Zygomycosis in the 1990s in a tertiary-care cancer center

Twenty-four patients with cancer met predetermined criteria for a diagnosis of zygomycosis over a 10-year period at our institution. All had hematolog ic malignancy, and most had either neutropenia or steroid use as a risk fac tor. Pulmonary involvement mimicking invasive aspergillosis was the most co mmon presentation, and dissemination was seen in 58% of patients on whom au topsies were performed. Three-fourths of the patients with pulmonary zygomy cosis had pathogenic microorganisms other than zygomycetes isolated from re spiratory specimens. The sensitivity of cultures in detecting zygomycetes f rom respiratory specimens was low. A culture positive for zygomycetes was t ypically a preterminal finding in the fatal, acute cases. Two-thirds of the patients died. Favorable outcome seemed to correlate with lack of pulmonar y involvement, surgical debridement, neutrophil recovery, and a cumulative total amphotericin B dose of 2000 mg. Therapy with high-dose amphotericin B , combined with aggressive surgery and immune reconstitution, offers the be st chance for survival of cancer patients with zygomycosis.