Recent advances in the understanding and management of mucormycosis

Pilmis, Benoît; Alanio, Alexandre; Lortholary, Olivier; Lanternier, Fanny

doi:10.12688/f1000research.15081.1

Cited by 61 publications

(75 citation statements)

References 48 publications

(55 reference statements)

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“…The spores of Rhizopus spp. are widespread in the environment and have been isolated from air, soil, food, decaying grass, and leaves (3). Patients with underlying conditions such as diabetes mellitus, neutropenia, malignancy, and solid organ or hematologic stem cell transplantation are at high risk for infection, and most cases of invasive mucormycosis occur in these populations.…”

Section: Discussionmentioning

confidence: 99%

“…can be acquired by the respiratory, gastrointestinal/oral, or percutaneous routes. Most infections involve rhinocerebral and pulmonary sites, and cutaneous involvement is reported less often (3). Cutaneous mucormycosis usually occurs in impaired skin, such as sites affected by trauma, burns, or medical interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Once the diagnosis of mucormycosis is confirmed, prompt initiation of appropriate antifungal therapy combined with surgical intervention is critical to prevent dissemination and deep-tissue involvement (2). Concomitant surgical and antifungal therapy was associated with significantly lower 90-day mortality compared to that with treatment with drugs alone in mucormycosis (3). Prompt surgical debridement with a negative margin for fungal elements is considered a crucial component of successful therapy.…”

Section: Discussionmentioning

confidence: 99%

“…While data on the ideal antifungal regimen for mucormycosis is limited, particularly in pediatric patients with hematologic malignancies, amphotericin B and its liposomal form are still considered the first-line treatment (2). Posaconazole and isavuconazole have antifungal activity against the Mucorales in vivo, and they are often used after induction treatment with amphotericin B. Fluconazole and itraconazole are not effective against the Mucorales (2,3). Studies on combined antifungal approaches such as amphotericin B with posaconazole and amphotericin B with caspofungin are limited.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, controlling underlying risk factors is also important for the successful treatment of mucormycosis, especially in immunocompromised patients. Predisposing risk factors include malignancy, treatment-related neutropenia, diabetes mellitus, and solid organ and hematologic stem cell transplantation (3). What is more, voriconazole prophylaxis for invasive aspergillosis in leukemic patients can increase the risk of mucormycosis since the Mucorales are known to be resistant to voriconazole both in vitro and in vivo.…”

Section: Discussionmentioning

confidence: 99%

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The Brief Case: Cutaneous Fungal Infection in a Pediatric Patient with Newly Diagnosed Acute Lymphocytic Leukemia

Suo

Dunn

2020

J Clin Microbiol

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A 4-year-old male presented to the emergency department with a worsening skin lesion at the prior intravenous (i.v.) injection site on his left arm. He had been diagnosed with acute lymphoblastic leukemia (ALL) 10 days prior and was currently undergoing induction chemotherapy. The lesion was first noticed by his father 2 days earlier as a dime-sized erythematous papule with no pain or focal swelling. Physical examination revealed a painful patch with an irregular erythematous border and central dark bulla overlying the left medial epicondyle (Fig. 1A). The patient was afebrile and noted to have left cervical lymphadenopathy. No intraluminal thrombosis was identified in the left upper extremity by Doppler ultrasonography. Laboratory findings were notable for severe neutropenia, with an absolute neutrophil count (ANC) of 70 cells/l (normal range, 1,500 to 8,000 cells/l). C-reactive protein and the erythrocyte sediment rate were both within normal limits. Levels of serum 1,3-␤-D-glucan (Fungitell test; Associates of Cape Cod, East Falmouth, MA), Aspergillus galactomannan (Bio-Rad, Hercules, CA) and Histoplasma serum antigen (Mira Vista Diagnostics, Indianapolis, IN) were all undetectable. Aerobic (n ϭ 1) and anaerobic (n ϭ 1) blood cultures (VersaTrek;Trek Diagnostic Systems, Cleveland, OH) and blood isolator tubes (Wampole; Abbott, Chicago, IL) for mycobacterial (n ϭ 1) and fungal (n ϭ 1) cultures all yielded no growth.A punch biopsy of the skin lesion was performed at the same time. The tissue sample was sent to both the microbiology and the surgical pathology labs. Microscopically, it showed abundant branching, aseptate hyphae that were present intravascularly ( Fig. 1B), as well as in the dermal and subcutaneous tissue. Fungal elements were also positive by Grocott's methenamine silver (GMS) staining. Cutaneous mucormycosis was suspected. The organism grew rapidly on inhibitory mold agar (IMA) (Remel, Thermo Fisher Scientific, Waltham, MA) with cotton candy-like colonies (Fig. 1C) after 48 h of incubation at 30°C. A tape preparation of the colony with lactophenol blue stain demonstrated the presence of stolons and root-like structures (rhizoids) and the formation of sporangiophores, singly or in groups, from nodes directly above the rhizoids (Fig. 1D). The organism was identified as Rhizopus spp., and the diagnosis of cutaneous mucormycosis was confirmed.The patient was treated with surgical debridement, systemic antifungal medications (liposomal amphotericin B 5 mg/kg/day combined with caspofungin 70 mg/m 2 /day), granulocyte infusions, and granulocyte colony-stimulating factor preparations (G-CSF). He remained afebrile and stable during the whole hospitalization. His chemotherapy plan was adjusted due to invasive mucormycosis. Complete remission of ALL was achieved on day 29 of chemotherapy (day 17 of antifungal treatment). His ANC normalized 20 days after initiation of antifungal treatment, and the debrided wound healed completely with no fungal elements identified or recovered in subsequent surgical patholog...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Brief Case: Cutaneous Fungal Infection in a Pediatric Patient with Newly Diagnosed Acute Lymphocytic Leukemia

