Mucormycosis is a very aggressive invasive fungal disease [ 1 x 1 Christopeit, M, Lindner, A, Surov, A et al. Right flank pain and high fever in a neutropenic patient with acute lymphoblastic leukaemia. Mycoses. 2013; 56: 90–92 Crossref | PubMed | Scopus (0) | Google Scholar See all References , 2 x 2 Neblett Fanfair, R, Benedict, K, Bos, J et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med. 2012; 367: 2214–2225 Crossref | PubMed | Scopus (107) | Google Scholar See all References ]. It is a fungal emergency that affects a variety of patient groups [ 3 x 3 Roden, MM, Zaoutis, TE, Buchanan, WL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005; 41: 634–653 Crossref | PubMed | Scopus (1104) | Google Scholar See all References 3 ]. The disease, previously termed zygomycosis [ 4 x 4 Ajello, L, Dean, DF, and Irwin, RS. The zygomycete Saksenaea vasiformis as a pathogen of humans with a critical review of the etiology of zygomycosis. Mycologia. 1976; 68: 52–62 Crossref | PubMed | Google Scholar See all References 4 ], is caused by mucoralean fungi, which have collectively also been called Mucormycetes [ 5 x 5 Gomes, MZ, Lewis, RE, and Kontoyiannis, DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev. 2011; 24: 411–445 Crossref | PubMed | Scopus (138) | Google Scholar See all References , 6 x 6 Kwon-Chung, KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis. 2012; 54: S8–S15 Crossref | PubMed | Scopus (0) | Google Scholar See all References ]. However, we prefer to use the name of the order, i.e. Mucorales.

Background. Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. Methods. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. Results. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0–14.1]; P < .001), pulmonary (HR, 2.2 [1.0–4.7]; P = .04), or skin localization (HR, 5.73 [1.9–17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0–5.2]; P < .05) or trauma (HR, 6.9 [1.6–28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8–19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. Conclusions. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

The frequency and diversity of serious fungal infections is increasing [ 1 x 1 Nucci, M, Garnica, M, Gloria, AB et al. Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil. Clin Microbiol Infect. 2013; 19: 745–751 Abstract | Full Text | Full Text PDF | PubMed | Scopus (43) | Google Scholar See all References , 2 x 2 Nucci, M and Anaissie, E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007; 20: 695–704 Crossref | PubMed | Scopus (413) | Google Scholar See all References , 3 x 3 Nucci, M and Anaissie, E. Emerging fungi. Infect Dis Clin North Am. 2006; 20: 563–579 Abstract | Full Text | Full Text PDF | PubMed | Scopus (0) | Google Scholar See all References ]. Severely immunocompromised patients are particularly vulnerable to infection from unusual moulds and yeasts, which are present in the environment. Clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Localized infections may occur following penetrating trauma in healthy individuals; dissemination usually occurs among immunocompromised patients and the outcome is closely related to the degree and persistence of immunosuppression [ 4 x 4 Nucci, M, Anaissie, EJ, Queiroz-Telles, F et al. Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection. Cancer. 2003; 98: 315–319 Crossref | PubMed | Scopus (163) | Google Scholar See all References 4 ]. Diagnosis usually requires isolation and identification of the infecting pathogen; however, serology, imaging techniques and clinical manifestations are not specific, and pan-fungal and species-specific PCR are useful investigational tools. Many of the emerging opportunistic moulds demonstrate in vitro and in vivo resistance to various antifungals. As a result, successful treatment may require adjunctive surgical debridement and, when possible, reconstitution of the host immune system.

We analyzed hospital records to provide a population-based estimate of zygomycosis incidence and trends over a 10-year period at a national level in France. Data showed an increasing incidence from 0.7/million in 1997 to 1.2/million in 2006 (p<0.001). We compared our data with those from the French Mycosis Study Group, a recently established voluntary network of French mycologists coordinated by the National Reference Center for Mycoses and Antifungals. We documented that incidence of zygomycosis increased, particularly in patients with hematologic malignancies or bone marrow transplants. The role of previous exposure to antifungal drugs lacking activity against zygomycetes could explain this increase but does not appear exclusive. Incidence also increased in the population of patients with diabetes mellitus. We conclude that observed trends reflect a genuine increase of zygomycosis cases in at-risk populations.

To investigate azole resistance in clinical Aspergillus isolates, we conducted prospective multicenter international surveillance. A total of 3,788 Aspergillus isolates were screened in 22 centers from 19 countries. Azole-resistant A. fumigatus was more frequently found (3.2% prevalence) than previously acknowledged, causing resistant invasive and noninvasive aspergillosis and severely compromising clinical use of azoles.