Skip to main content


Log in

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

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

A Correction to this article was published on 07 January 2019

A Correction to this article was published on 14 September 2018

This article has been updated



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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Change history

  • 07 January 2019

    Unfortunately, the original version of this article contains mistakes. The names “Jean El-Cheikh” and Aline El Zakhem were spelled incorrectly.

  • 14 September 2018

    The spelling of the name “Ali Bazarbachi” was incorrect.

  • 07 January 2019

    Unfortunately, the original version of this article contains mistakes. The names ���Jean El-Cheikh��� and Aline El Zakhem were spelled incorrectly.


  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  3. Adam RD, Hunter G, DiTomasso J, Comerci G Jr. Mucormycosis: emerging prominence of cutaneous infections. Clin Infect Dis. 1994;19:67–76.

    Article  CAS  Google Scholar 

  4. Kauffman CA, Malani AN. Zygomycosis: an emerging fungal infection with new options for management. Curr Infect Dis Rep. 2007;9:435–40.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  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;98:492–504

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  20. Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses. 2016;59:402–15.

    Article  Google Scholar 

  21. World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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. 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. Lass-Florl C. Zygomycosis: conventional laboratory diagnosis. Clin Microbiol Infect. 2009;15(Suppl 5):60–5.

    Article  Google Scholar 

  28. Dannaoui E. Molecular tools for identification of Zygomycetes and the diagnosis of zygomycosis. Clin Microbiol Infect. 2009;15(Suppl 5):66–70.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

Download references



Author information

Authors and Affiliations


Corresponding author

Correspondence to Souha S. Kanj.

Ethics declarations

Conflict of interest

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

Additional information

The ​original ​version ​of ​this ​article ​was ​revised: The spelling of the name “Ali Bazarbachi” was incorrect.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Zein, S., El-Sheikh, J., Zakhem, A. et al. Mucormycosis in hospitalized patients at a tertiary care center in Lebanon: a case series. Infection 46, 811–821 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: