Mucormycosis: an emerging disease?

Abstract

A B S T R A C TMucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species in order of frequency is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year, and the main risk-factors for the development of mucormycosis are ketoacidosis (diabetic or other), iatrogenic immunosuppression, use of corticosteroids or deferoxamine, disruption of mucocutaneous barriers by catheters and other devices, and exposure to bandages contaminated by these fungi. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. They colonise a high number of patients but do not cause invasion. Mucormycosis most commonly manifests in the sinuses (39%), lungs (24%), skin (19%), brain (9%), and gastrointestinal tract (7%), in the form of disseminated disease (6%), and in other sites (6%). Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. Confirmation of the clinical form requires the combination of symptoms compatible with histological invasion of tissues. The probable diagnosis of mucormycosis requires the combination of various clinical data and the isolation in culture of the fungus from clinical samples. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Liposomal amphotericin B is the therapy of choice for this condition. Itraconazole is considered to be inappropriate and there is evidence of its failure in patients suffering from mucormycosis. Voriconazole is not active in vitro against Mucorales, and failed when used in vivo. Posaconazole and ravuconazole have good activity in vitro. The overall rate of mortality of mucormycosis is approximately 40%.

Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B

“…4,7,8,15 Moreover, in comparison with the results of conventional mucormycosis treatment at our centre, this survival rate represented a positive improvement. 16 Considering the lower incidence of post-operative complications following endoscopic treatment, and the comparable findings reported by the present study and similar reports, we would recommend our treatment modality in selected cases.…”

“…Therefore, the results of all such studies, including our own, will be affected by their small sample sizes. 3,8 Despite these shortcomings, some of our evaluated variables were significantly correlated with patient prognosis.…”

“…4,5 Reversal of predisposing factors is an indispensable part of treatment. [6][7][8] Traditionally, some authors have recommended aggressive surgical resection of affected tissue. 9,10 However, following wide application of nasal endoscopy in sinus surgery, other authors have reported comparable results with frequent endoscopic debridement.…”

In Vitro Activities of Amphotericin B, Caspofungin, Itraconazole, Posaconazole, and Voriconazole against 45 Clinical Isolates of Zygomycetes: Comparison of CLSI M38-A, Sensititre YeastOne, and the Etest

“…VC and CAS showed very high MIC 90 s, 8 to 16 g/ml and 128 to Ͼ256 g/ml, respectively. AMB has traditionally been the treatment of choice for zygomycosis (1,2,4,12,18,24). The limited clinical use of ITC in the treatment of zygomycosis does not allow us to draw any conclusions from the in vitro data (8,15,17).…”

Rhinocerebral Mucormycosis Treated with Posaconazole: A Case Report

“…ve deri bütünlüğünün bozulması (travma, yanık vb.) gibi durumların bulunması mukormikoz gelişmesi için yüksek risk oluşturur (3)(4)(5). Mukormikoz, klinik prezantasyon ve tutulan anatomik bölgeye göre rinoserebral, pulmoner, kutanöz, gastrointestinal, disemine ve diğer lokalizasyonlar olmak üzere altı klinik kategoriye ayrılır (6).…”