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Key Features

Essentials of Diagnosis

  • Most common cause of non-Aspergillus invasive mold infection

  • Predisposing factors

    • Poorly controlled diabetes

    • Leukemia

    • Transplant recipient

    • Wound contamination by soil

  • Pulmonary, rhinocerebral, and skin are most common disease sites

  • Rapidly fatal without multidisciplinary interventions

General Considerations

  • The term "mucormycosis" applies to opportunistic infections caused by members of the genera Rhizopus, Mucor, Lichtheimia (formerly Absidia), and Cunninghamella

  • Predisposing conditions include

    • Hematologic malignancy

    • Stem cell transplantation

    • Solid organ transplantation

    • Diabetic ketoacidosis

    • Chronic kidney disease

    • Desferoxamine therapy

    • Use of corticosteroids or cytotoxic drugs

Clinical Findings

  • Invasive disease of the sinuses, orbits, and the lungs may occur

  • Necrosis is common due to hyphal tissue invasion that may manifest as ulceration of the hard palate or nasal palate or hemoptysis

  • Widely disseminated disease can occur

Diagnosis

  • No serologic or laboratory findings assist with diagnosis

  • Blood cultures are unhelpful

  • A reverse halo sign may be seen on chest CT

  • Cultures frequently negative

  • Biopsy almost always required for diagnosis. Histology demonstrates organisms in tissues as broad, branching nonseptate hyphae

Treatment

  • Optimal therapy involves

    • Reversal of predisposing conditions (if possible)

    • Surgical debridement

    • Prompt antifungal therapy

  • A prolonged course of a lipid preparation of intravenous liposomal amphotericin B (5 mg/kg with higher doses possibly given for CNS disease) should be started early

  • Posaconazole tablets (300 mg/day) orally are generally used after disease has been stabilized

  • Combination therapy with amphotericin and posaconazole is not proven but is commonly used because of the poor response to monotherapy

  • Isovuconazole has shown some clinical activity

  • Other azoles are not effective

Outcome

Prognosis

  • Even with prompt treatment, prognosis is guarded

References

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Arif  S,  et al. Emergence of molds other than Aspergillus in immunocompromised patients. Clin Chest Med. 2017 Sep;38(3):555–73.
[PubMed: 28797495]
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Jung  J,  et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect. 2015 Jul;21(7):684.e11–8.
[PubMed: 25882362]
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Marty  FM,  et al. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis. 2016 Jul;16(7):828–37.
[PubMed: 26969258]

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