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For further information, see CMDT Part 36-08: Mucormycosis

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

  • Lungs, 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

  • Oral posaconazole (300 mg/day) or oral isavuconazole (200 mg every 8 hours for 1–2 days, then 200 mg daily thereafter) can be used for

    • Less severe disease

    • Step-down therapy after disease stabilization

    • Salvage therapy due to poor response to or tolerance of amphotericin

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

Outcome

Prognosis

  • Even with prompt treatment, prognosis is guarded

References

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Brunet  K  et al. Mucormycosis treatment: recommendations, latest advances, and perspectives. J Mycol Med. 2020;30:101007.
[PubMed: 32718789]  
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Cornely  OA  et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19:e405.
[PubMed: 31699664]  
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Cornu  M  et al. Evaluation of mass spectrometry-based detection of panfungal serum disaccharide for diagnosis of invasive fungal infections: results from a collaborative study involving six European clinical centers. J Clin Microbiol. 2019;57:e01867.
[PubMed: 30787140]  
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Lionakis  MS  et al. Breakthrough invasive mold infections in the hematology patient: current concepts and future directions. Clin Infect Dis. 2018;67:1621.
[PubMed: 29860307]  

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