Zygomycosis is an important emerging fungal infection, associated with high morbidity and mortality. The Working Group on Zygomycosis
of the European Confederation of Medical Mycology (ECMM) prospectively collected cases of proven and probable zygomycosis
in 13 European countries occurring between 2005 and 2007. Cases were recorded by a standardized case report form, entered into an
electronic database and analysed descriptively and by logistic regression analysis. During the study period, 230 cases fulfilled pre-set criteria
for eligibility. The median age of the patients was 50 years (range, 1 month to 87 years); 60% were men. Underlying conditions
included haematological malignancies (44%), trauma (15%), haematopoietic stem cell transplantation (9%) and diabetes mellitus (9%).
The most common manifestations of zygomycosis were pulmonary (30%), rhinocerebral (27%), soft tissue (26%) and disseminated disease
(15%). Diagnosis was made by both histology and culture in 108 cases (44%). Among 172 cases with cultures, Rhizopus spp. (34%),
Mucor spp. (19%) and Lichtheimia (formerly Absidia) spp. (19%) were most commonly identified. Thirty-nine per cent of patients received
amphotericin B formulations, 7% posaconazole and 21% received both agents; 15% of patients received no antifungal therapy. Total
mortality in the entire cohort was 47%. On multivariate analysis, factors associated with survival were trauma as an underlying condition
(p 0.019), treatment with amphotericin B (p 0.006) and surgery (p <0.001); factors associated with death were higher age (p 0.005) and
the administration of caspofungin prior to diagnosis (p 0.011). In conclusion, zygomycosis remains a highly lethal disease. Administration
of amphotericin B and surgery, where feasible, significantly improve survival.