Zygomycosis Follow-up
- Author: Jose A Vazquez, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD more...
Further Inpatient Care
- Inpatient care of zygomycosis is frequently prolonged because of the severe nature of the illness.
- Patients with zygomycosis frequently undergo multiple surgical procedures in an attempt to eradicate devitalized tissue.
- Antifungals are generally provided parenterally for a period of several months to achieve cure.
Further Outpatient Care
- Once the patient is stabilized and no further surgical procedures are planned, discharge the patient home on antifungal therapy with follow-up visits every 2-4 weeks.
- Monitor patients on amphotericin B products at least biweekly for adverse effects and toxicity (eg, CBC counts, electrolytes, BUN, serum creatinine).
Inpatient & Outpatient Medications
- Because of the severity of the infection, most patients with zygomycosis undergo inpatient care for most of their treatment. If patient is clinically stable, the infection appears controlled, and the gastrointestinal tract is functional, he or she may be switched to oral posaconazole and discharged home with close monitoring for efficacy and toxicity.
Transfer
- Transfer patients to the service that can care for serious infections (eg, neurosurgery, otorhinolaryngology, infectious diseases, ophthalmology).
- Transfer patients with altered mental status to an appropriate critical care unit.
Deterrence/Prevention
- Control blood sugar in patients with diabetes mellitus.
- Control metabolic acidosis.
- Eliminate risk factors such as neutropenia and immune modulators.
- Closely monitor patients on deferoxamine therapy.
Complications
- Invasive zygomycosis generally spreads to adjacent organ systems (ie, osteomyelitis), including sinuses and adjacent bones.
- The ocular globe is frequently affected, which may cause blindness.
- Cavernous sinus thrombosis with cranial nerve palsies and extension of infection into the brain and meningitis is a possibility.
- Brain abscess and CNS infarction with ischemia and necrosis may occur.
- Pulmonary infiltrates, cavitary lesions, and life-threatening pulmonary hemorrhages are possible.
- Gastrointestinal hemorrhages may result from gastrointestinal perforation and may lead to peritonitis and sepsis.
Prognosis
- The prognosis of zygomycosis depends on several factors, including the infection site, rapidity of diagnosis, and type and severity of immunosuppression.
- The overall mortality rate among patients with zygomycosis is approximately 50%, although rhinocerebral and gastrointestinal forms of the infection carry a mortality rate of approximately 85%. Mortality rates are high because of the difficulty in establishing the diagnosis and the lack of adequate antifungal therapy. By the time a diagnosis of zygomycosis is confirmed, it has frequently spread via either local invasion with extensive tissue destruction or widely disseminated infection.
Patient Education
- Inform patients and family members that this is an extremely serious condition with a poor prognosis (high morbidity and mortality rate) unless aggressive action is taken early.
Kwon-Chung KJ, Bennett JE. Mucormycosis. In: Cann C, ed. Medical Mycology. Lea & Febiger; 1992:524-59.
Rippon JW. Zygomycosis. In: Wonsiewicz M, ed. Medical Mycology. The Pathogenic Fungi and the Pathogenic Actinomycetes. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998:681-713.
Kontoyiannis DP, Wessel VC, Bodey GP, et al. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis. Jun 2000;30(6):851-6. [Medline].
Greenberg RN, Scott LJ, Vaughn HH, et al. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis. Dec 2004;17(6):517-25. [Medline].
Kauffman CA. Zygomycosis: reemergence of an old pathogen. Clin Infect Dis. Aug 15 2004;39(4):588-90. [Medline].
Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. Apr 2000;13(2):236-301. [Medline].
Gonzalez CE, Rinaldi MG, Sugar AM. Zygomycosis. Infect Dis Clin North Am. Dec 2002;16(4):895-914, vi. [Medline].
Petrikkos G, Skiada A, Sambatakou H, et al. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis. Dec 2003;22(12):753-6. [Medline].
Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. Sep 1 2005;41(5):634-53. [Medline].
Ibrahim AS, Edwards JE, Filler SG. Zygomycosis. In: Dismukes WE, Pappas PG, Sobel JD, eds. Clinical Mycology. First ed. New York: Oxford University Press; 2003:241-251.
Thomson SR, Bade PG, Taams M, et al. Gastrointestinal mucormycosis. Br J Surg. Aug 1991;78(8):952-4. [Medline].
Lass-Flörl C, Resch G, Nachbaur D, Mayr A, Gastl G, Auberger J, et al. The value of computed tomography-guided percutaneous lung biopsy for diagnosis of invasive fungal infection in immunocompromised patients. Clin Infect Dis. Oct 1 2007;45(7):e101-4. [Medline].
Sun QN, Fothergill AW, McCarthy DI, et al. In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother. May 2002;46(5):1581-2. [Medline].
Dannaoui E, Meletiadis J, Mouton JW, et al. In vitro susceptibilities of zygomycetes to conventional and new antifungals. J Antimicrob Chemother. Jan 2003;51(1):45-52. [Medline].
Herbrecht R. Posaconazole: a potent, extended-spectrum triazole anti-fungal for the treatment of serious fungal infections. Int J Clin Pract. Jun 2004;58(6):612-24. [Medline].
van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP. Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases. Clin Infect Dis. Apr 1 2006;42(7):e61-5. [Medline].
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