Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.

Centre for Infectious Diseases and Microbiology Laboratory Services New South Wales Health Pathology and the Department of Infectious Diseases Westmead Hospital School of Medicine University of Sydney Sydney NSW Australia

Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain; Instituto de Investigación v Sanitaria Gregorio Marañón Madrid Spain; Medicine Department School of Medicine Universidad Complutense de Madrid Madrid Spain

Clinical Microbiology Laboratory Attikon University Hospital National and Kapodistrian University of Athens Athens Greece; Department of Medical Microbiology and Infectious Diseases Erasmus Medical Center Rotterdam The Netherlands

Department 1 of Internal Medicine University Hospital of Cologne Cologne Germany; CECAD Cluster of Excellence University of Cologne Cologne Germany

Department 1 of Internal Medicine University Hospital of Cologne Cologne Germany; German Centre for Infection Research partner site Bonn Cologne Cologne Germany; CECAD Cluster of Excellence University of Cologne Cologne Germany; Clinical Trials Center Cologne University Hospital of Cologne Cologne Germany

Department 1 of Internal Medicine University Hospital of Cologne Cologne Germany; German Centre for Infection Research partner site Bonn Cologne Cologne Germany; Department of Internal Medicine Hematology Oncology Goethe University Frankfurt Frankfurt Germany

Department 1 of Internal Medicine University Hospital of Cologne Cologne Germany; German Centre for Infection Research partner site Bonn Cologne Cologne Germany; Department of Internal Medicine Infectious Diseases Goethe University Frankfurt Frankfurt Germany

Department for Internal Medicine 2 University Hospital Würzburg Würzburg Germany

Department of Clinical Mycology Allergology and Immunology North Western State Medical University St Petersburg Russia

Department of Epidemiology and Infectious Diseases Hospital General Dr Manuel Gea González Mexico City Mexico; Medical Mycology and Fungal Immunology Wellcome Trust Strategic Award Program Aberdeen Fungal Group University of Aberdeen King's College Aberdeen UK

Department of General Visceral and Cancer Surgery University Hospital of Cologne Cologne Germany

Department of Hemato Oncology Amrita Institute of Medical Sciences Amrita Viswa Vidyapeetham University Kochi India

Department of Hematology Fondazione Policlinico Universitario A Gemelli IRCCS Universita Cattolica del Sacro Cuore Roma Italy

Department of Hematology Oncology and Palliative Care Klinikum Ernst von Bergmann Potsdam Germany

Department of Infectious Diseases Alfred Health and Monash University Melbourne Australia

Department of Infectious Diseases Hacettepe University School of Medicine Ankara Turkey

Department of Infectious Diseases Laiko General Hospital National and Kapodistrian University of Athens Athens Greece

Department of Infectious Diseases Singapore General Hospital Singapur Singapore

Department of Internal Medicine Division of Infectious Diseases American University of Beirut Medical Center Beirut Lebanon

Department of Internal Medicine Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil

Department of Medical Microbiology and Infectious Diseases Centre of Expertise in Mycology Radboudumc Canisius Wilhelmina Hospital Nijmegen Netherlands

Department of Medical Microbiology and Parasitology College of Medicine University of Lagos Yaba Lagos Nigeria; Faculty of Biology Medicine and Health The University of Manchester Manchester UK

Department of Medical Microbiology Hacettepe University School of Medicine Sıhhiye Ankara Turkey

Department of Medical Microbiology Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Medical Mycology Invasive Fungi Research Center School of Medicine Mazandaran University of Medical Sciences Sari Iran

Department of Medical Mycology Invasive Fungi Research Center School of Medicine Mazandaran University of Medical Sciences Sari Iran; Center of Expertise in Microbiology Infection Biology and Antimicrobial Pharmacology Tehran Iran; Molecular Microbiology Section Laboratory of Clinical Immunology and Microbiology National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda MD USA

Department of Medicine Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand

Department of Microbiology Immunology and Transplantation KU Leuven and Clinical Department of Laboratory Medicine and National Reference Center for Mycosis University Hospitals Leuven Leuven Belgium

Departments of Medicine Pediatrics Microbiology and Immunology Weill Cornell Medicine and New York Presbyterian Hospital New York City NY USA

Dermatology Service and Mycology Department Hospital General de México Dr Eduardo Liceaga Mexico City Mexico

Diagnostic and Interventional Radiology Thoracic Clinic University Hospital Heidelberg Heidelberg Germany

Division of Hygiene and Medical Microbiology Department of Hygiene Microbiology and Public Health Medical University Innsbruck Innsbruck Austria

Division of Infectious Diseases Department of Internal Medicine Catholic Hematology Hospital College of Medicine The Catholic University of Korea Seocho gu Seoul Korea

Division of Infectious Diseases Department of Medicine Microbiology and Immunology McGill University Montreal Quebec Canada

