Zygomycosis: An emerging fungal infection

Purpose. The epidemiology, pathogenesis, clinical presentation and diagnosis, and management of zygomycosis are reviewed. Summary. The frequency of zygomycosis has been increasing over the past 10 years; infections have been identified in up to 6.8% of patients at autopsy. The most common route of transmission for Zygomycetes fungi is inhalation of spores from the environment. Patients at highest risk for infections caused by Mucorales fungi include those with profound immunosuppression or diabetes, intravenous drug abusers, premature infants, those receiving deferoxamine, and recipients of bone marrow transplants. Mucormycosis commonly presents as rhinocerebral or pulmonary disease; gastrointestinal presentations also occur. Clinical manifestations of invasive mucormycosis are tissue necrosis and subsequent thrombosis. Common features of pulmonary disease include fever, dyspnea, hemoptysis, and cavitation upon radiologic examination. The mainstays of treatment are control or reversal of the underlying disease or immunosuppression, antifungal therapy, and aggressive surgical debridement. Posaconazole, a new triazole antifungal, has been used successfully in a number of cases that did not respond to amphotericin B. Conclusion. Zygomycosis appears to be on the rise in the United States. The standard treatment is a combination of amphotericin B therapy, surgical debridement, and reversal of the underlying disease or immunosuppression.