bonini, Giulia Morace, Francesco Cristini, Mariagrazia Garzia, Cristina Cattaneo, Anna Maria Tortorano, G. Lombardi, L. Ferrari, Morena Caira, Roberto Bandettini, Annamaria Nosari, N. Manca, Caterina Giovanna Valentini, R. R. Minniti, M. R. Rossi, Marisa R. Nucci, Patrizia Pecile, Maria Anna Viviani, Fausto Rossini, Luca Fumagalli, Nicola Vianelli, Anna Maria Barbui, A d'Arminio Monforte, G. Farina, L. Savi, Marta Stanzani, Fabio Facchetti, F. Pallavicini, S. Giordano, P. M. Placanica, Maria Teresa Montagna, Alessandro Busca, Maria Elena Tosti, Marta Riva, I. Caserta, Corrado Girmenia, E. Mirone, Clara Romano, Anna Chierichini, Anna Candoni, Marco Picardi, R. Piane, P. Spedini, V. Selva, Pier Leopoldo Capecchi, Matteo Bassetti, L. Ricci, Brunella Posteraro, O. Morelli, G. P. Gesu, M. Mettimano, P. Scarpellini, Rosa Fanci, Francesco Bruno, Roberto Monastero, Livio Pagano, D. Giudici, Luana Fianchi, Elio Castagnola, Paolo Grossi, C. Ossi, A. Pan, G. Pinsi, M. La Sorda, F. Rossano, Maurizio Sanguinetti, Pagano, L, Valentini, Cg, Posteraro, B, Girmenia, C, Ossi, C, Pan, A, Candoni, A, Nosari, A, Riva, M, Cattaneo, C, Rossini, F, Fianchi, L, Caira, M, Sanguinetti, M, Gesu, Gp, Lombardi, G, Vianelli, N, Stanzani, M, Mirone, E, Pinsi, G, Facchetti, F, Manca, N, Savi, L, Mettimano, M, Selva, V, Caserta, I, Scarpellini, P, Morace, G, D'Arminio Monforte, A, Grossi, P, Giudici, D, Tortorano, Am, Bonini, A, Ricci, L, Picardi, Marco, Rossano, F, Fanci, R, Pecile, P, Fumagalli, L, Ferrari, L, Capecchi, Pl, Romano, C, Busca, A, Barbui, A, Garzia, M, Minniti, Rr, Farina, G, Montagna, Mt, Bruno, F, Morelli, O, Chierichini, A, Placanica, Pm, Castagnola, E, Bandettini, R, Giordano, S, Monastero, R, Tosti, Me, Rossi, Mr, Spedini, P, Piane, R, Nucci, M, Pallavicini, F, Bassetti, M, Cristini, F, LA Sorda, M, and Viviani, M. L.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Antifungal drug ,Immunocompromised Host ,Pharmacotherapy ,Zygomycosis ,Drug Resistance, Fungal ,Amphotericin B ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Child ,Mycosis ,Aged ,Pharmacology ,Immunocompromised host ,Aged, 80 and over ,business.industry ,Mortality rate ,Mucormycosis ,Infant ,Middle Aged ,medicine.disease ,Surgery ,Infectious Diseases ,Oncology ,Italy ,Child, Preschool ,Female ,business ,medicine.drug - Abstract
The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.