Epidemiological survey on Zygomycosis in Europe

ECMM Working Group on Zygomycosis was initiated by Georgios L. Petrikkos (University of Athens, Greece) in 2004. The prospective study was planned to start on January 1st, 2005 to last for one year. One year (2004) retrospective data were also planned to be collected. All clinical and epidemiological data were to be analysed yearly and became available to all participants through the coordinating site.

To the time of planning the study, it was well-recognized that there were still few studies addressing the epidemiology of infections due to Zygomycetes in Europe. Most of them are detailed, yet, sporadic case reports or single-site reviews covering a time period. A systematic multicentre survey of these infections in Europe may, therefore, offer the opportunity to analyse epidemiological data that would consequently increase vigilance for early diagnosis and expand on existing prevention and treatment schemes. It will also give further details on the predisposing factors for these infections, highlight the possible role that antibacterial and antifungal chemotherapy play in the emergence of zygomycosis and disclose any potential temporal and geographical variation in its incidence. Therefore, the specific goals of this epidemiological survey were set as
1. to record cases of zygomycosis in collaborating countries and
2. to analyse the zygomycete strains isolated from these infections.

The year 2005 was a pilot year for the study. For 2006, the study was funded by GILEAD. A summary of the cases received up to spring 2006 was reported in Mycology Newsletter. Fifty-eight cases of zygomycosis have been included in the database (Italy 15, Greece 13, Germany 13, Austria 5, Spain 4, Finland 2, Russia 2, Belgium 2 and Norway 2 cases). The underlying diseases of these patients were: hematologic malignancy in 29, diabetes in 6, corticosteroids in 15, transplantation in 6 and trauma in 3 patients. The site of the zygomycosis was lungs in 19 patients, soft tissues in 11 and heart in 2; 19 cases were rhinocerebral and 1 disseminated; in 6 cases site was not reported or was unclear.

ECMM Working Group participants

Country

Co-ordinator

Austria

C. Lass-Floerl

Belgium

M. Aoun

Cyprus

M. Alexandrou

Finland

M. Richardson

France

B. Dupont

Germany

A. Groll

Greece

A. Mitrousia

Ireland

T. Rogers

Israel

D. Engelhard

Italy

L. Pagano

Norway

P. Gaustad

Russia

N. Klimko

Slovak Republic

V. Krcmery, L. Drgona

Spain

E. Bouza

Switzerland

J. Bille

The Netherlands

J. Meis

Turkey

E. Tümbay

UK

B. Jones

A meeting of the Zygomycosis Working Group of ECMM was held during the TIMM in Torino.
The first analysis of the cases was accepted at this conference as an oral presentation. One hundred and thirty-nine cases, from 11 countries, were analyzed (Italy 45, Greece 26, Germany 20, France 15, Austria 10, Spain 9, Russia 5, Belgium 4, Finland 2, Norway 2 and UK 1).

The first analysis showed that haematological malignancy correlated with pulmonary disease and underlying diabetes mellitus correlated with rhinocerebral disease. Regarding the diagnosis methods, it was noted that 80 (57.55%) cases were con firmed by culture (22 only culture, 58 histology and culture) and 13 (9.35%) only by histology. The most commonly isolated fungi were Mucor sp.(35) and Rhizopus sp. (29). Statistical analysis showed that patients who had received voriconazole prior to the diagnosis of zygomycosis had a higher mortality (p=0.009), but this result needs further analysis. The study is supported by an unrestricted grant by Gilead. It was decided that the study will go on until the end of 2007. A data review committee will study the results. More data will be presented in Istanbul, during the IUMS Congress.

From Mycology Newsletter 2004, P. 17, 2006 P. 6, 2007 P. 6-7