Abstract
Despite the recent introduction of mold-active agents (posaconazole and isavuconazole), in addition to amphotericin B products, to our armamentarium against mucormycosis, many uncertainties remain for the management of this uncommon opportunistic infection, as there are no data from prospective randomized clinical trials to guide therapy. In this mini-review, we present the current status of treatment options. In view of the heterogeneity of the disease (different types of affected hosts, sites of infection, and infecting Mucorales), mucormycosis management requires an individualized management plan that takes into account the net state of immunosuppression of the host, including comorbidities, certainty of diagnosis, site of infection, and antifungal pharmacological properties.
Highlights
The term “mucormycoses” is used to describe a spectrum of chronic, subacute, and frequently rapidly progressing infections caused by fungi of the Mucorales order of the class of Zygomycetes [1].Clinical presentations of mucormycosis are variable and include sinusitis, pulmonary, cutaneous, gastrointestinal, disseminated, and other uncommon presentations [2]
Information regarding the current approach to treatment is based on single-institution, retrospective studies including a limited number of patients with significant variability in their presentation and risk factors, registries with methodological flaws, and “expert opinions”
Suboptimal diagnosis based on tissue culture and/or histology misses cases and biases treatment experience towards culture and/or histology-positive cases or towards selected patient groups, where tissue is more readily accessible, such as sinusitis or trauma patients
Summary
The term “mucormycoses” is used to describe a spectrum of chronic, subacute, and frequently rapidly progressing infections caused by fungi of the Mucorales order of the class of Zygomycetes [1]. Clinical presentations of mucormycosis are variable and include sinusitis (pansinusitis, rhino-orbital or rhino-cerebral), pulmonary, cutaneous, gastrointestinal, disseminated, and other uncommon presentations [2]. Cunninghamella, Saksenaea, and Apophysomyces [3] These organisms are ubiquitous in nature as they can be found in decaying organic substrates and soil [4]. Mucorales have a tropism for angioinvasion, resulting in dissemination, tissue infarction and necrosis. Cutaneous disease rarely disseminates and is associated with better outcomes [21,22]. We will discuss the current status of treatment options, as well as recent data concerning the management of this disease, that have emerged from clinical, in vitro, and in vivo studies
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