How common is mucormycosis?
Mucormycosis is rare, but the exact number of cases is difficult to determine because no national surveillance exists in the United States. Population-based incidence estimates for mucormycosis were obtained from laboratory surveillance in the San Francisco Bay Area during 1992–1993 and suggested a yearly rate of 1.7 cases per 1 million population.1
Prospective surveillance among 16,808 transplant recipients performed in 23 institutions during 2001–2006 found that mucormycosis was the third most common type of invasive fungal infection in stem cell transplant recipients and accounted for 8% of all invasive fungal infections (77 mucormycete cases occurred among 983 stem cell transplant recipients who developed any fungal infection).2,3 Among solid organ transplant recipients, mucormycosis accounted for 2% of all invasive fungal infections (28 mucormycete cases occurred among 1,208 solid organ transplant recipients who developed any fungal infection).3,4 The number of cases varied widely across participating institutions.
Healthcare providers who are concerned about an unusual number of new cases should contact their state or local public health agency.
Although most cases of mucormycosis are sporadic (not part of an outbreak), outbreaks of mucormycosis have occured. In healthcare settings, it can be difficult to determine whether mucormycosis is healthcare-associated or whether the infections were acquired somewhere else. Some examples of sources implicated in healthcare-associated mucormycosis outbreaks include adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices, and building construction.7-14 Community-onset outbreaks have been associated with trauma sustained during natural disasters.15
Deaths due to mucormycosis
Mucormycosis is frequently a life-threatening infection. A review of published mucormycosis cases found an overall all-cause mortality rate of 54%.8 The mortality rate varied depending on underlying patient condition, type of fungus, and body site affected (for example, the mortality rate was 46% among people with sinus infections, 76% for pulmonary infections, and 96% for disseminated mucormycosis).8
- Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis. 1998 Nov;27(5):1138-47.
- Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010 Apr 15;50(8):1091-100.
- Park BJ, Pappas PG, Wannemuehler KA, Alexander BD, Anaissie EJ, Andes DR, et al. Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001-2006. Emerging infectious diseases. 2011 Oct;17(10):1855-64.
- Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010 Apr 15;50(8):1101-11.
- Rammaert B, Lanternier F, Zahar JR, Dannaoui E, Bougnoux ME, Lecuit M, et al. Healthcare-associated mucormycosis. Clin Infect Dis. 2012 Feb;54 Suppl 1:S44-54.
- Duffy J, Harris J, Gade L, Sehulster L, Newhouse E, O’Connell H, et al. Mucormycosis outbreak associated with hospital linens. Pediatr Infect Dis J. 2014 May;33(5):472-6.
- Neblett Fanfair R, Benedict K, Bos J, Bennett SD, Lo YC, Adebanjo T, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. New Engl J Med. 2012 Dec 6;367(23):2214-25.
- Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005 Sep 1;41(5):634-53.
- Novosad SA, Vasquez AM, Nambiar A, et al. Notes from the Field: Probable Mucormycosis Among Adult Solid Organ Transplant Recipients at an Acute Care Hospital – Pennsylvania, 2014-2015. MMWR Morb Mortal Wkly Rep. 2016;65(18):481-482.
- Garner D, Machin K. Investigation and management of an outbreak of mucormycosis in a paediatric oncology unit. J Hosp Infect. 2008;70(1):53-59.
- Mishra B, Mandal A, Kumar N. Mycotic prosthetic-valve endocarditis. J Hosp Infect. 1992;20(2):122-125.
- Del Palacio Hernanz A, Fereres J, Larregla Garraus S, Rodriguez-Noriega A, Sanz Sanz F. Nosocomial infection by Rhizomucor pusillus in a clinical haematology unit. J Hosp Infect. 1983;4(1):45-49.
- de Repentigny L, St-Germain G, Charest H, Kokta V, Vobecky S. Fatal zygomycosis caused by Mucor indicus in a child with an implantable left ventricular assist device. Pediatr Infect Dis J. 2008;27(4):365-369.
- Chaudhry R, Venugopal P, Chopra P. Prosthetic mitral valve mucormycosis caused by Mucor species. Int J Cardiol. 1987;17(3):333-335.
- Chaves MS, Franco D, Nanni JC, et al. Control of an outbreak of postoperative bone mucormycosis: An intervention study of contiguous cohorts. Am J Infect Control. 2016;44(12):1715-1717
- Davies 2017. Increased Incidence of Rhino-Orbital-Cerebral Mucormycosis After Colorado Flooding. Ophthalmic Plast Reconstr. Surg.