Zygomycosis in Europe: Analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007

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 analyzed descriptively and by logistic regression analysis. During the study period, 230 cases fulfilled preset criteria for eligibility. The median age of the patients was 50 years (range, 1month to 87years); 60% were male. Underlying conditions included hematological malignancies (44%), trauma (15%), hematopoietic 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. 39% 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 underlying condition (p=0.019), treatment with amphotericin B (p=0.006) and surgery (p