Treating mucormycosis using a multimodality approach: a case series

Abstract

Most fungal infections found in wounds are secondary or superadded, and are generally benign in their clinical course in healthy individuals, with the exception of mucormycosis. This is a life-threatening infection caused by fungi of the order Mucorales. Primary cutaneous disease may occur following traumatic implantation of spores, or use of contaminated bandages, or as a complication of extensive burns, diabetic acidosis and other specific immunocompromised conditions. The clinical spectrum is highly non-specific and is often triggered by seemingly innocuous trauma. The superficial vesicles or patchy erythema rapidly degrade to haemorrhagic necrosis and rapidly progressive gangrenous lesion. The problem with diagnosing mucormycosis remains, therefore, that the condition has poor clinical indicators and requires reliance on microscopy and fungal culture. Management starts with a clinical suspicion, taking into account the risk factors and lack of response to first-line agents, as well as an aggressive clinical course. Treatment is multimodal, with medical correction of the risk factors and optimisation of limiting factors, such as diabetes, neutropenia and immunosuppressants. Treatment generally involves radical and repetitive surgical debridement, intravenous amphotericin B with monitoring of the nephrotoxicity, along with adjuvant modalities, such as hyperbaric oxygen therapy, colony stimulating factor, interferons gamma and white blood cell transfusion. Successful courses of therapy typically last 4–6 weeks and require cumulative doses that are equivalent to >2g of amphotericin B deoxycholate.

The Co-infection of Mild COVID-19 and Rhinocerebral Mucormycosis in a Patient Without Diabetes or Prior Steroid Use

“…Treating mucormycosis is a multidisciplinary team approach which requires a set of radical and repetitive surgical debridement along with intravenous antifungals [14].…”

Mucor as a cause of surgical site infection

“…8 Early diagnosis, aggressive and often repeated debridement, along with amphotericin B is the mainstay of treatment; any delay contributes to mortality. 6–8 Early debridement of SSI is mandatory, and in this particular case, may have tilted the scales towards a better outcome; the typical whitish mould suggestive of fungal mucor infection should alert the clinician to the severity of the problem. Histopathology is confirmed by intracellular aseptate hyphae that are the hallmark of invasive mucormycosis.…”

Antifungal Drugs TDM: Trends and Update

“…362 The inclusion of the pharmacological unit in hospital staff meetings 363 is one aspect of AFS programs that could increase the appropriateness of repetitive TDM and lead to the development of reciprocal levels of education in multidisciplinary collaborations. 364,365 However, the growing number of software suites for dose prediction may be affected by problems of sampling accuracy and infusion time documentation. 366…”