Zygomycosis in Solid Organ Transplant Recipients in a Tertiary Transplant Center and Review of the Literature

Abstract

Zygomycetes are ubiquitous fungi that can cause invasive disease associated with high mortality. We report 10 solid organ transplant recipients with zygomycosis (incidence 2 per 1000) and reviewed 106 cases in the English-language literature. These included renal (n = 73), heart (n = 16), lung (n = 4), heart/lung (n = 2), liver (n = 19) and kidney/pancreas (n = 2) transplant recipients. All patients were receiving immunosuppression and the vast majority steroids. The clinical presentation included rhino-sino-orbital (n = 20), rhinocerebral (n = 16), pulmonary (n = 28), gastrointestinal (n = 13), cutaneous (n = 18), renal (n = 6) and disseminated disease (n = 15). Most frequently isolated genera were Rhizopus (73%) followed by Mucor (13%). The overall mortality was 49%. While rhino-sino-orbital disease had the best prognosis, rhinocerebral disease had high mortality (93%) comparable to disseminated disease. A favorable outcome was associated with limited, surgically accessible disease and early surgical intervention along with amphotericin B administration.

Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report

“…In another study, the lowest mortality rate 1 was reported in cutaneous mucormycosis (16%), rhinocerebral (67%), pulmonary (83%), gastrointestinal, and the disseminated form was associated with 100% mortality rate. 1 Einollahi and associates reported that rhinocerebral type was the most-common form of disease, followed by pulmonary in kidney transplant recipients. The overall mortality rate was 52%.…”

“…2,3,[7][8][9][10] A fungal stain (eg, Gomori methenamine silver) also is helpful if the fungus is not easily found. 1,9,11 In immunocompromised patients, these pathologic changes are usually associated with minimal inflammatory response. 9,11,12 Patients are usually treated with amphotericin B deoxycholate.…”

“…1 An intact T lymphocyte-macrophage system is necessary to eradicate these infections. Induction therapy with antilymphocyte antibodies or high-dose corticosteroids for allograft rejection adds an additional defect to humoral immunity.…”

“…Induction therapy with antilymphocyte antibodies or high-dose corticosteroids for allograft rejection adds an additional defect to humoral immunity. 1,2 Zygomycosis (mucormycosis) is an invasive opportunistic fungal infection. Diabetes mellitus, immunodeficiency, neutropenia, and malignancy are the main underlying conditions.…”

Rhinocerebral Mucormycosis in a Patient with Diabetes Type 1 Presenting as Ptosis and Facial Palsy Report from Alborz Hospital of Karaj from Iran

“…Mucormycosis can be divided into at least six clinical categories: rhino-orbital-cerebral, pulmonary, cutaneous, gastro-intestinal, disseminated, and miscellaneous. Rhino-orbital-cerebral is the most common form of infection in patients with DKA, whilst pulmonary mucormycosis is seen in leukemic patients who are receiving chemotherapy and in patients undergoing (HSCT) [8][9][10]. Rhino-orbital-cerebral Mucormycosis occur in patients with diabetes, and rhizopus is the predominant pathogen, with the incidence of 90% of rhinoorbital-cerebral infections [1].…”