Abstract
We analyzed hospital records to provide a population-based estimate of zygomycosis incidence and trends over a 10-year period at a national level in France. Data showed an increasing incidence from 0.7/million in 1997 to 1.2/million in 2006 (p<0.001). We compared our data with those from the French Mycosis Study Group, a recently established voluntary network of French mycologists coordinated by the National Reference Center for Mycoses and Antifungals. We documented that incidence of zygomycosis increased, particularly in patients with hematologic malignancies or bone marrow transplants. The role of previous exposure to antifungal drugs lacking activity against zygomycetes could explain this increase but does not appear exclusive. Incidence also increased in the population of patients with diabetes mellitus. We conclude that observed trends reflect a genuine increase of zygomycosis cases in at-risk populations.
Highlights
Zygomycoses are severe angioinvasive infections caused by common filamentous fungi, the zygomycetes
For casefatality ratio (CFR), we considered a possible underreporting in the Programme de Médicalisation du Système d’Information (PMSI) combined with inaccuracies in the registration of causes of deaths in the CepiDc
The highest rates were observed in 5 rural districts hosting
Summary
Zygomycoses are severe angioinvasive infections caused by common filamentous fungi, the zygomycetes. These ubiquitous opportunistic fungi can cause infections with high lethality in immunocompromised or diabetic patients. Some reports have suggested an increasing incidence of zygomycosis on the basis of analysis of data from monocentric studies [7,10,14,16]. Several explanations have been posited: longer survival of persons with severe hematologic malignancies or solid organ transplantations; increased knowledge of the infection and a better diagnosis yield; and prolonged use of new antifungal drugs ineffective against zygomycetes as prophylactic or empiric treatment in bone marrow transplant recipients or other immunocompromised patients [10,17,18,19,20]. To describe the demographic characteristics of patients and to estimate the incidence and casefatality ratio (CFR) associated with the major underlying diseases, we analyzed the electronic hospitalization and death records of patients in France in whom zygomycosis had been diagnosed
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