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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

  • Risk factors

    • Uncontrolled diabetes

    • Hematologic malignancy

    • Hematologic stem cell or solid organ transplantation

    • Direct inoculation of wounds (trauma, burns)

    • COVID-19

  • Lungs, rhino-orbital-cerebral regions, 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), Saksenaea, Apophysomyces, 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

    • Diabetes is associated with rhino-orbital-cerebral disease

    • Hematologic malignancy predisposes to pulmonary infection

  • 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


  • Biopsy of involved tissue is almost always required; the organisms appear in tissue as broad, branching nonseptate hyphae on histology

  • Molecular identification (eg, PCR) from tissue or blood may aid diagnosis

  • Cultures are frequently negative

  • Chest CT: a reverse "halo sign" (focal area of ground glass diminution surrounded by a ring of consolidation) may be seen


  • Optimal therapy involves

    • Reversal of predisposing conditions (if possible)

    • Surgical debridement

    • Prompt antifungal therapy

  • A prolonged course of intravenous liposomal amphotericin B (5–10 mg/kg, with higher doses 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



  • Even with prompt treatment, prognosis is guarded


Brunet  K  et al. Mucormycosis treatment: recommendations, latest advances, and perspectives. J Mycol Med. 2020;30:101007.
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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.
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Prakash  H  et al. Connecting the dots: Interplay of pathogenic mechanisms between COVID-19 disease and mucormycosis. J Fungi (Basel). 2021;7:616.
[PubMed: 34436155]  
Skiada  A  et al. Epidemiology and diagnosis of mucormycosis: ...

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