BackgroundAnecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients

MethodsWe performed prospective surveillance of patients with zygomycosis (group A; n=27) and compared them with contemporaneous patients with invasive aspergillosis (group B; n=54) and with matched contemporaneous high-risk patients without fungal infection (group C; n=54). We also performed molecular typing and in vitro susceptibility testing of Zygomycetes isolates

ResultsNearly all patients with zygomycosis either had leukemia (n=14) or were allogeneic bone marrow transplant recipients (n=13). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval {CI}], 2.76–38.97]; P=.001), diabetes (OR, 8.39 [95% CI, 2.04–34.35]; P=.003), and malnutrition (OR, 3.70 [95% CI, 1.03–13.27]; P=.045) were found to be independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85–108.15]; P=.0001) and sinusitis (OR, 76.72 [95% CI, 6.48–908.15]; P=.001) were the only factors that favored the diagnosis of zygomycosis

ConclusionsZygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition