Early Diagnosis Of Mucormycosis Research Articles

Agreement between two real-time commercial PCR kits and an in-house real-time PCR for diagnosis of mucormycosis.

Early diagnosis of mucormycosis is crucial for initiating effective treatment. The detection of Mucorales DNA by PCR in serum has revolutionized the diagnosis of this infection. However, the use of in-house methods can be time consuming. The availability of a commercial kit eliminates the need for in-house assay development, reducing laboratory workload and ensuring consistent performance across different healthcare settings. Currently, there are several commercial assays available, but many have limited evaluation. In this study, we compared two commercial kits and found that the MycoGENIE Kit offers a promising alternative to the in-house method.

МРТ ВИЗУАЛИЗАЦИЯ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. Rhino-orbito-cerebral mucormycosis is an angio-invasive infection caused by filamentous fungi of the Mucoraceae family. Numerous factors were proposed determining mucormycosis against the COVID-19 background. Predisposing factors include uncontrolled diabetes, hematological malignancies, transplantation of solid organs and stem cells, corticosteroids, and weakened immunity. Aim of the study was to investigate the tomographic signs of rhino-cerebral mucormycosis. Materials and Methods. A retrospective study of CT and/or MRI images of 120 patients was conducted, who have been diagnosed with COVID-19 associated with mucormycosis, based on histopathology and/or seeding. Results and Discussion. Imaging findings of rhino-orbito-cerebral mucormycosis associated with COVID-19 using an adapted simplified (three-stage) staging system that can be easily applied to everyday practice and helps standardize and improve communication between radiologists and clinicians. The severity of the disease varies from isolated lesions of the paranasal sinuses to extensive brain damage. Clinical outcomes in patients with COVID-19 with rhino-orbito-cerebral mucormycosis gradually increase depending on the severity of imaging. Conclusions. Early diagnosis of mucormycosis is crucial because visualization is essential at staging the disease and assessing the involvement of deeper structures that may be clinically unmanifest. Although both CT and MRI are useful, contrast-enhanced MRI is the method of choice and helps determine the extent of the disease, especially with respect to the deep spread in the maxillofacial region and brain.

Diagnosis of mucormycosis using a simple duplex PCR assay: Analysis of 160 clinical samples from COVID-19 patients.

Early diagnosis of mucormycosis, a severe and potentially fatal complication in immunocompromised and COVID-19 patients, is crucial for initiating timely antifungal therapy and reducing infection mortality. In this study, the diagnostic performance of a duplex polymerase chain reaction (PCR) assay was evaluated to detect Mucorales-specific and Rhizopus oryzae-specific targets in 160 clinical samples collected from 112 COVID-19 patients suspected of invasive fungal rhinosinusitis (IFRS). During potassium hydroxide (KOH) direct microscopy, non-septate hyphae were observed in 73 out of 160 samples (45.63%); however, using duplex PCR, 82 out of 160 specimens (51.25%) tested positive. Among the positive PCR samples, 67 (81.71%) exhibited a double band (both 175 and 450 base pairs [bp]) indicating the presence of R. oryzae, and 15 (18.29%) showed only a single band (175bp), suggesting the presence of non-R. oryzae Mucorales. DNAs from 10 microscopically negative samples and 4 samples with septate hyphae in microscopy were successfully amplified in PCR. Considering Calcofluor white fluorescence microscopy as the gold standard for laboratory diagnosis of mucormycosis, the duplex PCR assay utilized in this study exhibited a sensitivity of 93.88%, a specificity of 100%, a negative predictive value of 91.18%, and a positive predictive value of 100% for detecting mucormycosis in IFRS specimens. The duplex PCR assay demonstrated higher sensitivity compared to direct examination with KOH (82 vs. 73) and culture (82 vs. 41), enabling rapid detection/identification of Mucorales even in samples with negative culture or in biopsies with only a few hyphal elements.

POST COVID JAW OSTEOMYELITIS WITH MUCORMYCOSIS - AN INSTITUTIONAL STUDY

Mucoraceae are ubiquitous fungi and are found in, soil, air, contaminated water and hospital environments too. These fungi usually gain entry into host through respiratory tract and sinuses either by direct spread or by angioinvasion. Major sites of infection are sinuses, lungs, skin, brain, and gastrointestinal tract. From sinus it may invade maxilla causing osteomyelitis of jaw. Mucormycosis is an opportunistic infection and the major risk factors include poorly controlled diabetes mellitus (DM), iron overload, prolonged corticosteroid use and immunocompromised status. CORONA virus disease 2019 (Covid-19) is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The majority of patients have a good prognosis, but some patients become critically ill and even deaths occur. Disease itself decreases cell mediated immunity and increases iron load in covid patients. For treatment of Covid-19 corticosteroids, antiviral drugs and immunomodulatory drugs are being used. Steroid reduces inflammation in covid 19 patients, but it pushes up the blood sugar which causes ketoacidosis, increases iron load, affects cell mediated immunity and favours the mucor mycosis growth. So, there are reported increasing cases of mucormycosis in post COVID-19 patients. Present study includes 25 reported cases of mucormycosis with jaw osteomyelitis in post covid patients with respect to clinical characteristics, past medical history, comorbidities medication received during covid 19, radiographic feature, lab diagnostic methods, histopathological reports, and treatment. So as to gain an insight of this disease as early diagnosis of mucor mycosis and treatment which can significantly reduce the mortality and morbidity of mucormycosis patients

A case series on isolated maxillary sinus involvement in mucormycosis

Mucormycosis is a potentially fatal fungal infection that can affect various parts of the body, including the sinuses. Isolated maxillary sinus involvement usually indicates an early diagnosis of Mucormycosis. The aim of the study was to present a case series on the clinical presentation and management outcomes in patients with isolated maxillary sinus involvement in Mucormycosis to emphasize on the early diagnosis and management of the condition. A retrospective study of 10 patients who presented to the RGGGH ENT department with isolated maxillary sinus involvement in Mucormycosis that was confirmed by diagnostic nasal endoscopy, CT scan and fungal KOH swab and who were managed by endoscopic sinus surgery. In our study, out of 10 cases, two patients had unilateral symptoms and eight patients had bilateral symptoms. Most common presentation was nasal obstruction, nasal discharge, and facial pain. Complete disease clearance was achieved in all cases by endoscopic sinus surgery with debridement. Diabetes was the most common underlying comorbidity, present in all 10 patients. All patients were treated with a combination of antifungal therapy and surgical debridement. All patients showed improvement on followup, with no recurrence or mortality reported during the follow-up period. Mucormycosis with isolated maxillary sinus involvement is a timely presentation of mucormycosis but potentially life-threatening due to the nature of the disease to spread rapidly. Prompt diagnosis and management are crucial for improving outcomes in these patients. A combination of antifungal therapy and surgical debridement appears to be an effective treatment approach in these patients.

Treating patients with deep mycoses of the maxillofacial region against a COVID-19 background

BACKGROUND: Complications characterized by necrosis of the nasal mucosa and the hard palate, as well as the middle and lower nasal concha with exposure of the alveolar process, destruction of the posterior wall of the maxillary sinus and the bottom of the orbit caused by a fungal infection were noted during the COVID-19 pandemic. By January 2022, such cases had been documented in 18 countries worldwide. The main predisposing factors for this condition are diabetes mellitus and inadequate use of corticosteroids. Rhinocerebral mucormycosis or zygomycosis is a rare disease caused by filamentous fungi affecting the nose, paranasal sinuses, and brain.
 AIM: To present the treatment strategy for patients with deep mycoses of the maxillofacial region against a background of transferred COVID-19 in the State Clinical Hospital named after F.I. Inozemtsev DZM.
 MATERIAL AND METHODS: Fifteen patients with a cerebral form of mucormycosis of the maxillofacial region arose against a background of a new coronavirus infection associated with SARS-CoV-2.
 RESULTS: The study shows the importance of timely initiation of radical surgical treatment for the rhinocerebral form of mucormycosis in the maxillofacial region, which arose against the background of SARS-CoV-2, to prevent the spread of osteomyelitic foci in bone tissue.
 CONCLUSION: Early diagnosis of mucormycosis, timely treatment with antipsychotic medications and surgical intervention, control of the level of glycemia, and reasonable use of corticosteroids prevented the development of complications.

Sensitivity of KOH Mount in the Early Diagnosis of Fungal Infections of Nose and Paranasal Sinuses in COVID-19 Infected Patients Suspected with Mucormycosis

Introduction: Mucormycosis represents a group of life threatening infections caused by fungi of the order Mucorales especially in Coronavirus Disease 2019 (COVID-19). It is a highly invasive and rapidly progressive disease resulting in high grades of morbidity and increased mortality. Aim: To study the sensitivity of potassium hydroxide (KOH) mount in the early diagnosis of mucormycosis in COVID-19 infected patients. Materials and Methods: A prospective, longitudinal (single group) study was done in McGANN Teaching District Hospital, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, among the patients with high index of clinical suspicion of mucormycosis from May 2021 to August 2021. Specimen from the nasal cavity or the suspected lesion on hard palate, gums, skin was sent for KOH mount and fungal culture and also biopsy of the nasal mucosa sent for histopathological examination. The sample was sent both preoperatively and intraoperatively. The positive KOH report and its role in early diagnosis and management of mucormycosis suspected cases were assessed. Results: Out of 26 patients, 6 (23.1%) were females and 20 (76.9%) were males. COVID-19 positive suspected mucormycosis were 5 (19.2%) and post COVID-19 suspected mucormycosis were 21 (80.8%). Species isolated after processing the sample were rhizopus in 10 (38.5%), candida in 1 (3.8%), aspergillus in 1 (3.8%); while in 14 (53.8%) no organisms were isolated. Out of 26 patients KOH positive sample on the day of admission confirming with positive intraoperative histopathological examination were 10 (41.7%). Admission day fungal culture positivity was seen in (n=12, 46.2% ) and negativity in 14 (53.8%) cases. Intraoperative fungal culture was positive in 24 (92.3%) cases. There was 100% specificity for both fungal culture and KOH mount and sensitivity for KOH was 41.7% and 50% for fungal culture. False negativity rate for KOH was 58.3% and for fungal culture was 50%. Conclusion: The results of KOH mount can be obtained within an hour of sending nasal scrapping samples. Hence, it helps in making the early diagnosis and early initiation of treatment for suspected cases. But in the current study, even in patients presenting with high clinical suspicion of mucormycosis, the sensitivity of KOH mount on the day of admission to the hospital was 41.7%.In view of severe morbidity and mortality of mucormycosis, this sensitivity though less is of paramount importance in these patients because treatment can be started early.

Clinical features, diagnosis, and treatment outcome of Rhino-orbito-cerebral mucormycosis: A 2-year experience at a tertiary care center

ABSTRACT Context: The incidence of the fungal disease, mucormycosis, is showing a steady increase among the Indian population in recent past years. Considered as a form of acute invasive fungal rhinosinusitis, the disease is characterized by high morbidity and mortality rates. Aims: The aim of this study was to study the clinical presentations, species distribution, and treatment outcomes in patients of rhinomucormycosis. Settings and Design: This was a tertiary care hospital-based case series. Subjects and Methods: The study was carried out between June 2018 and February 2020. All laboratory-confirmed cases of rhinomucormycosis were included in the study population. Results: Sixteen cases of histopathologically and microbiologically confirmed cases of rhinomucormycosis were included in the study. The study population included ten females and six males. Diabetes mellitus was found to be the most common comorbid condition in the study group (81.25%). Among the study group, swelling of cheek and thick blood-stained discharge were the most common presenting symptoms (9 cases out of 16). The most common clinical type was rhino-orbital mucormycosis. Rhizopus was the most common species encountered (87.5%). In spite of utmost care, treatment outcome was not favorable in most of the cases. Conclusion: An early diagnosis of mucormycosis in the background of immunocompromised status can help in initiating appropriate treatment, thereby reducing the morbidity and mortality associated with this disease condition.

Diagnosis of invasive Mucormycosis on Histopathological examination at a tertiary referral hospital

This study is conducted with an aim to Diagnosis of invasive Mucormycosis on Histopathological examination at a tertiary referral hospital. Rhino cerebral Mucormycosis is the current life-threatening infection commonly affecting immunocompromised patients especially post COVID-19 within 6 weeks having poor glycemic control, Intravenous drug users, ICU patients, post chemotherapy, iron overload, persistent neutropenia and follow-up cases of hematological malignancies. It affects the nasal and paranasal sinuses by air-borne spores producing the infection. A prospective case series conducted at the department of pathology, KAMSRC ‘between’ May 1to September 30th 2021 with a study population of 27 cases. Variables included age, gender, and history of covid, duration and development of symptoms, Clinical presentation, clinical diagnosis, co-morbidities, histopathological examination and microbiological correlation. The most prevalent isolated agent is Mucor (48.1%) followed by Rhizopus (18.5%), Aspergillus (11.1%) and mixed mucor with aspergillus (11.1%).A prospective case series conducted at the department of pathology, KAMSRC, reported 27 cases of post covid-19 Mucormycosis aged 30-68 years. Clinical features at presentation included unilateral facial pain with proptosis (80%), loss of vision, headache, nasal crusting, Cough with dyspnea and mild fever. All cases were admitted in ICU with severity in symptoms with 7 deaths recorded during treatment (25.9%). Immunofluorescence with Robin blue/Calcofluor white stainfor fungal elements was also combined to highlight Mucor species.Fungal cultures were diagnostic for fungal elements obtained after 48hrs on Sabouraud’s/Potato dextrose agar(SDA/PDA). Three cases were negative for fungal elements withonly dense mixed inflammatory infiltrate admixed necrosis. Correlation with KOH mount & fungal culture on SDA/PDA showed 13 cases of mucor, 5 cases of rhizopus, 3 cases of aspergillus & 2 cases of mucor with aspergillus growth, 3 cases were negative with no fungal growth. Also correlated with the microbiology department where nasal crusting and nasal tissue was obtained for fungal elements for KOH wet mount and fungal culture. KOH wet mount microscopy revealed Broad aseptate hyphae with wide angle branching suggestive of Mucormycosis. Simultaneous analytical study of CBP showed raised total WBC counts in 4 individuals (19,620-24,670 cumm) with others having normal CBC.CRP was in the range of 32-68mg/dl with ESR 35-98 mm/hr. : Understanding the mechanism of host innate immunity and specific preventive strategies are important for favorable prognosis. Histopathological examination aids in early diagnosis of Mucormycosis.

Utilidad de la biopsia por congelación para el diagnóstico y tratamiento de la mucormicosis. Reporte de un caso y revisión de la literatura

Antecedentes: la mucormicosis hace referencia a las infecciones por hongos de la familia Mucoraceae, del orden Mucorales. Existen tres géneros importantes responsables de las infecciones humanas: Rhizopus, Mucor y Absidia. Se ha descrito mucormicosis rinocerebral, sinonasal, pulmonar, gastrointestinal, cutánea y diseminada. Generalmente afecta a pacientes inmunodeprimidos o con algún grado de compromiso del sistema inmunológico. Reporte de caso: paciente femenina de 24 años, con cuadro clínico de aproximadamente 1 mes de evolución de otalgia izquierda, que recibió diferentes manejos antibióticos sin mejoría del cuadro. Refiere que se le realizó un procedimiento en cara y arcada superior dental izquierda con posterior cambio de la coloración de la piel, palidez y necrosis. Se realiza diagnóstico de sepsis de tejidos blandos y diabetes mellitus de novo. Es valorado por el servicio de dermatología, donde toman biopsia para cortes por congelación, en los cuales se reconocen filamentos hialinos en forma de cintas, hifas de paredes irregulares y de diámetro variable, algunas irregularmente ramificadas, en ángulos mayores de 45° y escasos septos, los cuales resaltan con la coloración de ácido peryódico de Schiff (PAS) en los posteriores cortes en parafina. El objetivo del presente artículo es describir la utilidad de la biopsia por congelación en el diagnóstico precoz de la mucormicosis. Conclusiones: el uso de la biopsia por congelación en el contexto de la mucormicosis ha mostrado ser una herramienta valiosa para la evaluación intraoperatoria de la piel y los tejidos blandos, con grandes impactos en la efectividad del tratamiento y la supervivencia, por lo que debe ser utilizada en conjunto con las características clínicas al momento de la toma de decisiones.

Invasive Mucormycosis in post covid patients at a Tertiary Health Care Centre

Rhino cerebral Mucormycosis is the current life-threatening infection commonly affecting immunocompromised patients espe-cially post COVID-19 within 6 weeks having poor glycemic control, Intravenous drug users, ICU patients, post chemotherapy, iron overload, persistent neutropenia and follow-up cases of hematological malignancies. It affects the nasal and paranasal sinuses by air-borne spores producing the infection. A prospective case series conducted at the department of pathology, KAMSRC between May 1st to September 30th 2021 with a study population of 27 cases. Variables included age, gender, history of covid, duration and development of symptoms, Clinical presentation, clinical diagnosis, co-morbidities, histopathological examination and microbiological correlation. The most prevalent isolated agent is Mucor (48.1%) followed by Rhizopus (18.5%), Aspergillus (11.1%) and mixed mucor with aspergillus (11.1%). Conclusion: Understanding the mechanism of host innate immunity and specific preventive strategies are important for favorable prognosis. Histopathological examination aids in early diagnosis of Mucormycosis

Clinical approach to palatal necrosis in an immunocompromised patient: A dental professional’s role

Mucormycosis is a rare, emerging fungal infection caused by Mucormycetes/Zygomycetes/Phycomycetes. It is an airborne infection that shows systemic dissemination. The prevalence of mucormycosis varies and is 14/100,000 population in India. The rhino-orbitocerebral form is common in the maxillofacial region. Effective antifungal therapy, surgical debridement, a reversal of immunosuppression, and management of the underlying medical condition are the treatment modalities followed in mucormycosis. The dental professionals play a pivotal role in the early diagnosis of mucormycosis allowing timely initiation of the therapy and surgical debridement reducing morbidity and mortality. This case report presents a case of mucormycosis affecting the left maxillary posterior region in a 42-year-old male who reported with a chief complaint of swelling, nasal obstruction, nasal discharge, and headache, diagnosed at an early stage, and treated with surgical debridement through a multidisciplinary approach.

Evaluation of a Novel Mitochondrial Pan-Mucorales Marker for the Detection, Identification, Quantification, and Growth Stage Determination of Mucormycetes.

Mucormycosis infections are infrequent yet aggressive and serious fungal infections. Early diagnosis of mucormycosis and its discrimination from other fungal infections is required for targeted treatment and more favorable patient outcomes. The majority of the molecular assays use 18 S rDNA. In the current study, we aimed to explore the potential of the mitochondrial rnl (encoding for large-subunit-ribosomal-RNA) gene as a novel molecular marker suitable for research and diagnostics. Rnl was evaluated as a marker for: (1) the Mucorales family, (2) species identification (Rhizopus arrhizus, R. microsporus, Mucor circinelloides, and Lichtheimia species complexes), (3) growth stage, and (4) quantification. Sensitivity, specificity, discriminatory power, the limit of detection (LoD), and cross-reactivity were evaluated. Assays were tested using pure cultures, spiked clinical samples, murine organs, and human paraffin-embedded-tissue (FFPE) samples. Mitochondrial markers were found to be superior to nuclear markers for degraded samples. Rnl outperformed the UMD universal® (Molyzm) marker in FFPE (71.5% positive samples versus 50%). Spiked blood samples highlighted the potential of rnl as a pan-Mucorales screening test. Fungal burden was reproducibly quantified in murine organs using standard curves. Identification of pure cultures gave a perfect (100%) correlation with the detected internal transcribed spacer (ITS) sequence. In conclusion, mitochondrial genes, such as rnl, provide an alternative to the nuclear 18 S rDNA genes and deserve further evaluation.

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

Mucormycosis is an opportunistic fungal infection, which is occasionally seen in immunosuppressive patients, and has high morbidity and mortality rates despite treatment. The case is here reported of a patient admitted to our Intensive Care Unit (ICU) with diagnosis of diabetic ketoacidosis, acute kidney injury, acute cerebral infarct and rhino-orbital mucormycosis.This level of advanced rhino-orbital mucormycosis caused severe cutaneous and subcutaneous lesions has not been reported previously in literature and thus the case is evaluated in respect of the early diagnosis of mucormycosis and treatment.

Mucormycosis of the hard palate: a rare case report

Mucormycosis is a rare but aggressive opportunistic fungal infection. Mucormycosis refers to several different diseases; the causative agents of mucormycosis are the filamentous fungi of the Mucoraceae family, of the order Mucorales. Here, we report a case of mucormycosis in the hard palate of a 46-year-old woman without any predisposing factors. For early diagnosis of mucormycosis, histopathological examination is essential. In the present case, the fungus was identified by hematoxylin and eosin staining and confirmed by PAS and Grocott's silver methenamine special staining. As mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma to those who are not familiar with its clinical presentation. The patient was successfully treated with a combination of surgical debridement and amphotericin-B. Through this case report, we would like to emphasize that mucormycosis of the hard palate occurs even in immunocompetent patients.