Suo

Dunn

2020

J Clin Microbiol

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Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

Darouei,

Zare,

Torkashvan

et al. 2024

Clinical Case Reports

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Key Clinical MessageUnilateral renal mucormycosis is a rare infection that should be suspected in patients with recurrent renal infections presenting nonspecific clinical features that do not respond to conventional therapies, especially in impaired immune systems due to related risk factors. Moreover, histopathological examinations should be performed to confirm the diagnosis. For treatment, the preference is that the patient is hospitalized, and surgical intervention and rapid administration of intravenous antifungals for 2–3 weeks are the treatment choices. After discharge, the patient should be followed up with periodic blood urea nitrogen and creatinine levels and, if needed, an imaging modality such as a CT scan or sonography.AbstractRenal mucormycosis (RM) is a rare form of mucormycosis infection and is more often in immunocompromised patients with risk factors. Unilateral renal involvement is infrequent in patients and is available as case reports. This condition usually presents with renal colic, fever and chills, and oliguria and has a high mortality rate. Herein, we report a case of unilateral renal mucormycosis presenting with pyelonephritis and acute kidney injury in a 32‐year‐old patient. The patient had numerous urological procedures in previous years due to nephrolithiasis state, which put him in an immunocompromised state. The histopathological examination of the pylocalyceal system revealed a collection of broad non‐septated fungal hyphae branching at 90° accompanied by numerous neutrophils and necrotic tissue in favor of mucormycosis. He was successfully treated with 5 mg/kg/day Liposomal Amphotericin B for 3 weeks, discharged with good general condition, and remained asymptomatic for 3 months after discharge. The diagnosis of RM relies on solid clinical suspicion, which can be authenticated by histopathological examination, and the combination of antifungal therapy and surgical intervention can result in a good outcome.

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The relationship between cumulative dose of immunosuppressive agents and COVID‐19‐associated mucormycosis: A multicenter cross‐sectional study

Rastkar

SeyedAlinaghi

Asanjarani

et al. 2022

Health Science Reports

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Background and Aims: Immunosuppressive therapy has a key role in developing coronavirus disease-2019 (COVID-19)-associated mucormycosis. In this study, we investigated the effect of the type and cumulative dose of immunosuppressive agents on COVID-19-associated mucormycosis. Methods:We designed a descriptive cross-sectional study involving three COVID-19 hospitals in Iran. Clinical and demographic data were gathered from the medical records and checked by two independent researchers to minimize errors in data collection.Results: Seventy-three patients were included in the study. The mean age of cases was 57.41 (SD = 12.64) and 43.8% were female. Among patients, 20.5% were admitted to the intensive care unit (ICU) during COVID-19. Furthermore, 17 patients (23.29%) had a history of diabetes mellitus. Sixty-nine patients (94.52%) had a history of receiving corticosteroids (dexamethasone) during treatment of COVID-19, and of those, five patients (6.85%) received Tocilizumab beside. The mean cumulative dose of corticosteroids prescribed was 185.22 mg (SD = 114.738). The average cumulative dosage of tocilizumab was 720 mg (SD = 178.89). All of the included patients received amphotericin B for mucormycosis treatment, and 42 survived (57.53%). Also, there was a significant relationship between hospitalization in ICU for COVID-19 and the mucormycosis outcome (p = 0.007).However, there weren't any significant associations between cumulative doses of immunosuppressive drugs and mucormycosis outcome (p = 0.52). Conclusion: The prevalence of COVID-19-associated mucormycosis is increasing and should be considered in the treatment protocols of COVID-19. Controlling risk factors such as diabetes, malignancy and the administration of immunosuppressive agents based on recommended dosage in validated guidelines are ways to prevent mucormycosis.

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Recent advances in the understanding and management of mucormycosis

Abstract: Mucormycoses were difficult-to-manage infections owing to limited diagnostic tools and therapeutic options. We review here advances in pathology understanding, diagnostic tools including computed tomography, and serum polymerase chain reaction and therapeutic options.

Cited by 61 publications

References 48 publications

The Brief Case: Cutaneous Fungal Infection in a Pediatric Patient with Newly Diagnosed Acute Lymphocytic Leukemia

The Brief Case: Cutaneous Fungal Infection in a Pediatric Patient with Newly Diagnosed Acute Lymphocytic Leukemia

Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

The relationship between cumulative dose of immunosuppressive agents and COVID‐19‐associated mucormycosis: A multicenter cross‐sectional study

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