Division of Infectious Diseases Los Angeles Biomedical Research Institute at Harbor University of California at Los Angeles Medical Center Torrance CA USA

Division of Infectious Diseases The Children's Hospital of Philadelphia Philadelphia PA USA

Division of Infectious Diseases University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System Infectious Diseases Section University of Pittsburgh Pittsburgh PA USA

Division of Paediatric Haematology and Oncology Hospital for Children and Adolescents Johann Wolfgang Goethe University Frankfurt Germany

Division of Pediatric Infectious Diseases Department of Pediatrics Duke University Medical Center Durham NC USA

Divisions of Critical Care and Pulmonology Department of Medicine Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa

Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Federal University of Health Sciences of Porto Alegre Hospital Dom Vicente Scherer Porto Alegre Brazil

Fungus Testing Laboratory University of Texas Health Science Center San Antonio TX USA

Hämatologie and Internistische Onkologie Lukas Krankenhaus Bünde Onkologische Ambulanz Bünde Germany

Infectious Diseases Clinic Sant'Orsola Malpighi Hospital Department of Medical and Surgical Sciences University of Bologna Bologna Italy

Infectious Diseases Clinic Vedanta Institute of Medical Sciences Navarangpura Ahmeddabad India

Infectious Diseases Service Department of Medicine and Institute of Microbiology Lausanne University Hospital Lausanne Switzerland; Institute of Microbiology Department of Laboratories Lausanne University Hospital Lausanne Switzerland

Infectious Diseases Unit 3rd Department of Paediatrics Faculty of Medicine Aristotle University School of Health Sciences Thessaloniki Greece; Hippokration General Hospital Thessaloniki Greece

Infectious Diseases Unit Istituto Giannina Gaslini Children's Hospital Genoa Italy

Infectious Diseases Unit Szent Istvan and Szent Laszlo Hospital Budapest Hungary

InfectiousDisease Research Program Department of Paediatric Hematology Oncology and Center for Bone Marrow Transplantation University Children's Hospital Münster Münster Germany

Institut Pasteur National Reference Center for Invasive Mycoses and Antifungals Department of Mycology CNRS UMR2000 Parasitology Mycology Laboratory Lariboisière Saint Louis Fernand Widal Hospitals Assistance Publique Hôpitaux de Paris Université de Paris Paris France

Institut Pasteur National Reference Center for Invasive Mycoses and Antifungals Department of Mycology Paris Descartes University Necker Enfants Malades University Hospital Department of Infectious Diseases and Tropical Medicine Centre d'Infectiologie Necker Pasteur Institut Imagine AP HP Paris France

Institute of Hematology and Blood Transfusion Prague Czech Republic

Laboratory of Antimicrobial Chemotherapy Ion Ionescu de la Brad University Iaşi Romania

Los Angeles County and University of Southern California Medical Center Los Angeles CA USA

Mycology Reference Laboratory National Centre for Microbiology Instituto de Salud Carlos 3 Madrid Spain

Oncohematology Clinic Faculty of Medicine Comenius University and National Cancer Institute Bratislava Slovakia

P D Hinduja Hospital and Medical Research Centre Department of Medicine Veer Sarvarkar Marg Mumbai India

Public Health Wales Microbiology Cardiff UHW Heath Park Cardiff UK

Radiology Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul Porto Alegre Brazil

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel; Infectious Diseases Unit Tel Aviv Medical Center Tel Aviv Israel

School of Medicine and Pharmacy University Mohammed the fifth Hay Riad Rabat Morocco

Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology Medical University of Graz Graz Austria; Division of Infectious Diseases and Global Public Health Department of Medicine University of California San Diego San Diego USA

Special Mycology Laboratory Division of Infectious Diseases Department of Medicine Universidade Federal de São Paulo São Paulo Brazil

UK NHS Mycology Reference Centre Manchester University NHS Foundation Trust Manchester UK

Université Paris Descartes Faculté de Médecine APHP Hôpital Européen Georges Pompidou Unité de Parasitologie Mycologie Service de Microbiologie Paris France

University of Melbourne Melbourne VIC Australia; The National Centre for Infections in Cancer Peter MacCallum Cancer Centre Parkville Melbourne VIC Australia

Westerdijk Fungal Biodiversity Institute Utrecht The Netherlands; Centre of Expertise in Mycology RadboudUMC Canisius Wilhelmina Hospital Nijmegen The Netherlands; Ministry of Health Directorate General of Health Services Ibri Oman

Komentář v

Front Public Health. 2023 Dec 19;11:1292162. doi: 10.3389/fpubh.2023.1292162. PubMed

Zobrazit více v PubMed

Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008; 47: 503–09. PubMed

Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis—has anything changed in the past 20 years? Clin Otolaryngol 2018; 43: 1454–64. PubMed

Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. Lancet Infect Dis 2011; 11: 301–11. PubMed

Tissot F, Agrawal S, Pagano L, et al. ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica 2017; 102: 433–44. PubMed PMC

Kung HC, Huang PY, Chen WT, et al. 2016 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan. J Microbiol Immunol Infect 2018; 51: 1–17. PubMed

Cornely OA, Arikan-Akdagli S, Dannaoui E, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014; 20: 5–26. PubMed

Blyth CC, Gilroy NM, Guy SD, et al. Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2014; 44: 1333–49. PubMed

Skiada A, Lanternier F, Groll AH, et al. Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica 2013; 98: 492–504. PubMed PMC

Cornely OA, Lass-Florl C, Lagrou K, Arsic-Arsenijevic V, Hoenigl M. Improving outcome of fungal diseases. Guiding experts and patients towards excellence. Mycoses 2017; 60: 420–25. PubMed

Hoenigl M, Gangneux JP, Segal E, et al. Global guidelines and initiatives from the European Confederation of Medical Mycology to improve patient care and research worldwide: new leadership is about working together. Mycoses 2018; 61: 885–94. PubMed

Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41: 634–53. PubMed

Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol 2019; 57: 395–402. PubMed

Corzo-Leon DE, Chora-Hernandez LD, Rodriguez-Zulueta AP, Walsh TJ. Diabetes mellitus as the major risk factor for mucormycosis in Mexico: epidemiology, diagnosis, and outcomes of reported cases. Med Mycol 2018; 56: 29–43. PubMed

Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago MJ. Incidence of zygomycosis in transplant recipients. Clin Microbiol Infect 2009; 15: 37–40. PubMed

Hibbett DS, Binder M, Bischoff JF, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res 2007; 111: 509–47. PubMed

Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis 2012; 54: S8–S15. PubMed PMC

Skiada A, Pagano L, Groll A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011; 17: 1859–67. PubMed

Sridhara SR, Paragache G, Panda NK, Chakrabarti A. Mucormycosis in immunocompetent individuals: an increasing trend. J Otolaryngol 2005; 34: 402–06. PubMed

Guinea J, Escribano P, Vena A, et al. Increasing incidence of mucormycosis in a large Spanish hospital from 2007 to 2015: Epidemiology and microbiological characterization of the isolates. PLoS One 2017; 12: e0179136. PubMed PMC

Xhaard A, Lanternier F, Porcher R, et al. Mucormycosis after allogeneic haematopoietic stem cell transplantation: a French multicentre cohort study (2003–2008). Clin Microbiol Infect 2012; 18: e396–400. PubMed

Pagano L, Ricci P, Tonso A, et al. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. Br J Haematol 1997; 99: 331–36. PubMed

Hammer MM, Madan R, Hatabu H. Pulmonary mucormycosis: radiologic features at presentation and over time. AJR Am J Roentgenol 2018; 210: 742–47. PubMed

Nam BD, Kim TJ, Lee KS, Kim TS, Han J, Chung MJ. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur Radiol 2018; 28: 788–95. PubMed

Wahba H, Truong MT, Lei X, Kontoyiannis DP, Marom EM. Reversed halo sign in invasive pulmonary fungal infections. Clin Infect Dis 2008; 46: 1733–37. PubMed

Legouge C, Caillot D, Chretien ML, et al. The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin Infect Dis 2014;58: 672–78. PubMed

Singla K, Samra T, Bhatia N. Primary cutaneous mucormycosis in a trauma patient with Morel-Lavallee lesion. Indian J Crit Care Med 2018; 22: 375–77. PubMed PMC

Neblett Fanfair R, Benedict K, Bos J, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med 2012; 367: 2214–25. PubMed

Al-Tarrah K, Abdelaty M, Behbahani A, Mokaddas E, Soliman H, Albader A. Cutaneous mucormycosis postcosmetic surgery: a case report and review of the literature. Medicine (Baltimore) 2016;95: e4185. PubMed PMC

Warkentien T, Rodriguez C, Lloyd B, et al. Invasive mold infections following combat-related injuries. Clin Infect Dis 2012; 55: 1441–49. PubMed PMC

Rodriguez CJ, Tribble DR, Malone DL, et al. Treatment of suspected invasive fungal infection in war wounds. Mil Med 2018; 183: 142–46. PubMed

Hay RJ. Mucormycosis: an infectious complication of traumatic injury. Lancet 2005; 365: 830–31. PubMed

Jayasuriya NS, Tilakaratne WM, Amaratunga EA, Ekanayake MK. An unusual presentation of rhinofacial zygomycosis due to Cunninghamella sp in an immunocompetent patient: a case report and literature review. Oral Dis 2006; 12: 67–69. PubMed

