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Table 1 Demographics, clinical features and mycological characteristics of the initial cluster of invasive Mucorale infections and the cluster the following year

From: Seasonal clustering of sinopulmonary mucormycosis in patients with hematologic malignancies at a large comprehensive cancer center

Age/Sex RF Symptoms Imaging Mucorale Mycological diagnosis EORTC/MSG criteria Site of infection Prophy/Treatment at Dx Treatment Outcome
39/F AML Fever, Cough CP Nodule, surrounding GGO Rhizopus microsporus or azygosporus BAL Mucorales PCR+ Poss w/PCR+ Pulmonary Vori, Caspo (8 months) LAMB, then posa Death
71/M MM, auto HCT Fever, Skin lesions Nodule Rhizopus microsporus or azygosporus Skin swab culture +; BAL pan-fungal & Mucorales PCRs+ Poss w/PCR+ Disseminated: pulmonary, cutaneous LAMB and posa Death
31/F DLBCL Fever Resp. failure Hypotension Dense consolidations, pleural effusions Rhizopus microsporus or azygosporus BAL pan-fungal & Mucorales PCRs+; Autopsy histopath + Proven Pulmonary Vori, Mica (1 month) Nil – diagnosed after death Death
52/M ALL Fever, Resp. failure Nodule Rhizopus microsporus or azygosporus BAL Mucorales PCR +; Autopsy histopath & culture + Proven Pulmonary Flu Nil – diagnosed after death Death
56/M AML Fever Nodule, surrounding GGO Rhizopus microsporus or azygosporus BAL Mucorales PCR+ Poss w/PCR+ Pulmonary Vori (5 months) LAMB, then posa Hospice
63/F AML Fever, Palatal lesions Nodules w/cavitation; Diffuse sinus mucosal thickening Rhizopus microsporus or azygosporus; Mucor circinelloides Palate biopsy culture & histopath +; BAL culture, Mucorales & pan-fungal PCRs+ Proven Sinopulmonary Flu LAMB Hospice
73/M AML Chills, Resp. failure Pulmonary nodules/consolidation; Masses w/in ventricles (Brain) Rhizomucor pusillus BAL Mucorales PCR+ Poss w/PCR+ Disseminated: pulmonary, CNS Flu LAMB Death
50/F ALL, HCT Forearm skin lesion Normal Rhizopus oryzae complex Skin biopsy culture and Mucorales PCR + Proven Cutaneous Flu Surgery, LAMB + posa, then posa Cure
70/F AML Neutropenic fever, cough Pulmonary nodules/consolidations Rhizopus microsporus or azygosporus BAL panfungal PCR+ Poss w/PCR+ Pulmonary Posa prophylaxis ceased due to transaminitis   Death
71/M MDS, HCT Pulmonary nodules Pulmonary nodules/consolidation Cunninghamella bertholletiae Autopsy histopath and Mucorales PCR+ Proven Pulmonary Mica Nil Death
45/F AML Neutropenic fever Pulmonary nodules/consolidation Rhizomucor pusillus Lung tissue histopath+ Proven Pulmonary Posa (subtherapeutic level) Surgery + LAMB/terbinafine/isuvaconazole Death
59/F MDS, HCT Neutropenic fever, chest pain Pulmonary nodules/kidney lesions Rhizomucor meihei Autopsy histopath, panfungal and Mucorales PCR+ Proven Disseminated – pulmonary, renal Vori (transaminitis), Mica Surgery Death
  1. White = initial cluster in 2014; Grey = cluster in 2015, RF Risk factors, EORTC/MSG European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group, Dx Diagnosis, Resp. failure – respiratory failure, AML Acute Myeloid Leukemia, CP Chest pain, GGO Ground glass opacity, CT Chest tomography, BAL Bronchoalveolar lavage, Vori Voriconazole, Caspo Caspofungin, LAMB Liposomal amphotericin, MM Multiple Myeloma, HCT Hematopoietic cell transplantation, + positive, PCR Polymerase chain reaction, DLBCL Diffuse large B cell lymphoma, Mica Micafungin, ALL Acute lymphoblastic leukemia