Neuroblastoma, Hodgkin’s or non-Hodgkin’s lymphoma, aplastic anaemia, Fanconi’s anaemia, myelodysplastic syndrome, myeloid sarcoma and multiple myeloma were less frequent (Table 1). Mucormycosis mainly developed after four courses of cytostatic chemotherapy (Table 2). Prolonged severe neutropenia (<0.5 × 109/l) was detected in 91% of the patients with median duration for 30 days. Lymphocytopenia (<1.0 × 109/l) was determined in
88% of the patients with median duration for 25 days. Corticosteroids were received by 66% of the patients, and median duration of corticosteroid use was 48 days. Mucormycosis developed in 18 patients after allo-HSCT and mainly in the late posttransplant period (median 110 days). We found that in 50% of the patients mucormycosis was diagnosed 1–65 days
after invasive aspergillosis. The primary focus of infection most often was Volasertib mouse located in the lungs (70%) AP24534 supplier and paranasal sinuses (24%). In rare cases, it was found in bones, intestines, skin or soft tissues (Table 3). Further spread of the infection and involvement of two or more organs was observed in 50% patients. The most frequent clinical symptoms of mucormycosis were fever >38.5 °C (100%), cough (61%), haemoptysis and local chest pain (31%). All patients with rhinocerebral mucormycosis had local pain, five had nose bleeding, and five tissue necrosis and distinctive black eschars. Patients with gastrointestinal mucormycosis had sings of ‘acute abdomen’ with gradually increasing intensity of pain.[6] Chest CT scans were performed in all patients. In the early stages of the disease in all patients with lung involvement focal infiltrative changes were found. Focal lesions were in 87% of these cases, bilateral lesions 50%, hydrothorax 50%. Specific signs of mycotic lung involvement as ‘halo sign’ or ‘reversed halo sign’
were rarely observed. CT scans of paranasal sinuses were performed in 40% patients. Signs of fungal sinusitis were determined in 22% of the patients. Mycological tests of bronchial lavage fluid, sputum and sinus aspirate, pleural fluid, cerebrospinal fluid, blood and biopsies were performed. Histological examination was done in 56% of patients. Non-septate non-pigmented hyphae were Thymidine kinase identified with direct microscopy and/or on histology in 100% of patients. Positive culture was obtained from 64% of the patients, with the following identifications: Rhizopus sp. (n = 7), Lichtheimia corymbifera (n = 4), Rhizomucor pusillus (n = 4), Rhizopus microsporus (n = 2), Rhizopus oryzae (n = 2), Rhizomucor sp. (n = 3), Mucor sp. (n = 1). Before diagnosis of mucormycosis empirical antifungal therapy (amphotericin B, voriconazole and echinocandins) was received by 33% of the patients and 42% were treated with voriconazole and echinocandins for invasive aspergillosis.