Wang Y, Zhu M, Bao Y, et al. Cutaneous mucormycosis caused by Rhizopus microsporus in an immunocompetent patient: a case report and review of literature. Medicine (Baltimore) 2018; 97: e11141. PubMed PMC

Jundt JS, Wong MEK, Tatara AM, Demian NM. Invasive cutaneous facial mucormycosis in a trauma patient. J Oral Maxillofac Surg 2018; 76: 1930. e1–5. PubMed

Candoni A, Klimko N, Busca A, et al. Fungal infections of the central nervous system and paranasal sinuses in onco-haematologic patients. Epidemiological study reporting the diagnostic-therapeutic approach and outcome in 89 cases. Mycoses 2019; 62: 252–60. PubMed

Bae MS, Kim EJ, Lee KM, Choi WS. Rapidly progressive rhino-orbito-cerebralmucormycosis complicated with unilateral internal carotid artery occlusion: a case report. Neurointervention 2012; 7: 45–49. PubMed PMC

Vallverdu Vidal M, Iglesias Moles S, Palomar Martinez M. Rhino-orbital-cerebral mucormycosis in a critically ill patient. Med Intensiva 2017; 41: 509–10. PubMed

Bhansali A, Bhadada S, Sharma A, et al. Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J 2004; 80: 670–74. PubMed PMC

Goh LC, Shakri ED, Ong HY, et al. A seven-year retrospective analysis of the clinicopathological and mycological manifestations of fungal rhinosinusitis in a single-centre tropical climate hospital. J Laryngol Otol 2017; 131: 813–16. PubMed

Thomson SR, Bade PG, Taams M, Chrystal V. Gastrointestinal mucormycosis. Br J Surg 1991; 78: 952–54. PubMed

Dekkers R, Verweij PE, Weemaes CM, Severijnen RS, Van Krieken JH, Warris A. Gastrointestinal zygomycosis due to Rhizopus microsporus var. rhizopodiformis as a manifestation of chronic granulomatous disease. Med Mycol 2008; 46: 491–94. PubMed

Roilides E, Zaoutis TE, Katragkou A, Benjamin DK Jr, Walsh TJ. Zygomycosis in neonates: an uncommon but life-threatening infection. Am J Perinatol 2009; 26: 565–73. PubMed PMC

Chugh KS, Sakhuja V, Gupta KL, et al. Renal mucormycosis: computerized tomographic findings and their diagnostic significance. Am J Kidney Dis 1993; 22: 393–97. PubMed

Sharma R, Shivanand G, Kumar R, et al. Isolated renal mucormycosis: an unusual cause of acute renal infarction in a boy with aplastic anaemia. Br J Radiol 2006; 79: e19–21. PubMed

Marak RS, Misra R, Ansari MS, et al. Successful medical management of renal zygomycosis: a summary of two cases and a review of the Indian literature. Med Mycol 2010; 48: 1088–95. PubMed

Thomas AJ, Shah S, Mathews MS, Chacko N. Apophysomyces elegans - renal mucormycosis in a healthy host: a case report from south India. Indian J Med Microbiol 2008; 26: 269–71. PubMed

Yu J, Li RY. Primary renal zygomycosis due to Rhizopus oryzae. Med Mycol 2006; 44: 461–66. PubMed

Jianhong L, Xianliang H, Xuewu J. Isolated renal mucormycosis in children. J Urol 2004; 171: 387–88. PubMed

Marty FM, Ostrosky-Zeichner L, Cornely OA, et al. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 2016; 16: 828–37. PubMed

Shoham S, Magill SS, Merz WG, et al. Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol 2010; 48: 511–17. PubMed

Legrand M, Gits-Muselli M, Boutin L, et al. Detection of circulating mucorales DNA in critically ill burn patients: preliminary report of a screening strategy for early diagnosis and treatment. Clin Infect Dis 2016; 63: 1312–17. PubMed

Hong HL, Lee YM, Kim T, et al. Risk factors for mortality in patients with invasive mucormycosis. Infect Chemother 2013; 45: 292–98. PubMed PMC

Palejwala SK, Zangeneh TT, Goldstein SA, Lemole GM. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis. J Neurol Surg B 2016; 77: P088. PubMed PMC

Walsh TJ, Skiada A, Cornely OA, et al. Development of new strategies for early diagnosis of mucormycosis from bench to bedside. Mycoses 2014; 57: 2–7. PubMed PMC

Abidi MZ, Sohail MR, Cummins N, et al. Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011:a comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies. Mycoses 2014; 57: 687–98. PubMed PMC

Bitar D, Che D. [Epidemiology of mucormycosis in metropolitan France, 1997–2010]. Med Sci (Paris) 2013; 29: 7–12 (in French). PubMed

Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 2011; 24: 247–80. PubMed PMC

Kung VL, Chernock RD, Burnham CD. Diagnostic accuracy of fungal identification in histopathology and cytopathology specimens. Eur J Clin Microbiol Infect Dis 2018; 37: 157–65. PubMed

Chermetz M, Gobbo M, Rupel K, et al. Combined orofacial aspergillosis and mucormycosis: fatal complication of a recurrent paediatric glioma-case report and review of literature. Mycopathologia 2016; 181: 723–33. PubMed

Davoudi S, Kasraianfard A, Ahmadinejad Z, et al. Cytomegalovirus reactivation and preemptive therapy after liver transplant. Exp Clin Transplant 2014; 12: 72–75. PubMed

Dhaliwal HS, Singh A, Sinha SK, et al. Diagnosed only if considered: isolated renal mucormycosis. Lancet 2015; 385: 2322. PubMed

Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med 2001; 125: 375–78. PubMed

Hoeppli RJC. Histological observations in experimental schistosomiasis japonica. Chin Med J (Engl) 1932; 46: 1179–86.

Splendore A Sobre a cultura d’una nova especie de cogumello pathogenico. Revista de Sociedade Scientifica de Sao Paulo 1908; 62: 62–63.

Ben-Ami R, Luna M, Lewis RE, Walsh TJ, Kontoyiannis DP. A clinicopathological study of pulmonary mucormycosis in cancer patients: extensive angioinvasion but limited inflammatory response. J Infect 2009; 59: 134–8. PubMed PMC

Chakrabarti A, Chatterjee SS, Das A, et al. Invasive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J 2009; 85: 573–81. PubMed

Ruping MJ, Heinz WJ, Kindo AJ, et al. Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother 2010; 65: 296–302. PubMed

Jensen HE, Salonen J, Ekfors TO. The use of immunohistochemistry to improve sensitivity and specificity in the diagnosis of systemic mycoses in patients with haematological malignancies. J Pathol 1997; 181: 100–05. PubMed

Jung J, Park YS, Sung H, et al. Using immunohistochemistry to assess the accuracy of histomorphologic diagnosis of aspergillosis and mucormycosis. Clin Infect Dis 2015; 61: 1664–70. PubMed

Sunagawa K, Ishige T, Kusumi Y, et al. Renal abscess involving mucormycosis by immunohistochemical detection in a patient with acute lymphocytic leukemia: a case report and literature review. Jpn J Infect Dis 2013; 66: 345–47. PubMed

Bernal-Martinez L, Buitrago MJ, Castelli MV, Rodriguez-Tudela JL, Cuenca-Estrella M. Development of a single tube multiplex real-time PCR to detect the most clinically relevant Mucormycetes species. Clin Microbiol Infect 2013; 19: e1–7. PubMed

Drogari-Apiranthitou M, Panayiotides I, Galani I, et al. Diagnostic value of a semi-nested PCR for the diagnosis of mucormycosis and aspergillosis from paraffin-embedded tissue: a single center experience. Pathol Res Pract 2016; 212: 393–97. PubMed

Ruangritchankul K, Chindamporn A, Worasilchai N, Poumsuk U, Keelawat S, Bychkov A. Invasive fungal disease in university hospital: a PCR-based study of autopsy cases. Int J Clin Exp Pathol 2015; 8: 14840–52. PubMed PMC

Salehi E, Hedayati MT, Zoll J, et al. Discrimination of aspergillosis, mucormycosis, fusariosis, and scedosporiosis in formalin-fixed paraffin-embedded tissue specimens by use of multiple real-time quantitative PCR assays. J Clin Microbiol 2016; 54: 2798–803. PubMed PMC

Springer J, Goldenberger D, Schmidt F, et al. Development and application of two independent real-time PCR assays to detect clinically relevant Mucorales species. J Med Microbiol 2016;65: 227–34. PubMed

Springer J, Lackner M, Ensinger C, et al. Clinical evaluation of a Mucorales-specific real-time PCR assay in tissue and serum samples. J Med Microbiol 2016; 65: 1414–21. PubMed

Zaman K, Rudramurthy SM, Das A, et al. Molecular diagnosis of rhino-orbito-cerebral mucormycosis from fresh tissue samples. J Med Microbiol 2017; 66: 1124–29. PubMed

Schwarz P, Bretagne S, Gantier JC, et al. Molecular identification of Zygomycetes from culture and experimentally infected tissues. J Clin Microbiol 2006; 44: 340–49. PubMed PMC

Lass-Florl C, Resch G, Nachbaur D, et al. The value of computed tomography-guided percutaneous lung biopsy for diagnosis of invasive fungal infection in immunocompromised patients. Clin Infect Dis 2007; 45: e101–04. PubMed

Lau A, Chen S, Sorrell T, et al. Development and clinical application of a panfungal PCR assay to detect and identify fungal DNA in tissue specimens. J Clin Microbiol 2007;45: 380–85. PubMed PMC

