Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients

Hsin Yun Sun, Graeme Forrest, Krishan L. Gupta, Jose M. Aguado, Olivier Lortholary, Marino Blanes Julia, Nasia Safdar, Robin Patel, Shimon Kusne, Nina Singh

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed. Methods: SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included. Results: Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57% (51 of 90). Overall mortality was 52.3% (46 of 88), and the mortality in patients with CNS disease was 73.5% (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95% CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95% CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease. ConclusionS: Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalTransplantation
Volume90
Issue number1
DOIs
StatePublished - Jul 15 2010

Fingerprint

Zygomycosis
Central Nervous System Diseases
Transplants
Mortality
Mycoses
Odds Ratio
Amphotericin B
Confidence Intervals
Central Nervous System
Orbital Diseases
Lipids
Orbit
PubMed
Cohort Studies
Logistic Models
Regression Analysis
Transplant Recipients
Organizations
Survival
Research

Keywords

  • Rhino-orbital-cerebral.
  • Solid organ transplant
  • Zygomycosis

ASJC Scopus subject areas

  • Transplantation

Cite this

Sun, H. Y., Forrest, G., Gupta, K. L., Aguado, J. M., Lortholary, O., Julia, M. B., ... Singh, N. (2010). Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. Transplantation, 90(1), 85-92. https://doi.org/10.1097/TP.0b013e3181dde8fc

Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. / Sun, Hsin Yun; Forrest, Graeme; Gupta, Krishan L.; Aguado, Jose M.; Lortholary, Olivier; Julia, Marino Blanes; Safdar, Nasia; Patel, Robin; Kusne, Shimon; Singh, Nina.

In: Transplantation, Vol. 90, No. 1, 15.07.2010, p. 85-92.

Research output: Contribution to journalArticle

Sun, HY, Forrest, G, Gupta, KL, Aguado, JM, Lortholary, O, Julia, MB, Safdar, N, Patel, R, Kusne, S & Singh, N 2010, 'Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients', Transplantation, vol. 90, no. 1, pp. 85-92. https://doi.org/10.1097/TP.0b013e3181dde8fc
Sun HY, Forrest G, Gupta KL, Aguado JM, Lortholary O, Julia MB et al. Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. Transplantation. 2010 Jul 15;90(1):85-92. https://doi.org/10.1097/TP.0b013e3181dde8fc
Sun, Hsin Yun ; Forrest, Graeme ; Gupta, Krishan L. ; Aguado, Jose M. ; Lortholary, Olivier ; Julia, Marino Blanes ; Safdar, Nasia ; Patel, Robin ; Kusne, Shimon ; Singh, Nina. / Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. In: Transplantation. 2010 ; Vol. 90, No. 1. pp. 85-92.
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abstract = "Background: Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed. Methods: SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included. Results: Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57{\%} (51 of 90). Overall mortality was 52.3{\%} (46 of 88), and the mortality in patients with CNS disease was 73.5{\%} (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95{\%} confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95{\%} CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95{\%} CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease. ConclusionS: Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.",
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AU - Lortholary, Olivier

AU - Julia, Marino Blanes

AU - Safdar, Nasia

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AU - Kusne, Shimon

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