Hyperbaric oxygen therapy and other adjunctive treatments for zygomycosis

Abstract

Zygomycetes are increasingly reported as a cause of life-threatening invasive fungal infections in profoundly immunocompromised patients and in those with diabetic ketoacidosis. Zygomycosis, typically presents as soft tissue, rhino-orbitocerebral, pulmonary or disseminated disease and is characterized by rapid clinical progression and high mortality rates. Treatment with amphotericin B lipid formulations in combination with surgery and, perhaps, the addition of caspofungin offers the best chance for survival; posaconazole, a new antifungal triazole, is increasingly used for consolidation or maintenance therapy. Because of the poor prognosis of zygomycosis, particularly in immunocompromised cancer patients, adjunctive treatments such as hyperbaric oxygen therapy, use of immunomodulatory cytokines, and in vivo iron starvation continue to be explored. However, although each of these modalities is based on a plausible scientific rationale and has been helpful in the management of individual patients, there is no clinical evidence for their general effectiveness as adjunctive treatments in patients with zygomycosis. Further experimental and clinical investigations are necessary to determine whether and how these treatments can impact on outcome and to determine which patients and which types of infection may benefit from them.

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…Hyperbaric oxygen therapy has been used as an adjuvant therapy for cutaneous or rhino-orbital infections, with unproven efficacy (146,244,317,332). In neutropenic patients, use of G-CSF, GM-CSF, granulocyte transfusions, or recombinant gamma interferon is an anecdotally beneficial temporary approach to therapy until granulocyte recovery (245,317).…”

“…on May 10, 2018 by guest http://cmr.asm.org/ also underwent surgical interventions (19,103,315,332).…”

Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3)

“…In vitro, the growth of Mucorales has been reported to be inhibited by high oxygen concentration. 111 There has been only limited clinical use of hyperbaric oxygen as adjunctive therapy, mostly in diabetic patients with rhino-orbito-cerebral disease. A retrospective single-center review suggested a survival benefit for 6 patients with rhino-cerebral mucormycosis treated with hyperbaric oxygen compared with a group of 7 patients treated with surgery and antifungals alone.…”

Necrotizing Fasciitis Due to Rhizopus in Blast Injury Wound - An Unusual Life Threatening Situation

“…Hyperbaric oxygen therapy (HBOT) has been appreciated and has direct antifungal activity due to increased supply of oxygen-based free radicals, reversing fungal growth, enhances lactic acidosis, restitution of phagocytosis, oxidative burst of polymorphonuclear leukocytes and enhancement of healing. 94% survival of patients has been described in patients suffering from diabetes mellitus with HBOT management [12].…”