Breaking the Mold

Abstract

Diagnosis of mucormycosis is typically difficult to make based on imaging studies, sputum culture, bronchoalveolar lavage culture, or needle aspirate. Surgical debridement prior to dissemination of infection improves clinical outcomes. Surgery combined with early, high-dose systemic antifungal therapy yields greater than a 1.5-fold increase in survival rates. The Mucorales are inherently resistant to most widely used antifungal agents. Amphotericin B is appropriate for empirical therapy, whereas posaconazole and isavuconazole are best reserved for de-escalation, refractory cases, or patients intolerant to amphotericin B.

Mucormycosis in renal transplant recipients: review of 174 reported cases

“…The overall survival is 92% in patients receiving posaconazole therapy, its higher than those receiving amphotericin B. Recent studies also have shown overall success rates of 60–70% with posaconazole as salvage therapy for zygomycetes infection [17, 18]. These encouraging data suggest that posaconazole may represent a prospective drug against mucormycosis.…”

Posaconazole and isavuconazole induced hypomagnesaemia

“…We speculate that this otherwise immunocompetent patient developed mucormycosis in the context of impaired glucose tolerance which was triggered by steroid use. Both hyperglycaemia and glucocorticoid use represent well-established risk factors for mucormycosis, probably due to impaired chemotaxis and neutrophil fungicidal activity and macrophage function respectively [1], [2], [6]. Once identified, aggressive surgical management as well as a multi-disciplinary approach has been shown to reduce mortality [7].…”

“…Mucormycosis is a relatively rare infection caused by ubiquitous fungi of the phylum Zygomycota, of which Rhizopus arrhizus is the most commonly isolated pathogen [1], [2]. It has an extremely high mortality rate which varies with the degree of immunosuppression but remains over 50% for rhino-orbital-cerebral disease [1], [2].…”

“…It has an extremely high mortality rate which varies with the degree of immunosuppression but remains over 50% for rhino-orbital-cerebral disease [1], [2].…”

Rhino-Orbito-Cerebral Mucormycosis Resistant to Amphotericin B: Two Diabetic Cases

“…Patients with diabetes mellitus (DM) have markedly increased incidence of invasive mucormycosis. Despite the advancement of new antifungal drugs and combination therapies, the management of mucormycosis is still challenging (1,2). Here we presented the two cases of mucormycosis with a history of diabetic ketoacidosis.…”