Zygomycosis in a Tertiary‐Care Cancer Center in the Era of<i>Aspergillus‐</i>Active Antifungal Therapy: A Case‐Control Observational Study of 27 Recent Cases

Kontoyiannis, Dimitrios P.; Lionakis, Michail S.; Lewis, Russell E.; Chamilos, Georgios; Healy, Mimi; Perego, Cheryl; Safdar, Amar; Kantarjian, Hagop M.; Champlin, Richard E.; Walsh, Thomas J.; Raad, Issam

doi:10.1086/428780

Cited by 655 publications

(553 citation statements)

References 39 publications

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“…15,16 However, there is a concern that prior voriconazole use predisposes to zygomycosis. 13,17,18 Our data appear to support the suggestion of breakthrough zygomycosis. However, we do not believe that it is a problem unique to voriconazole or one that is solely attributable to it.…”

Section: 04supporting

confidence: 80%

Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole

Trifilio

Singhal

Williams

et al. 2007

Bone Marrow Transplant

218

171

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Seventy-one allograft recipients receiving voriconazole, in whom complete clinical, microbiologic and pharmacokinetic data were available, were studied to determine the efficacy of voriconazole in preventing fungal infections. The length of voriconazole therapy was 6-956 days (median 133). The total number of patient-days on voriconazole was 13 805 (B38 years). A total of 10 fungal infections were seen in patients on voriconazole (18% actuarial probability at 1 year): Candida glabrataand Mucor (n ¼ 1). Two of the four zygomycosis cases were preceded by short durations of voriconazole therapy, but prolonged itraconazole prophylaxis. The plasma steady-state trough voriconazole levels around the time the infection occurred were o0.2, o0.2, 0.33, 0.55, 0.63 and 1.78 lg/ml in the six candidiasis cases. Excluding the four zygomycosis cases, all the six candidiasis cases were seen among the 43 patients with voriconazole levels of p2 lg/ml and none among the 24 with levels of 42 lg/ml (P ¼ 0.061). We conclude that voriconazole is effective at preventing aspergillosis. However, breakthrough zygomycosis is seen in a small proportion of patients. The role of therapeutic voriconazole monitoring with dose adjustment to avoid breakthrough infections with fungi that are otherwise susceptible to the drug needs to be explored prospectively.

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Section: 04supporting

confidence: 80%

Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole

Trifilio

Singhal

Williams

et al. 2007

Bone Marrow Transplant

218

171

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“…8 Two of our three patients, who underwent emergency surgery owing to hemoptysis, had zygomycosis. Although it is rarer than aspergillosis, zygomycosis carries a high mortality rate in hematology patients, [27][28][29] as is our experience. 30 Its rapid invasion is directly related to neutropenia; in this situation early diagnosis and aggressive treatment are imperative.…”

Section: Discussionmentioning

confidence: 84%

Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia

Nosari

Ravini

Cairoli

et al. 2007

Bone Marrow Transplant

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Antifungal therapy may be unable to eradicate invasive mycosis in leukemia patients. The presence of persisting pulmonary nodules owing to mycosis seems to increase the risk of fungal relapse after chemotherapy and transplant procedures. Between 1997 and 2004, 10 acute leukemia patients underwent pulmonary surgery for invasive mycosis. The median time from diagnosis of mycosis to surgery was 135 days (range 21-147). Three patients underwent emergency surgery, owing to hemoptysis. In the other seven patients with nodule/cavitation remaining after antifungal treatment, surgery (three wedge resections, four lobectomies) was scheduled before transplant. Pathologic examination confirmed two aspergillosis and three zygomycosis. The only side effect was pneumothorax in one case. Nine patients were considered cured. Six patients underwent bone marrow transplantation (three allogeneic, three autologous) with antifungal prophylaxis without relapse during the transplant procedure. In selected patients scheduled for bone marrow transplantation, surgical resection of localized pulmonary fungus nodules combined with antifungal prophylaxis seem to be an effective treatment for preventing mycotic relapse.

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“…In a case control study of 27 cases of zygomycosis, associated risk factors were noted to be voriconazole use, malnutrition, and diabetes mellitus [3]. Our patient had all three risk factors.…”

Section: Discussionmentioning

confidence: 58%

Trilogy of sequential infections in a diabetic male

Dogra

Talwar

Saxena

et al. 2015

Respirology Case Reports

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Uncontrolled diabetes is a known immunosuppressive state. It predisposes individuals to bacterial and fungal infections. The present case report demonstrates sequential infections by Klebsiella followed by tuberculosis and later development of mucormycosis in a poorly controlled diabetic patient. Timing of diagnosis is of essence because of high mortality seen with such pulmonary infections. High index of suspicion needs to be maintained as the same individual may harbor multiple infections as highlighted in this case.

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Zygomycosis in a Tertiary‐Care Cancer Center in the Era ofAspergillus‐Active Antifungal Therapy: A Case‐Control Observational Study of 27 Recent Cases

Abstract: Zygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition.

Cited by 655 publications

References 39 publications

Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole

Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole

Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia

Trilogy of sequential infections in a diabetic male

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