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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.
摘要：
毛霉菌病已成为一组严重感染，主要发生在免疫功能低下的患者中。我们在多中心分析了希腊毛霉菌病的流行病学，对所有年龄段的患者进行全国前瞻性调查，2005-2022年。共记录108例。年发病率在2009年后有所下降，此后表现稳定，0.54例/百万人口。最常见的形式是鼻脑（51.8％），皮肤（32.4％），和肺（11.1％）。主要基础疾病为血液系统恶性肿瘤/中性粒细胞减少症（29.9%），造血干细胞移植(4.7%),糖尿病（DM）（15.9%），其他免疫缺陷(23.4%)，而22.4%的病例涉及机动车事故后皮肤/软组织感染的免疫能力强的个体，外科/医源性创伤,烧伤,以及与自然灾害有关的伤害。此外,据报道，在21.5％的具有各种主要条件的病例中，DM或类固醇诱导的DM是合并症。根霉（主要是根霉）占主导地位（67.1%），其次是Licheimia（8.5％）和Mucor（6.1％）。抗真菌药物治疗主要为两性霉素B脂质体（86.3%），中位剂量7毫克/千克/天，范围3-10毫克/千克/天，有或没有泊沙康唑。2005-2008年期间，粗死亡率为62.8%，但2009年后显著下降，为34.9%(p=0.02)，血液学病例减少了四倍，更少的医源性感染，晚期鼻脑型病例较少。DM患病率的增加应提醒临床医生及时诊断该患者人群中的毛霉菌病。
