Mucormycosis in Australia: contemporary epidemiology and outcomes

K. J. Kennedy, K. Daveson, M.A. Slavin, S. J. van Hal, T. C. Sorrell, A. Lee, D. J. Marriott, B. Chapman, C. L. Halliday, K. Hajkowicz, E. Athan, N. Bak, E. Cheong, C. H. Heath, C.O. Morrissey, S. Kidd, R. Beresford, C. Blyth, T. M. Korman, J. O. Robinson & 3 others W Meyer, S. C. -A. Chen, on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)775-781
Number of pages7
JournalClinical Microbiology and Infection
Volume22
Issue number9
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • Apophysomyces
  • epidemiology
  • mortality
  • Mucorales
  • mucormycete
  • mucormycosis
  • Rhizopus
  • Saksenaea
  • zygomycosis

Cite this

Kennedy, K. J., Daveson, K., Slavin, M. A., van Hal, S. J., Sorrell, T. C., Lee, A., ... on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases (2016). Mucormycosis in Australia: contemporary epidemiology and outcomes. Clinical Microbiology and Infection, 22(9), 775-781. https://doi.org/10.1016/j.cmi.2016.01.005
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. ; on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases. / Mucormycosis in Australia : contemporary epidemiology and outcomes. In: Clinical Microbiology and Infection. 2016 ; Vol. 22, No. 9. pp. 775-781.
@article{5b294cde5bf94d85913afb7a33b58d9c,
title = "Mucormycosis in Australia: contemporary epidemiology and outcomes",
abstract = "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.",
keywords = "Apophysomyces, epidemiology, mortality, Mucorales, mucormycete, mucormycosis, Rhizopus, Saksenaea, zygomycosis",
author = "Kennedy, {K. J.} and K. Daveson and M.A. Slavin and {van Hal}, {S. J.} and Sorrell, {T. C.} and A. Lee and Marriott, {D. J.} and B. Chapman and Halliday, {C. L.} and K. Hajkowicz and E. Athan and N. Bak and E. Cheong and Heath, {C. H.} and C.O. Morrissey and S. Kidd and R. Beresford and C. Blyth and Korman, {T. M.} and Robinson, {J. O.} and W Meyer and Chen, {S. C. -A.} and {on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases} and Michelle Ananda-Rajah",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.cmi.2016.01.005",
language = "English",
volume = "22",
pages = "775--781",
journal = "Clinical Microbiology and Infection",
issn = "1198-743X",
publisher = "Wiley-Blackwell",
number = "9",

}

Kennedy, KJ, Daveson, K, Slavin, MA, van Hal, SJ, Sorrell, TC, Lee, A, Marriott, DJ, Chapman, B, Halliday, CL, Hajkowicz, K, Athan, E, Bak, N, Cheong, E, Heath, CH, Morrissey, CO, Kidd, S, Beresford, R, Blyth, C, Korman, TM, Robinson, JO, Meyer, W, Chen, SC-A & on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases 2016, 'Mucormycosis in Australia: contemporary epidemiology and outcomes' Clinical Microbiology and Infection, vol. 22, no. 9, pp. 775-781. https://doi.org/10.1016/j.cmi.2016.01.005

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.; on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases.

In: Clinical Microbiology and Infection, Vol. 22, No. 9, 01.09.2016, p. 775-781.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mucormycosis in Australia

T2 - contemporary epidemiology and outcomes

AU - Kennedy, K. J.

AU - Daveson, K.

AU - Slavin, M.A.

AU - van Hal, S. J.

AU - Sorrell, T. C.

AU - Lee, A.

AU - Marriott, D. J.

AU - Chapman, B.

AU - Halliday, C. L.

AU - Hajkowicz, K.

AU - Athan, E.

AU - Bak, N.

AU - Cheong, E.

AU - Heath, C. H.

AU - Morrissey, C.O.

AU - Kidd, S.

AU - Beresford, R.

AU - Blyth, C.

AU - Korman, T. M.

AU - Robinson, J. O.

AU - Meyer, W

AU - Chen, S. C. -A.

AU - on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases

AU - Ananda-Rajah, Michelle

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

KW - Apophysomyces

KW - epidemiology

KW - mortality

KW - Mucorales

KW - mucormycete

KW - mucormycosis

KW - Rhizopus

KW - Saksenaea

KW - zygomycosis

UR - http://www.scopus.com/inward/record.url?scp=84964608282&partnerID=8YFLogxK

U2 - 10.1016/j.cmi.2016.01.005

DO - 10.1016/j.cmi.2016.01.005

M3 - Article

VL - 22

SP - 775

EP - 781

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - 9

ER -

Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A et al. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clinical Microbiology and Infection. 2016 Sep 1;22(9):775-781. https://doi.org/10.1016/j.cmi.2016.01.005