Mucormycosis

Mucormycoses describe a spectrum of chronic, subacute, and rapidly progressing infections caused by the fungi Mucorales. Clinical presentations, which are pleiotropic, include sinusitis (pansinusitis, rhino-orbital, or rhinocerebral), pulmonary, cutaneous, gastrointestinal, disseminated, and other uncommon presentations. Mucormycosis is typically seen following extensive trauma, in patients with uncontrolled diabetes, and in the setting of severe and prolonged immune suppression. In heavily immunocompromised patients, Mucorales have proclivity for angioinvasion, thereby resulting in tissue infarction, necrosis, and dissemination. Diagnosis requires a high index of clinical suspicion based on risk factors, clinical and radiologic presentation, and biopsy for histopathology and culture of the affected areas. Noninvasive rapid diagnostic tests are lacking. Reversal of immunosuppression and control of underlying metabolic abnormalities are important pillars of therapy, along with surgery and appropriate early antifungal agents. Despite the recent introduction of mold-active oral triazoles (posaconazole and isavuconazole) in addition to amphotericin B products, no randomized trials are available to guide therapy. Aggressive surgical resection of necrotic tissue is critical, especially in localized infection. Delayed diagnosis and the degree of immunosuppression are key determinants for poor outcome.