Mucormycosis in Australia: contemporary epidemiology and outcomes.
Clin Microbiol Infect. 2016 Jan 19;
Authors: Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A, Marriott DJ, Chapman B, Halliday CL, Hajkowicz K, Athan E, Bak N, Cheong E, Heath CH, Morrissey CO, Kidd S, Beresford R, Blyth C, Korman TM, Robinson JO, Meyer W, Chen SC, Australia and New Zealand Mycoses Interest Group
Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immunocompetent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p=0.001, CI (2.1-42.8)). Haematological malignancy (48.6%), chemotherapy (41.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in 9 (12.1%) instances. Eight (10.8%) patients had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% vs 10/66; 15.2%; p<0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immunocompetent hosts, most often associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR=24.0, p=0.038 CI (1.2-481.4)), haematological malignancy (OR=7.7, p=0.001, CI (2.3-25.2)) and ICU admission (OR=4.2, p=0.02, CI (1.3-13.8)). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p=0.006). The mortality of mucormycosis remains particularly high in immunocompromised hosts. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
PMID: 26806139 [PubMed - as supplied by publisher]