eMedicine Specialties > Infectious Diseases > Fungal Infections

Mucormycosis: Follow-up

Author: Nancy F Crum-Cianflone, MD, MPH, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego; HIV Research Physician, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Jul 1, 2008

Follow-up

Further Inpatient Care

  • Successful courses of therapy typically last 4-6 weeks and require cumulative doses of greater than 2 g of amphotericin B. Posaconazole offers another option. Repeated surgical debridement of necrotic tissue identified by follow-up head CT scan or MRI is often indicated.
  • Monitor renal function of patients taking amphotericin B; doubling of serum creatinine over the baseline levels is an indication for changing to liposomal amphotericin B.

Further Outpatient Care

  • Ongoing clinical surveillance and diagnostic imaging are required to ensure complete resolution of mucormycosis and to detect relapse.

Transfer

  • Treat patients with mucormycosis in a tertiary referral center with subspecialty units experienced in the care of the condition and the underlying causes.

Deterrence/Prevention

  • Place patients with severe prolonged neutropenia in rooms equipped with high-efficiency particulate air (HEPA) filters, where practicable.
  • Avoid the use of contaminated medical bandages and other equipment to prevent cutaneous disease; frequently check the wound or wounds.

Prognosis

  • Surviving mucormycosis requires rapid diagnosis and aggressive coordinated medical and surgical therapy.
  • Mucormycosis carries a mortality rate of 50-85%. The mortality rate associated with rhinocerebral disease is 50-70%. Disseminated disease carries a mortality rate that approaches 100%. Cutaneous disease carries the lowest mortality rate (15%). The advent of novel antifungals, such as posaconazole, may offer improvement in these mortality rates; further studies are needed.

Patient Education

  • Educate patients about the signs of disease, such as facial swelling and black nasal discharge, and instruct patients to present promptly for evaluation if these signs occur.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the typical clinical presentation of rhinocerebral mucormycosis or act on the characteristic histological features of the disease may lead to poor patient outcomes and litigation.
  • The use of contaminated bandages and other dressings has caused cutaneous mucormycosis. Failure to examine area under dressings or to recognize the significance of deterioration in preexisting wounds may produce severe cutaneous and, ultimately, disseminated disease.
 


More on Mucormycosis

Overview: Mucormycosis
Differential Diagnoses & Workup: Mucormycosis
Treatment & Medication: Mucormycosis
Follow-up: Mucormycosis
Multimedia: Mucormycosis
References
[ CLOSE WINDOW ]

References

  1. Kontoyiannis DP, Wessel VC, Bodey GP, et al. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis. Jun 2000;30(6):851-6. [Medline].

  2. Pagano L, Ricci P, Tonso A, et al. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). Br J Haematol. Nov 1997;99(2):331-6. [Medline].

  3. Lee FY, Mossad SB, Adal KA. Pulmonary mucormycosis: the last 30 years. Arch Intern Med. Jun 28 1999;159(12):1301-9. [Medline].

  4. Szalai G, Fellegi V, Szabo Z, et al. Mucormycosis mimicks sinusitis in a diabetic adult. Ann N Y Acad Sci. Nov 2006;1084:520-30. [Medline].

  5. Mohindra S, Mohindra S, Gupta R, et al. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses. Jul 2007;50(4):290-6. [Medline].

  6. Gelston CD, Durairaj VD, Simoes EA. Rhino-orbital mucormycosis causing cavernous sinus and internal carotid thrombosis treated with posaconazole. Arch Ophthalmol. Jun 2007;125(6):848-9. [Medline].

  7. Keating GM. Posaconazole. Drugs. 2005;65(11):1553-67; discussion 1568-9. [Medline].

  8. Greenberg RN, Mullane K, van Burik JA, et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. Jan 2006;50(1):126-33. [Medline].

  9. Sedlacek M, Cotter JG, Suriawinata AA, et al. Mucormycosis peritonitis: more than 2 years of disease-free follow-up after posaconazole salvage therapy after failure of liposomal amphotericin B. Am J Kidney Dis. Feb 2008;51(2):302-6. [Medline].

  10. Rickerts V, Atta J, Herrmann S, et al. Successful treatment of disseminated mucormycosis with a combination of liposomal amphotericin B and posaconazole in a patient with acute myeloid leukaemia. Mycoses. 2006;49 Suppl 1:27-30. [Medline].

  11. van Well GT, van Groeningen I, Debets-Ossenkopp YJ, et al. Zygomycete infection following voriconazole prophylaxis. Lancet Infect Dis. Sep 2005;5(9):594. [Medline].

  12. Trifilio SM, Bennett CL, Yarnold PR, et al. Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy. Bone Marrow Transplant. Apr 2007;39(7):425-9. [Medline].

  13. Al-Abdely HM. Management of rare fungal infections. Curr Opin Infect Dis. Dec 2004;17(6):527-32. [Medline].

  14. Greenberg RN, Scott LJ, Vaughn HH, et al. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis. Dec 2004;17(6):517-25. [Medline].

  15. Maertens J, Demuynck H, Verbeken EK, et al. Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis. Bone Marrow Transplant. Aug 1999;24(3):307-12. [Medline].

  16. McAdams HP, Rosado de Christenson M, Strollo DC, et al. Pulmonary mucormycosis: radiologic findings in 32 cases. AJR Am J Roentgenol. Jun 1997;168(6):1541-8. [Medline].

  17. O'Neill BM, Alessi AS, George EB, et al. Disseminated rhinocerebral mucormycosis: a case report and review of the literature. J Oral Maxillofac Surg. Feb 2006;64(2):326-33. [Medline].

  18. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. Apr 2000;13(2):236-301. [Medline].

  19. Sugar AM. Agents of mucormycosis and related species. In: Mandell GL, Bennett GE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2005:2973-2984.

  20. Tobon AM, Arango M, Fernandez D, et al. Mucormycosis (zygomycosis) in a heart-kidney transplant recipient: recovery after posaconazole therapy. Clin Infect Dis. Jun 1 2003;36(11):1488-91. [Medline].

  21. Van Cutsem J, Boelaert JR. Effects of deferoxamine, feroxamine and iron on experimental mucormycosis (zygomycosis). Kidney Int. Dec 1989;36(6):1061-8. [Medline].

  22. 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. Jun 1998;26(6):1383-96. [Medline].

  23. Wingard JR, White MH, Anaissie E, et al. A randomized, double-blind comparative trial evaluating the safety of liposomal amphotericin B versus amphotericin B lipid complex in the empirical treatment of febrile neutropenia. L Amph/ABLC Collaborative Study Group. Clin Infect Dis. Nov 2000;31(5):1155-63. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Rhizopus species, mucormycosis, zygomycosis, phycomycosis, Mucorales, Rhizopus mucormycosis , Rhizomucor mucormycosis , Cunninghamella mucormycosis , Apophysomyces mucormycosis , Saksenaea mucormycosis , Absidia mucormycosis , Mucor mucormycosis , Syncephalastrum mucormycosis , Cokeromyces mucormycosis , Mortierella mucormycosis, conidiobolomycosis, entomophthoramycosis, basidiobolomycosis, pulmonary mucormycosis, rhinocerebral mucormycosis, cutaneous mucormycosis, gastrointestinal mucormycosis, disseminated mucormycosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nancy F Crum-Cianflone, MD, MPH, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego; HIV Research Physician, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Nancy F Crum-Cianflone, MD, MPH is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Brown University
Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubicin  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.