Zygomycosis is rare but tends to occur in patients with hematologic malignancies. It is very rare in patients with solid tumors.
Risk factors for acquiring infection (page 852):
(1) prolonged, severe neutropenia (absolute count < 500 neutrophils per µL)
(2) lymphopenia (absolute count < 1,000 per µL)
(3) hyperglycemia (glucose > 200 mg/dL for >= 7 days prior to onset of infection)
(4) preexisting renal failure (serum creatinine > 2.5 mg/dL for >= 14 days prior to onset of infection)
(5) significant steroid use (> 600 mg cumulative prednisone dose in the 4 weeks before the onset of infection)
Splenectomy was listed as a predisposing factor in Table 2.
Diagnosis may be delayed or missed.
Patients with no risk factors or clinical evidence of infection were classified as probable colonization or contamination.
Risk factors for mortality:
(1) involvement of lungs and/or >= 2 noncontiguous sites
(2) no or partial surgical debridement
(3) failure to restore neutrophil count (continued neutropenia). WBC transfusions were found beneficial in some patients.
(4) amphotericin B therapy not aggressive (high dose) or only short term. Mortality 100% in those not treated with amphotericin B or who received it for < 1 week. Prognosis was good if the patient received > 2,000 mg.
(5) hyperacute/fulminant disease
