Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 29;9(4):425.
doi: 10.3390/jof9040425.

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

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 , George Petrikkos  1   15
Affiliations

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

Maria Drogari-Apiranthitou et al. J Fungi (Basel). .

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: Greece; Mucorales; epidemiology; mucormycosis; zygomycosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Annual incidence of mucormycosis in Greece based on the prospective survey.
Figure 2
Figure 2
Localisation of mucormycosis in patients with haematologic malignancy (HM) or diabetes mellitus (DM) before and after 2009.
Figure 3
Figure 3
Outcome of mucormycosis cases per year.
See this image and copyright information in PMC

References

    1. Ibrahim A.S., Spellberg B., Walsh T.J., Kontoyiannis D.P. Pathogenesis of Mucormycosis. Clin. Infect. Dis. 2012;54((Suppl. S1)):S16–S22. doi: 10.1093/cid/cir865. - DOI - PMC - PubMed
    1. Hoenigl M., Seidel D., Sprute R., Cunha C., Oliverio M., Goldman G.H., Ibrahim A.S., Carvalho A. COVID-19-associated fungal infections. Nat. Microbiol. 2022;7:1127–1140. doi: 10.1038/s41564-022-01172-2. - DOI - PMC - PubMed
    1. Skiada A., Pavleas I., Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J. Fungi. 2020;6:265. doi: 10.3390/jof6040265. - DOI - PMC - PubMed
    1. Skiada A., Drogari-Apiranthitou M., Pavleas I., Daikou E., Petrikkos G. Global Cutaneous Mucormycosis: A Systematic Review. J. Fungi. 2022;8:194. doi: 10.3390/jof8020194. - DOI - PMC - PubMed
    1. Petrikkos G., Skiada A., Sambatakou H., Toskas A., Vaiopoulos G., Giannopoulou M., Katsilambros N. Mucormycosis: Ten-Year Experience at a Tertiary-Care Center in Greece. Eur. J. Clin. Microbiol. Infect. Dis. 2003;22:753–756. doi: 10.1007/s10096-003-1035-y. - DOI - PubMed

LinkOut - more resources