Successful Treatment of Cutaneous Mucormycosis Infection Following Living Donor Liver Transplant and Review of Literature

Background Mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantation. Method Presenting a case report of a patient who developed mucor infection of the surgical wound, 10 days after transplant, was successfully treated by wide surgical debridement and amphotericin injection and we analyse the risk factors involved for infection. Results The risk factors that were identified were malnutrition, contaminated surgical wound and CMV infection. Conclusion With an early diagnosis of mucormycosis by clinical findings, culture, or tissue biopsy, and aggressive treatment consisting of administration of liposomal amphotericin B and surgical resection of all infected tissue, excellent results are achieved.

Absidia Corymbiferain an immune competent accident victim with multiple abdominal injuries: case report

BackgroundWe report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground.Case presentationThe patient was admitted to hospital with massive abdominal trauma. During an 8-hour emergency operation he received transfusions of compacted red blood cells, plasma, platelets and hemagel. He developed a crush syndrome with acute renal failure, resolved with extra-corporeal dialysis and had to undergo splenectomy because of spleen hematoma. As wound secretion and central venous catheter (CVC) blood cultures and drainage fluid were positive for Enterococcus Faecium, Providentia Rettgeri, Hafnia Alvei and Candida Albicans, tecoplanin, metronidazole, imipenem, and flucanozole were administered.Although the CVC was changed high fever persisted and discharge continued from the large abdominal wound. Repeated tampons in different sections and wound secretion smears were positive for A. corymbifera. Flucanozole was stopped and liposomal amphotericin (Ambisome; 5 mg/Kg i.v.) given for over 3 months.The patient improved; fever gradually disappeared. After 8 days, tampons and wound secretion smears were negative for A. corymbifera. No other fungal infections developed. Drainage fluid was later positive for tecoplanin-resistant E. faecium and Pseudomonas Aeroginosa responding only to meropenem and ciprofloxacin. Abdominal computerized tomography visualized fluid accumulation around the iliac-femoral bypass. Abcess was ruled out when scintigraphy showed no tracer uptake. The lesion was drained. Drainage fluid cultures were negative for bacteria and fungi. Fluid accumulation gradually disappeared with prolonged antibiotic and antifungal therapy.One year after the accident the patient is in good health, with normal quality of life.ConclusionSuccessful outcome was due to early, specific antifungal therapy, at sufficiently high dosage which was prolonged for an adequate period of time. Early diagnosis of mucormycosis is essential for efficacious anti-fungal treatment and prevention of irreversible spread of mucormycosis to vital organs. It presupposes awareness that A. corymbifera infection can develop in healthy individuals who are stressed and traumatized through skin-ground contact in accidents.

SUCCESSFUL TREATMENT OF MUCOR INFECTION AFTER LIVER OR PANCREAS-KIDNEY TRANSPLANTATION

Mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantation. We present five cases of mucor infection after transplantation (three after a series of 750 orthotopic liver transplantation and two after a series of 13 simultaneous pancreas-kidney transplantation in patients with type 1 diabetes) subjected to medical and surgical treatment and analyze the factors related to the development of this infection. The clinical forms were two cutaneous (laparotomy wound or prior surgical drain site), two rhino-maxillary, and one pulmonary. As risk factors for mucormycosis all patients had pre- or posttransplantation diabetes, and showed at least one episode of acute rejection that required aggressive immunosuppression (2-7 g of methylprednisolone; also three patients were treated with antithymocyte globulin [ATG] monoclonal antibody [orthoclone and/or OKT3]). We also found renal failure, acidosis, malnutrition, and Candida and cytomegalovirus infections as factors related to mucor infection. Diagnosis of fungal infection was confirmed by exudate or fluid culture in three cases and by biopsy in two. All patients were treated with liposomal amphotericin B (from 3.5 to 5.6 g of total dose) and resection until the surgical margins were free of infection. All patients survived after this severe infection. With an early diagnosis of mucormycosis by clinical findings, culture, or tissue biopsy, and aggressive treatment consisting of administration of liposomal amphotericin B and surgical resection of all infected tissue, excellent results are achieved.