ZYGOMYCOSIS (MUCORMYCOSIS) AND HIV-INFECTION - REPORT OF 3 CASES AND REVIEW

We report three cases of zygomycosis (mucormycosis) occurring in three individuals infected with the human immunodeficiency virus (HIV) and review 12 other published cases. We present the only two case reports of disseminated zygomycosis in AIDS patients, and the only AIDS patien t with renal zygomycosis to survive without nephrectomy, receiving int ravenous (i.v.) amphotericin alone. Coinfection with zygomycosis and H IV is rare, occurs primarily in patients with low CD4(+) lymphocyte co unts, does not always require the usual predisposing conditions for zy gomycosis, and may be the presenting opportunistic infection among HIV -infected persons. Transient episodes of neutropenia occurring within 4 months before presentation may be a risk factor for this disease. Zy gomycosis may arise in multiple sites including the basal ganglia, cut aneous tissue, kidney, respiratory tract, and may be disseminated. Occ urring more commonly in, but not restricted to, injection drug users, it is significantly associated with sites other than basal ganglia in those patients with advanced HIV disease or AIDS, The presenting sympt oms are related to the site of involvement, and the illness may develo p insidiously or progress rapidly to a fulminant course. Successful th erapy usually consists of surgical debridement and intravenous amphote ricin B. Overall mortality in this review is 40%, and is significantly associated with sites of disease inaccessible to surgical debridement .