Forty-One Recent Cases of Invasive Zygomycosis From a Global Clinical Registry.

Invasive zygomycosis accounts for a significant proportion of all invasive fungal diseases (IFD), but clinical data on the clinical course and treatment response is limited.

Fungiscope” - A Global Rare Fungal Infection Registry is a university-based case registry that collects data of patients with rare IFD, using a web-based electronic case form at www.fungiscope.net.

Fourty-one patients with invasive zygomycosis were registered. Five were pediatric (12.2%), 28 (68.3%) male. Median age was 49 years (range 2-88). Most common underlying conditions were malignancies (n=26; 63.4%), diabetes mellitus (n=7; 17%) and solid organ transplant (n=4; 9.8%). Diagnosis was made by culture in 28 patients (68.3%), by histology in 26 patients (63.4%). Main sites of infection were lungs (n=24; 58.5%), soft tissues (n=8; 19.5%), rhino-sinu-orbital (n=8; 19.5%), brain (n=6; 14.6%). Disseminated infection of >1 non-contiguous sites was seen in 4 patients (9.8%). A favorable response was observed in 23 patients (56.1%). Overall survival was 51.2%. At diagnosis, ten patients (24.4%) were under continuous antifungal prophylaxis with itraconazole (n=1; 2.4%) or posaconazole (n=3; 7.3%). Empiric treatment was administered to 17 patients (41.4%). Survival was significantly improved in patients receiving active (n=7; 17.1%), as opposed to inactive empiric treatment (p=0.036). Initial targeted treatment with activity against zygomycetes was administered to 34 patients (82.9%). Liposomal amphotericin B was associated with improved response (p=0.012), and survival rates (p=0.004). Additional surgical treatment was performed in 21 patients (51.2%) and was not associated with improved response or survival.

Invasive zygomycosis is associated with low response rates to surgical and antifungal therapy. There was a marked amount of breakthrough infections under antifungal prophylaxis, including posaconazole. Only few patients received empiric treatment with activity against zygomycetes. Initial treatment with a polyene was associated with improved survival rates.

Rueping:Essex/Schering-Plough: Speakers Bureau. Heinz:Schering-Plough/Essex: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Gilead: Speakers Bureau; Pfizer: Speakers Bureau. Rickerts:Gilead: Research Funding; pfizer: Research Funding. Lass-Floerl:Gilead: Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau. Herbrecht:Pfizer: Research Funding, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Schering-Plough/Essex: Consultancy, Speakers Bureau. Silling:MSD: Consultancy, Research Funding; Pfizer: Research Funding; Astellas: Research Funding; Janssen-Cilag: Research Funding; Schering-Plough/Essex: Research Funding. Ullmann:Basilea: Consultancy; Aicuris: Consultancy; Pfizer: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Schering-Plough/Essex: Consultancy, Speakers Bureau; Astellas: Consultancy, Speakers Bureau. Maertens:MSD: Consultancy, Research Funding; Pfizer: Research Funding; Astellas: Consultancy; Bio-Rad: Consultancy; Nektar: Consultancy; Schering-Plough/Essex: Consultancy; Zeneus/Cephalon: Consultancy; Viropharma: Consultancy. Maschmeyer:Pfizer: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau. Vehreschild:Schering-Plough/Essex: Speakers Bureau; MSD: Speakers Bureau. Cornely:German Federal Ministry of Research and Education: Support - BMBF Grant 01KN0706; Astellas: Consultancy, Research Funding, Speakers Bureau; Basilea: Consultancy, Research Funding; Bayer: Research Funding; Genzyme: Research Funding; Gilead: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding; Merck/MSD: Consultancy, Research Funding, Speakers Bureau; Optimer: Research Funding; Schering-Plough/Essex: Consultancy, Research Funding, Speakers Bureau; Vicuron: Research Funding; F2G: Consultancy; Mölnlycke: Consultancy; Nektar: Consultancy; Zeneus: Consultancy; SpePharm: Speakers Bureau; United Medical: Speakers Bureau.