Mucormycosis: update on clinical presentation, diagnosis, and treatment

Abstract

Purpose of review Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. Recent findings The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. Summary Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.

Mucormycosis in patients admitted to a university hospital: a case series

“…Liposomal amphotericin B is the cornerstone of treatment; however, the ideal dose depends on the disease and patient's condition, with the central guidelines recommending 10mg/kg/day if the CNS is involved and in patients with solid organ transplants. In progressive disease, using L-AMB associated with POSA may be recommended (Garnes & Kontoyiannis, 2023;Nielsen et al, 2023). Maintenance therapy with triazoles is recommended after therapy with L-AMB, and those with demonstrated efficacy are POSA and isavuconazole (Garnes & Kontoyiannis, 2023).…”

“…In progressive disease, using L-AMB associated with POSA may be recommended (Garnes & Kontoyiannis, 2023;Nielsen et al, 2023). Maintenance therapy with triazoles is recommended after therapy with L-AMB, and those with demonstrated efficacy are POSA and isavuconazole (Garnes & Kontoyiannis, 2023). Some treatment perspectives are based on the use of adjuvant immune therapies, such as granulocyte transfusion (Garnes & Kontoyiannis, 2023), and some authors have described associated therapies of L-AMB and echinocandins, notably in refractory cases (Smith & Lee, 2022).…”

“…Surgery, in combination with systemic antifungal therapies, plays a vital role in the treatment, removing necrotic and devitalized tissues, which happened in all reported patients (Garnes & Kontoyiannis, 2023). In those with no feasibility for a surgical procedure, topical or intravitreal use of L-AMB has been studied (Garnes & Kontoyiannis, 2023).…”

“…Surgery, in combination with systemic antifungal therapies, plays a vital role in the treatment, removing necrotic and devitalized tissues, which happened in all reported patients (Garnes & Kontoyiannis, 2023). In those with no feasibility for a surgical procedure, topical or intravitreal use of L-AMB has been studied (Garnes & Kontoyiannis, 2023). In patient 2, it was not possible to perform debridement of the entire involved bone due to its large extension, including skull base bones, with a high possibility of cranial collapse and death.…”

“…It is positive, with an average of up to four days before histological exams/ culture and up to one day before positive imaging. Furthermore, evaluating therapeutic response may be favorable, as it can become negative in up to seven days (Garnes & Kontoyiannis, 2023).…”