Contrasts between mucormycosis and aspergillosis in oncohematological patients.

Abstract

In retrospective multicenter study from years 2007-2017, we evaluated 59 oncohematological patients with mucormycosis and 541 with invasive aspergillosis (IA). Mucormycosis developed more often in children and adolescents (P = .001), as well as after the emergence of graft versus host disease (P = .0001). Patients with mucormycosis had more severe neutropenia (88%vs 82%), the median duration was 30 versus 14 days (P = .0001) and lymphocytopenia (77%vs 65%), with a median duration (25vs 14 days, P = .001) as compared to patients with IA. The lung infection was less frequent in patients with mucormycosis than in IA patients (73%vs 97%, P = .02), but more frequent was involvement of 2 or more organs (42%vs 8%, P = .001) and involvement of paranasal sinuses (15%vs 6%, P = .04). Typical clinical features of mucormycosis were localized pain syndrome (53%vs 5%, P = .0001), hemoptysis (32%vs 6%, P = .001), pleural effusion on lung CT scan (53%vs 7%, P = .003), lesions with destruction (38%vs 8%, P = .0001), and a "reverse halo" sign (17%vs 3%). The overall 12-week survival was significantly lower in patients with mucormycosis than for IA patients (49%vs 81%, P = .0001). In both groups unfavorable prognosis factors were ≥2 organs involvement (P = .0009), and concomitant bacterial or viral infection (P = .001, P = .008, respectively). In mucormycosis patients favorable prognosis factor was remission of underlying disease (P = .006).