Rickerts V, Mousset S, Lambrecht E, et al. Comparison of histopathological analysis, culture, and polymerase chain reaction assays to detect invasive mold infections from biopsy specimens. Clin Infect Dis 2007; 44: 1078–83. PubMed

Kasai M, Harrington SM, Francesconi A, et al. Detection of a molecular biomarker for zygomycetes by quantitative PCR assays of plasma, bronchoalveolar lavage, and lung tissue in a rabbit model of experimental pulmonary zygomycosis. J Clin Microbiol 2008;46: 3690–702. PubMed PMC

Hrncirova K, Lengerova M, Kocmanova I, et al. Rapid detection and identification of mucormycetes from culture and tissue samples by use of high-resolution melt analysis. J Clin Microbiol 2010;48: 3392–94. PubMed PMC

Buitrago MJ, Bernal-Martinez L, Castelli MV, Rodriguez-Tudela JL, Cuenca-Estrella M. Performance of panfungal- and specific-PCR-based procedures for etiological diagnosis of invasive fungal diseases on tissue biopsy specimens with proven infection: a 7-year retrospective analysis from a reference laboratory. J Clin Microbiol 2014; 52: 1737–40. PubMed PMC

Alanio A, Garcia-Hermoso D, Mercier-Delarue S, et al. Molecular identification of Mucorales in human tissues: contribution of PCR electrospray-ionization mass spectrometry. Clin Microbiol Infect 2015; 21: 594. PubMed

Hayden RT, Qian X, Procop GW, Roberts GD, Lloyd RV. In situ hybridization for the identification of filamentous fungi in tissue section. Diagn Mol Pathol 2002; 11: 119–26. PubMed

Nagao K, Ota T, Tanikawa A, et al. Genetic identification and detection of human pathogenic Rhizopus species, a major mucormycosis agent, by multiplex PCR based on internal transcribed spacer region of rRNA gene. J Dermatol Sci 2005; 39: 23–31. PubMed

Bialek R, Konrad F, Kern J, et al. PCR based identification and discrimination of agents of mucormycosis and aspergillosis in paraffin wax embedded tissue. J Clin Pathol 2005; 58: 1180–84. PubMed PMC

Rickerts V, Just-Nubling G, Konrad F, et al. Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples. Eur J Clin Microbiol Infect Dis 2006; 25: 8–13. PubMed

Hata DJ, Buckwalter SP, Pritt BS, Roberts GD, Wengenack NL. Real-time PCR method for detection of zygomycetes. J Clin Microbiol 2008; 46: 2353–58. PubMed PMC

Dannaoui E, Schwarz P, Slany M, et al. Molecular detection and identification of zygomycetes species from paraffin-embedded tissues in a murine model of disseminated zygomycosis:a collaborative European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG) evaluation. J Clin Microbiol 2010; 48: 2043–46. PubMed PMC

Hammond SP, Bialek R, Milner DA, Petschnigg EM, Baden LR, Marty FM. Molecular methods to improve diagnosis and identification of mucormycosis. J Clin Microbiol 2011; 49: 2151–53. PubMed PMC

Buitrago MJ, Aguado JM, Ballen A, et al. Efficacy of DNA amplification in tissue biopsy samples to improve the detection of invasive fungal disease. Clin Microbiol Infect 2013; 19: e271–77. PubMed

Gade L, Hurst S, Balajee SA, Lockhart SR, Litvintseva AP. Detection of mucormycetes and other pathogenic fungi in formalin fixed paraffin embedded and fresh tissues using the extended region of 28S rDNA. Med Mycol 2017; 55: 385–95. PubMed

Ghadi NG, Shokohi T, Seifi Z, et al. Identification of Mucorales in patients with proven invasive mucormycosis by polymerase chain reaction in tissue samples. Mycoses 2018; 1: 909–915. PubMed

Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev 2011; 24: 411–45. PubMed PMC

Petraitis V, Petraitiene R, Antachopoulos C, et al. Increased virulence of Cunninghamella bertholletiae in experimental pulmonary mucormycosis: correlation with circulating molecular biomarkers, sporangiospore germination and hyphal metabolism. Med Mycol 2013; 51: 72–82. PubMed

Lanternier F, Dannaoui E, Morizot G, et al. A global analysis of mucormycosis in France: the RetroZygo study (2005–2007). Clin Infect Dis 2012; 54: S35–43. PubMed

Lu XL, Liu ZH, Shen YN, et al. Primary cutaneous zygomycosis caused by Rhizomucor variabilis: a new endemic zygomycosis? A case report and review of 6 cases reported from China. Clin Infect Dis 2009; 49: e39–43. PubMed

Etienne KA, Gillece J, Hilsabeck R, et al. Whole genome sequence typing to investigate the apophysomyces outbreak following a tornado in Joplin, Missouri, 2011. PLoS One 2012; 7: e49989. PubMed PMC

