, Volume 46, Issue 6, pp 811–821 | Cite as

Mucormycosis in hospitalized patients at a tertiary care center in Lebanon: a case series

  • Saeed El Zein
  • Jean El-Sheikh
  • Aline Zakhem
  • Dima Ibrahim
  • Ali Bazarbachi
  • Souha S. KanjEmail author
Original Paper



Mucormycosis (MCM) is a rare fungal infection affecting people with impaired immunity. Data related to MCM from Lebanon are scarce. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with MCM hospitalized at a tertiary care center in Lebanon.


We conducted a retrospective chart review between Jan 1, 2008 and Jan 10, 2018. All patients with proven or probable MCM were included.


A total of 20 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. Most common sites of involvement were rhino-orbital and pulmonary, respectively. The number of MCM cases/10.000 hospital admissions increased significantly between 2008 and 2017 (0.47 vs. 1.18; P < 0.05). A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. All-cause mortality was 60%; however, death was attributed to MCM in 20% of cases.


The incidence of MCM has significantly increased over the past 10 years at our institution, most likely due to the increasing patient population at risk. Understanding the epidemiology of MCM in our setting would help guide antifungal therapy.


Mucormycosis Incidence Lebanon Epidemiology 




Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012;54:23–34.CrossRefGoogle Scholar
  2. 2.
    Petrikkos G, Skiada A, Sambatakou H, Toskas A, Vaiopoulos G, Giannopoulou M, et al. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis. 2003;22:753–6.CrossRefGoogle Scholar
  3. 3.
    Adam RD, Hunter G, DiTomasso J, Comerci G Jr. Mucormycosis: emerging prominence of cutaneous infections. Clin Infect Dis. 1994;19:67–76.CrossRefGoogle Scholar
  4. 4.
    Kauffman CA, Malani AN. Zygomycosis: an emerging fungal infection with new options for management. Curr Infect Dis Rep. 2007;9:435–40.CrossRefGoogle Scholar
  5. 5.
    Kontoyiannis DP, Wessel VC, Bodey GP, Rolston KV. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis. 2000;30:851–6.CrossRefGoogle Scholar
  6. 6.
    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;50:1091–100.CrossRefGoogle Scholar
  7. 7.
    Chinn RY, Diamond RD. Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun. 1982;38:1123–9.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Skiada A, Lanternier F, Groll AH, Pagano L, Zimmerli S, Herbrecht R, et al. Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica. 2013;98:492–504CrossRefGoogle Scholar
  9. 9.
    De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised Definitions of Invasive Fungal Disease from the 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 (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.CrossRefGoogle Scholar
  10. 10.
    Al-Ajam MR, Bizri AR, Mokhbat J, Weedon J, Lutwick L. Mucormycosis in the Eastern Mediterranean: a seasonal disease. Epidemiol Infect. 2006;134:341–6.CrossRefGoogle Scholar
  11. 11.
    Dounia B, Dieter Van C, Fanny L, Eric D, Didier C, Francoise D, et al. Increasing incidence of zygomycosis (Mucormycosis), France, 1997–2006. Emerg Infect Dis. 2009;15:1395.CrossRefGoogle Scholar
  12. 12.
    Saegeman V, Maertens J, Meersseman W, Spriet I, Verbeken E, Lagrou K. Increasing incidence of mucormycosis in University Hospital, Belgium. Emerg Infect Dis. 2010;16:1456–8.CrossRefGoogle Scholar
  13. 13.
    Guinea J, Escribano P, Vena A, Muñoz P, Martínez-Jiménez MdC, Padilla B, et al. Increasing incidence of mucormycosis in a large Spanish hospital from 2007 to 2015: epidemiology and microbiological characterization of the isolates. PLoS One. 2017;12:e0179136.CrossRefGoogle Scholar
  14. 14.
    Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C, et al. zygomycosis in a tertiary-care cancer center in the era of aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005;191:1350–60.CrossRefGoogle Scholar
  15. 15.
    Pongas GN, Lewis RE, Samonis G, Kontoyiannis DP. Voriconazole-associated zygomycosis: a significant consequence of evolving antifungal prophylaxis and immunosuppression practices? Clin Microbiol Infect. 2009;15:93–7.CrossRefGoogle Scholar
  16. 16.
    Skiada A, Pagano L, Groll A, Zimmerli S, Dupont B, Lagrou K, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17:1859–67.CrossRefGoogle Scholar
  17. 17.
    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;41:634–53.CrossRefGoogle Scholar
  18. 18.
    Kontoyiannis DP. Decrease in the number of reported cases of zygomycosis among patients with diabetes mellitus: a hypothesis. Clin Infect Dis. 2007;44:1089–90.CrossRefGoogle Scholar
  19. 19.
    Chakrabarti A, Das A, Mandal J, Shivaprakash MR, George VK, Tarai B, et al. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol. 2006;44:335–42.CrossRefGoogle Scholar
  20. 20.
    Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses. 2016;59:402–15.CrossRefGoogle Scholar
  21. 21.
    World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.Google Scholar
  22. 22.
    Talmi YP, Goldschmied-Reouven A, Bakon M, Barshack I, Wolf M, Horowitz Z, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg. 2002;127:22–31.CrossRefGoogle Scholar
  23. 23.
    El-Herte RI, Baban TA, Kanj SS. Mucormycosis. A review on environmental fungal spores and seasonal variation of human disease. Adv Infect Dis. 2012;2:76–81.CrossRefGoogle Scholar
  24. 24.
    Dolatabadi S, Ahmadi B, Rezaei-Matehkolaei A, Zarrinfar H, Skiada A, Mirhendi H, et al. Mucormycosis in Iran: a six-year retrospective experience. J Med Mycol. 2018;
  25. 25.
    Nashibi R, Afzalzadeh S, Mohammadi MJ, Yari AR, Yousefi F. Epidemiology and treatment outcome of mucormycosis in Khuzestan, Southwest of Iran. Arch Clin Infect Dis. 2017;12:e37221.Google Scholar
  26. 26.
    Ministry of Environment, United Nations Development Programme. Global Environmental Finance. Lebanon’s third National Communication to the United Nations Framework Convention on Climate Change. Lebanon: Beirut; 2011.Google Scholar
  27. 27.
    Lass-Florl C. Zygomycosis: conventional laboratory diagnosis. Clin Microbiol Infect. 2009;15(Suppl 5):60–5.CrossRefGoogle Scholar
  28. 28.
    Dannaoui E. Molecular tools for identification of Zygomycetes and the diagnosis of zygomycosis. Clin Microbiol Infect. 2009;15(Suppl 5):66–70.CrossRefGoogle Scholar
  29. 29.
    Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014;20(Suppl 3):5–26.CrossRefGoogle Scholar
  30. 30.
    Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A, et al. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clin Microbiol Infect. 2016;22:775–81.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication September 2018

Authors and Affiliations

  • Saeed El Zein
    • 1
  • Jean El-Sheikh
    • 2
  • Aline Zakhem
    • 1
  • Dima Ibrahim
    • 1
  • Ali Bazarbachi
    • 2
  • Souha S. Kanj
    • 1
    Email author
  1. 1.Division of Infectious DiseasesAmerican University of Beirut Medical CenterBeirutLebanon
  2. 2.Division of Hematology Oncology, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon

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