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Mucormycosis in Australia: Contemporary epidemiology and outcomes

Kennedy, K.J., Daveson, K., Slavin, M.A., van Hal, S.J., Sorrell, T.C., Lee, A., Marriott, D.J., Chapman, B., Halliday, C.L., Hajkowicz, K., Athan, E., Bak, N., Cheong, E., Heath, C.H., Morrissey, C.O., Kidd, S., Beresford, R., Blyth, C., Korman, T.M., Robinson, J.O., Meyer, W., Chen, S.C.-A., Clark, J., McCormack, J., Looke, D., Playford, E.G., Chen, S., Gottlieb, T., Halliday, C., Marriott, D., McMullan, B., Meyer, W., Sorrell, T., van Hal, S., Ananda-Rajah, M., Morrissey, C.O., Slavin, M., Bak, N., Kidd, S., Arthur, I., Blyth, C., Heath, C., Kennedy, K., Daveson, K., Morris, A. and Chambers, S. (2016) Mucormycosis in Australia: Contemporary epidemiology and outcomes. Clinical Microbiology and Infection, 22 (9). pp. 775-781.

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Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004–2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1–42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2–481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3–25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3–13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.

Item Type: Journal Article
Murdoch Affiliation(s): School of Veterinary and Life Sciences
Publisher: Elsevier Ltd
Copyright: © 2016 European Society of Clinical Microbiology and Infectious Diseases.
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