Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports

Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence de...

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Main Authors: Maria Drogari-Apiranthitou, Anna Skiada, Ioannis Panayiotides, Timoleon-Achilleas Vyzantiadis, Aikaterina Poulopoulou, Myrto Christofidou, Anastasia Antoniadou, Emmanuel Roilides, Elias Iosifidis, Vassiliki Mamali, Athina Argyropoulou, Styliani Sympardi, Nikoletta Charalampaki, Nikolaos Antonakos, Paraskevi Mantzana, Zafeiria Mastora, Ourania Nicolatou-Galitis, Maria Orfanidou, Zoi-Dorothea Pana, Ioannis Pavleas, Angelos Pefanis, Vissaria Sakka, Anastasia Spiliopoulou, Maria Stamouli, Polydoros Tofas, Eleni Vagiakou, George Petrikkos
Format: Article
Language:English
Published: MDPI AG 2023-03-01
Series:Journal of Fungi
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Online Access:https://www.mdpi.com/2309-608X/9/4/425
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Summary:Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. <i>Rhizopus</i> (mostly <i>R. arrhizus</i>) predominated (67.1%), followed by <i>Lichtheimia</i> (8.5%) and <i>Mucor</i> (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (<i>p</i> = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population.
ISSN:2309-608X