Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)

Objectives: To analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology survey. Methods: A prospective multicenter study performed between 2004 and 2007 at 49 Italian Departments. Results: During the study period 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematologic malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to the EORTC’s criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. Fifty-one patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy; remarkably all the 7 patients receiving sequential therapy with L-AmB and Posaconazole improved. As a whole it was registered an attributable mortality rate of 32% (19/60), that is reduced to 18% in patients treated with L-AmB (8/44). Conclusions: Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. In our study appears an inversion of this trend, with a better prognosis and a mortality significantly lower than that reported in literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, could have improved the prognosis of these patients.