Zygomycosis: Epidemiology and Treatment Options*

Although it has hitherto been considered a rare type of infection, the incidence of zygomycosis (also known as mucormycosis) appears to be increasing. Zygomycosis is almost always lethal if not aggressively treated, and often lethal even with appropriate medical management. Zygomycetes are generally opportunistic organisms, although infection can occur in a normal host. Aerosolization of spores occurs easily, and the portals of entry include the respiratory tract, a disrupted integument, and ingestion of contaminated food. Zygomycetes are often angioinvasive and can manifest as sinusitis, pneumonia, skin infection, and sometimes gastrointestinal infections or necrosis. Patterns of infection vary by the host’s underlying condition. Histopathologically, one sees wide, thin-walled, “ribbony,” aseptate hyphae. Some reports suggest that an increase in zygomycotic infections may be because of increasing voriconazole use. Because Zygomycetes are not susceptible to voriconazole, their emergence in the presence of this drug is not unexpected. The optimal treatment for zygomycosis should include a combination of surgical debridement, medical antifungal therapy, and efforts to improve host defenses. Amphotericin B is the firstline choice for zygomycosis treatment. Posaconazole has shown some efficacy for zygomycosis, but it is not currently approved for its treatment; it is only available for compassionate use. (Adv Stud Med. 2006;6(6C):S526-S530)