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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