Contrasts between mucormycosis and aspergillosis in oncohematological patients

Abstract

In retrospective multicenter study from years 2007â 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 (25 vs 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).