Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports

Drogari-Apiranthitou, Maria; Skiada, Anna; Panayiotides, Ioannis; Vyzantiadis, Timoleon-Achilleas; Poulopoulou, Aikaterina; Christofidou, Myrto; Antoniadou, Anastasia; Roilides, Emmanuel; Iosifidis, Elias; Mamali, Vassiliki; Argyropoulou, Athina; Sympardi, Styliani; Charalampaki, Nikoletta; Antonakos, Nikolaos; Mantzana, Paraskevi; Mastora, Zafeiria; Nicolatou-Galitis, Ourania; Orfanidou, Maria; Pana, Zoi-Dorothea; Pavleas, Ioannis; Pefanis, Angelos; Sakka, Vissaria; Spiliopoulou, Anastasia; Stamouli, Maria; Tofas, Polydoros; Vagiakou, Eleni; Petrikkos, George

doi:10.3390/jof9040425

Open AccessArticle

Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports

by

Maria Drogari-Apiranthitou

^1,*

,

Anna Skiada

²

,

Ioannis Panayiotides

³,

Timoleon-Achilleas Vyzantiadis

⁴

,

Aikaterina Poulopoulou

⁴,

Myrto Christofidou

⁵,

Anastasia Antoniadou

¹

,

Emmanuel Roilides

⁶,

Elias Iosifidis

⁶,

Vassiliki Mamali

⁷,

Athina Argyropoulou

⁸,

Styliani Sympardi

⁹,

Nikoletta Charalampaki

¹⁰,

Nikolaos Antonakos

¹,

Paraskevi Mantzana

¹¹,

Zafeiria Mastora

¹²,

Ourania Nicolatou-Galitis

¹³,

Maria Orfanidou

¹⁴,

Zoi-Dorothea Pana

¹⁵,

Ioannis Pavleas

¹⁶,

Angelos Pefanis

¹⁷,

Vissaria Sakka

¹⁸

,

Anastasia Spiliopoulou

⁵

,

Maria Stamouli

¹⁹,

Polydoros Tofas

²⁰,

Eleni Vagiakou

¹⁴ and

George Petrikkos

^1,15 Show full author list Hide full author list

¹

Infectious Diseases Research Laboratory, 4th Department of Internal Medicine, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece

²

1st Department of Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece

³

2nd Department of Pathology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece

⁴

Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece

⁵

Department of Microbiology, University Hospital of Patras, 26504 Patras, Greece

⁶

Infectious Diseases Unit, 3nd Department of Paediatrics, School of Medicine, Aristotle University and Hippokration General Hospital, 54642 Thessaloniki, Greece

⁷

Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece

⁸

Department of Clinical Microbiology, Evangelismos General Hospital, 10676 Athens, Greece

⁹

1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, 19600 Eleusis, Greece

¹⁰

Clinical Microbiology Laboratory, Thriasio General Hospital of Eleusis, 19600 Eleusis, Greece

¹¹

Department of Microbiology, AHEPA University Hospital, 54636 Thessaloniki, Greece

¹²

1st Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, 10676 Athens, Greece

¹³

CureCancer, 15451 Athens, Greece

¹⁴

Clinical Microbiology Laboratory, General Hospital of Athens Georgios Gennimatas, 11527 Athens, Greece

¹⁵

School of Medicine, European University of Cyprus, Nicosia 2404, Cyprus

¹⁶

Intensive Care Unit, Laiko General Hospital, 11527 Athens, Greece

¹⁷

Department of Internal Medicine, Sotiria General and Chest Diseases Hospital of Athens, 11527 Athens, Greece

¹⁸

3rd Department of Internal Medicine, Sotiria General and Chest Diseases Hospital of Athens, 11527 Athens, Greece

¹⁹

2nd Department of Internal Medicine, Propaedeutic, Haematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece

²⁰

Athens Euroclinic, 11521 Athens, Greece

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^*

Author to whom correspondence should be addressed.

J. Fungi 2023, 9(4), 425; https://doi.org/10.3390/jof9040425

Submission received: 5 February 2023 / Revised: 25 March 2023 / Accepted: 26 March 2023 / Published: 29 March 2023

(This article belongs to the Special Issue Fungal Diseases in Europe)

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Abstract

Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. Rhizopus (mostly R. arrhizus) predominated (67.1%), followed by Lichtheimia (8.5%) and Mucor (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (p = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population.

Keywords: mucormycosis; zygomycosis; Mucorales; epidemiology; Greece

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MDPI and ACS Style

Drogari-Apiranthitou, M.; Skiada, A.; Panayiotides, I.; Vyzantiadis, T.-A.; Poulopoulou, A.; Christofidou, M.; Antoniadou, A.; Roilides, E.; Iosifidis, E.; Mamali, V.; et al. Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports. J. Fungi 2023, 9, 425. https://doi.org/10.3390/jof9040425

AMA Style

Drogari-Apiranthitou M, Skiada A, Panayiotides I, Vyzantiadis T-A, Poulopoulou A, Christofidou M, Antoniadou A, Roilides E, Iosifidis E, Mamali V, et al. Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports. Journal of Fungi. 2023; 9(4):425. https://doi.org/10.3390/jof9040425

Chicago/Turabian Style

Drogari-Apiranthitou, Maria, Anna Skiada, Ioannis Panayiotides, Timoleon-Achilleas Vyzantiadis, Aikaterina Poulopoulou, Myrto Christofidou, Anastasia Antoniadou, Emmanuel Roilides, Elias Iosifidis, Vassiliki Mamali, and et al. 2023. "Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports" Journal of Fungi 9, no. 4: 425. https://doi.org/10.3390/jof9040425

APA Style

Drogari-Apiranthitou, M., Skiada, A., Panayiotides, I., Vyzantiadis, T.-A., Poulopoulou, A., Christofidou, M., Antoniadou, A., Roilides, E., Iosifidis, E., Mamali, V., Argyropoulou, A., Sympardi, S., Charalampaki, N., Antonakos, N., Mantzana, P., Mastora, Z., Nicolatou-Galitis, O., Orfanidou, M., Pana, Z.-D., ... Petrikkos, G. (2023). Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports. Journal of Fungi, 9(4), 425. https://doi.org/10.3390/jof9040425

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Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports

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