Epidemiology and prognostic factors of mucormycosis in France (2012–2022): a cross-sectional study nested in a prospective surveillance programme - Archive ouverte HAL
Journal Articles The Lancet Regional Health - Europe Year : 2024

Epidemiology and prognostic factors of mucormycosis in France (2012–2022): a cross-sectional study nested in a prospective surveillance programme

1 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
2 CHV - Centre Hospitalier de Versailles André Mignot
3 IP - Institut Pasteur [Paris]
4 Santé publique France - French National Public Health Agency [Saint-Maurice, France]
5 Service de Parasitologie et Mycologie [CHU Toulouse]
6 RESTORE - Geroscience and rejuvenation research center
7 Centre d'infectiologie Necker-Pasteur [CHU Necker]
8 Laboratoire de parasitologie et mycologie médicale [CHU Strasbourg]
9 PHAVI - Pathogens Host Arthropod Vectors Interfaces
10 Hub Bioinformatique et Biostatistique - Bioinformatics and Biostatistics HUB
11 IICiMed - Cibles et Médicaments des Infections et de l'Immunité - UR 1155
12 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
13 Laboratoire Parasitologie - Mycologie [CHU Clermont-Ferrand]
14 Service de mycologie et de parasitologie médicale [CHU de Poitiers]
15 EBI [Poitiers] - Écologie et biologie des interactions
16 Unité de Parasitologie-Mycologie, Service de Microbiologie [Hôpital Necker-Enfants-Malades, Paris]
17 BPF - Biologie et Pathogénicité fongiques - Fungal Biology and Pathogenicity
18 Laboratoire de parasitologie et de mycologie médicales [CHU Amiens]
19 Laboratoire de Parasitologie-Mycologie, Nice
20 Hôpital Bretonneau
21 CEPR - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100
22 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
23 ESCAPE - Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle
24 CHU Reims - Hôpital universitaire Robert Debré [Reims]
25 CHU Caen
26 ABTE - Aliments Bioprocédés Toxicologie Environnements
27 Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris]
28 Service de parasitologie et mycologie [CHRU de Besançon]
29 LCE - Laboratoire Chrono-environnement (UMR 6249)

Abstract

Background Mucormycosis is a deadly invasive fungal infection recently included in the WHO priority pathogen list. Here we sought to describe epidemiological trends of mucormycosis in France, and to evaluate factors associated with mortality. Methods From 2012 to 2022, we implemented a nationwide prospective surveillance programme for mucormycosis in France, focusing on epidemiology, species, seasonal variations. Factors associated with 3-month mortality were studied by univariable and multivariable logistic regression. Findings Among 550 cases of mucormycosis, the main underlying conditions were haematological malignancy (HM, 65.1%, 358/550), trauma (8%, 44/550), diabetes (7.5%, 41/550) and solid-organ transplants (6.5%, 36/550). Site of infection was pulmonary in 52.4% (288/550), rhinocerebral in 14.5% (80/550), and cutaneo-articular in 17.1% (94/550). Main species identified were Rhizopus arrhizus (21%, 67/316), Rhizopus microsporus (13.6%, 43/316), Lichtheimia corymbifera and Mucor circinelloides (13.3%, 42/316 each), Rhizomucor pusillus (12%, 38/316), and Lichtheimia ramosa (10.8%, 34/316). We found associations between underlying condition, site of infection, and infecting species, including a previously undescribed triad of trauma, cutaneo-articular localisations, and L. ramosa/M. circinelloides. Diagnostic contribution of Polymerase Chain Reaction (PCR) increased from 16% (4/25) in 2012 to 91% (61/67) in 2022, with more than 50% of diagnoses relying solely on PCR in 2022. We also found seasonal variations with relatively more cases in autumn. Ninety-day mortality was 55.8% (276/495). Independent prognostic factors were age, diagnosis in Intensive Care Unit (ICU), and HM while diagnosis after 2015 (i.e. large implementation of PCR) and surgery were associated with reduced mortality. Interpretation This study reveals major mucormycosis epidemiological changes in France, with a large predominance of HM patients, and a parallel between PCR multicentre implementation and improved prognosis. We also evidence new associations between species, localisations and risk factors, as well as seasonal variations.
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hal-04688848 , version 1 (05-09-2024)

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Laura Gouzien, Didier Che, Sophie Cassaing, Olivier Lortholary, Valérie Letscher-Bru, et al.. Epidemiology and prognostic factors of mucormycosis in France (2012–2022): a cross-sectional study nested in a prospective surveillance programme. The Lancet Regional Health - Europe, 2024, 45, pp.101010. ⟨10.1016/j.lanepe.2024.101010⟩. ⟨hal-04688848⟩
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