Garcia-Hermoso D, Criscuolo A, Lee SC, et al. Outbreak of invasive wound mucormycosis in a burn unit due to multiple strains of Mucor circinelloides f. circinelloides resolved by whole-genome sequencing. MBio 2018; 9. PubMed PMC

Rammaert B, Lanternier F, Zahar JR, et al. Healthcare-associated mucormycosis. Clin Infect Dis 2012; 54: S44–54. PubMed

Cheng VC, Chan JF, Ngan AH, et al. Outbreak of intestinal infection due to Rhizopus microsporus. J Clin Microbiol 2009; 47: 2834–43. PubMed PMC

Lanternier F, Poiree S, Elie C, et al. Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB)for the initial treatment of mucormycosis. J Antimicrob Chemother 2015; 70: 3116–23. PubMed

Pagano L, Valentini CG, Posteraro B, et al. Zygomycosis in Italy:a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology). J Chemother 2009; 21: 322–29. PubMed

Cornely OA, Maertens J, Bresnik M, et al. Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 2007; 44: 1289–97. PubMed

Stanzani M, Vianelli N, Cavo M, Maritati A, Morotti M, Lewis RE. Retrospective cohort analysis of liposomal amphotericin b nephrotoxicity in patients with hematological malignancies. Antimicrob Agents Chemother 2017; 61. PubMed PMC

Kyvernitakis A, Torres HA, Jiang Y, Chamilos G, Lewis RE, Kontoyiannis DP. Initial use of combination treatment does not impact survival of 106 patients with haematologic malignancies and mucormycosis: a propensity score analysis. Clin Microbiol Infect 2016; 22: 811. PubMed

Pagano L, Offidani M, Fianchi L, et al. Mucormycosis in hematologic patients. Haematologica 2004; 89: 207–14. PubMed

Nosari A, Oreste P, Montillo M, et al. Mucormycosis in hematologic malignancies: an emerging fungal infection. Haematologica 2000; 85: 1068–71. PubMed

Walsh TJ, Goodman JL, Pappas P, et al. Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. Antimicrob Agents Chemother 2001; 45: 3487–96. PubMed PMC

Ibrahim AS, Gebremariam T, Husseiny MI, et al. Comparison of lipid amphotericin B preparations in treating murine zygomycosis. Antimicrob Agents Chemother 2008; 52: 1573–76. PubMed PMC

Larkin JA, Montero JA. Efficacy and safety of amphotericin B lipid complex for zygomycosis. Infect Med 2003; 20: 201–06.

Forrest GN, Mankes K. Outcomes of invasive zygomycosis infections in renal transplant recipients. Transpl Infect Dis 2007; 9: 161–64. PubMed

Ullmann AJ, Sanz MA, Tramarin A, et al. Prospective study of amphotericin B formulations in immunocompromised patients in 4 European countries. Clin Infect Dis 2006; 43: e29–38. PubMed

Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med 1999; 34: 764–71. PubMed

Roilides E, Antachopoulos C. Isavuconazole: an azole active against mucormycosis. Lancet Infect Dis 2016; 16: 761–62. PubMed

Abuodeh RO, Galgiani JN, Scalarone GM. Molecular approaches to the study of Coccidioides immitis. Int J Med Microbiol 2002;292: 373–80. PubMed

Mellinghoff SC, Bassetti M, Dorfel D, et al. Isavuconazole shortens the QTc interval. Mycoses 2017; 61: 256–260. PubMed

Maertens JA, Raad II, Marr KA, et al. Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet 2016; 387: 760–69. PubMed

DiPippo AJ, Rausch CR, Kontoyiannis DP. Tolerability of isavuconazole after posaconazole toxicity in leukemia patients. Mycoses 2018; 62: 81–86. PubMed

Duarte RF, Lopez-Jimenez J, Cornely OA, et al. Phase 1b study of new posaconazole tablet for prevention of invasive fungal infections in high-risk patients with neutropenia. Antimicrob Agents Chemother 2014; 58: 5758–65. PubMed PMC

Cornely OA, Duarte RF, Haider S, et al. Phase 3 pharmacokinetics and safety study of a posaconazole tablet formulation in patients at risk for invasive fungal disease. J Antimicrob Chemother 2016;71: 1747. PubMed PMC

Maertens J, Cornely OA, Ullmann AJ, et al. Phase 1B study of the pharmacokinetics and safety of posaconazole intravenous solution in patients at risk for invasive fungal disease. Antimicrob Agents Chemother 2014; 58: 3610–17. PubMed PMC

Cornely OA, Robertson MN, Haider S, et al. Pharmacokinetics and safety results from the phase 3 randomized, open-label, study of intravenous posaconazole in patients at risk of invasive fungal disease. J Antimicrob Chemother 2017; 72: 3406–13. PubMed

Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B. Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother 2008; 52: 1556–58. PubMed PMC

Ibrahim AS, Gebremariam T, Schwartz JA, Edwards JE Jr, Spellberg B. Posaconazole mono- or combination therapy for treatment of murine zygomycosis. Antimicrob Agents Chemother 2009; 53: 772–75. PubMed PMC

Klimko NN, Khostelidi SN, Volkova AG, et al. Mucormycosis in haematological patients: case report and results of prospective study in Saint Petersburg, Russia. Mycoses 2014; 57: 91–96. PubMed

Reed C, Bryant R, Ibrahim AS, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis 2008; 47: 364–71. PubMed PMC

Jenks JD, Reed SL, Seidel D, et al. Rare mold infections caused by Mucorales, Lomentospora prolificans and fusarium, San Diego:the role of antifungal combination therapy. Int J Antimicrob Agents 2018; 52: 706–12. PubMed PMC

Rodriguez CJ, Tribble DR, Malone DL, et al. Treatment of suspected invasive fungal infection in war wounds. Mil Med 2018; 183: 142–46. PubMed

Marty FM, Cornely OA, Mullane KM, et al. Isavuconazole for treatment of invasive fungal diseases caused by more than one fungal species. Mycoses 2018; 61: 485–97. PubMed

Greenberg RN, Mullane K, van Burik JA, et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother 2006; 50: 126–33. PubMed PMC

van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP. Posaconazole is effective as salvage therapy in zygomycosis:a retrospective summary of 91 cases. Clin Infect Dis 2006; 42: e61–65. PubMed

Vehreschild JJ, Birtel A, Vehreschild MJ, et al. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol 2013; 39: 310–24. PubMed

Walsh TJ, Hiemenz JW, Seibel NL, et al. Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. Clin Infect Dis 1998; 26: 1383–96. PubMed

Herbrecht R, Letscher-Bru V, Bowden RA, et al. Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion. Eur J Clin Microbiol Infect Dis 2001; 20: 460–66. PubMed

Kim JH, Benefield RJ, Ditolla K. Utilization of posaconazole oral suspension or delayed-released tablet salvage treatment for invasive fungal infection. Mycoses 2016; 59: 726–33. PubMed

Ma J, Jia R, Li J, et al. Retrospective clinical study of eighty-one cases of intracranial mucormycosis. J Glob Infect Dis 2015;7: 143–50. PubMed PMC

Davoudi S, Anderlini P, Fuller GN, Kontoyiannis DP. A long-term survivor of disseminated aspergillus and mucorales infection: an instructive case. Mycopathologia 2014; 178: 465–70. PubMed

Valentini CG, Candoni A, Fianchi L, et al. Efficacy of combined surgery and antifungal therapies for the management of invasive zygomycoses in patients with haematological malignancies. Mycoses 2010; 53: 89–92. PubMed

Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE. Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg 1994; 57: 1044–50. PubMed

Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood 2011; 118: 1216–24. PubMed PMC

Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma 2004; 45: 1351–60. PubMed

Singh N, Aguado JM, Bonatti H, et al. Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome. J Infect Dis 2009; 200: 1002–11. PubMed

Sun HY, Aguado JM, Bonatti H, et al. Pulmonary zygomycosis in solid organ transplant recipients in the current era. Am J Transplant 2009; 9: 2166–71. PubMed

Lanternier F, Sun HY, Ribaud P, Singh N, Kontoyiannis DP, Lortholary O. Mucormycosis in organ and stem cell transplant recipients. Clin Infect Dis 2012; 54: 1629–36.

Li YH, Sun P, Guo JC. Clinical analysis of diabetic combined pulmonary mucormycosis. Mycopathologia 2017; 182: 1111–17. PubMed

Dannaoui E, Meis JF, Loebenberg D, Verweij PE. Activity of posaconazole in treatment of experimental disseminated zygomycosis. Antimicrob Agents Chemother 2003; 47: 3647–50. PubMed PMC

Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar injection of amphotericin B for orbital mucormycosis. Ophthalmic Plast Reconstr Surg 2017; 33: e94–97. PubMed

A Global Analysis of Cases of Mucormycosis Recorded in the European Confederation of Medical Mycology / International Society for Human and Animal Mycology (ECMM / ISHAM) Zygomyco.net Registry from 2009 to 2022

Interlaboratory assays from the fungal PCR Initiative and the Modimucor Study Group to improve qPCR detection of Mucorales DNA in serum: one more step toward standardization

Nomenclature for human and animal fungal pathogens and diseases: a proposal for standardized terminology

Mucormycosis in a Severe Trauma Patient Treated with a Combination of Systemic Posaconazole and Topical Amphotericin B-Case Report

COVID-19-Associated Mucormycosis (CAM): Case-Series and Global Analysis of Mortality Risk Factors