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Mucormycosis

  • Author: Nancy F Crum-Cianflone, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: Apr 03, 2015
 

Background

Mucormycosis refers to several different diseases caused by infection with fungi in the order of Mucorales. Rhizopus species are the most common causative organisms. In descending order, the other genera with mucormycosis-causing species include Mucor, Cunninghamella, Apophysomyces, Absidia, Saksenaea, Rhizomucor, and other species.[1, 2]

Most mucormycosis infections are life-threatening, and risk factors, such as diabetic ketoacidosis and neutropenia, are present in most cases. Severe infection of the facial sinuses, which may extend into the brain, is the most common presentation. Pulmonary, cutaneous, and gastrointestinal (GI) infections are also recognized.

Successful mucormycosis treatment requires correction of the underlying risk factor(s), antifungal therapy with liposomal amphotericin B, and aggressive surgery.

The following is a postmortem image of a patient who had diabetic ketoacidosis and left rhinocerebral mucormycosis.

Postmortem photograph of a woman with diabetes and Postmortem photograph of a woman with diabetes and left rhinocerebral mucormycosis complicating ketoacidosis. Rhizopus oryzae was the causative organism. Note the orbital and facial cellulitis and the black nasal discharge. (Courtesy of A. Allworth, MD, Brisbane, Australia.)

See also Pediatric Mucormycosis and Rhinocerebral Mucormycosis.

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Etiology and Pathophysiology

Risk factors

Immunocompromising conditions are the main risk factor for mucormycosis. Patients with uncontrolled diabetes mellitus, especially with ketoacidosis, are at high risk. Patients with cancer—especially those who are neutropenic and receiving broad-spectrum antibiotics—as well as individuals receiving immunosuppressive agents—including oral or intravenous steroids and tumor necrosis factor (TNF)–alpha blockers—are at risk. In addition, hematologic cancer patients with opportunistic herpetic infections (eg, cytomegalovirus) and graft versus host disease are at increased risk.

Extreme malnutrition is also linked to mucormycosis, especially the gastrointestinal (GI) form. Iron is a growth stimulant for Mucorales, and deferoxamine acts as a siderophore that delivers iron to the fungi. Older iron chelators such as deferoxaminetherapy and all causes of iron overload are additional risk factors for mucormycosis. Trauma and the use of contaminated medical supplies over wounds are associated with cutaneous mucormycosis. In addition, patients with burns and those who use intravenous drugs are at a higher risk.

Some patients with mucormycosis have no identifiable risk factors.[3, 4]

Pathophysiology

Mucoraceae are ubiquitous fungi that are commonly found in soil and in decaying matter. Rhizopus can be found in moldy bread. Given the ubiquitous nature of these fungi, most humans are exposed to these organisms on a daily or weekly basis. Nonetheless, they rarely cause disease because of the low virulence of the organisms; instead, they mainly affect individuals with immunocompromising conditions. Immunocompromised hosts with poorly controlled diabetes mellitus (especially with ketoacidosis), who are receiving glucocorticosteroids, who have neutropenia in the setting of hematologic or solid malignancy, who have undergone transplantation, who have iron overload, and who have burns are at risk for disease.

The major route of infection is via inhalation of conidia; other routes include ingestion and traumatic inoculation (see the images below). Ingestion leads to GI disease and occurs primarily among malnourished patients, but it can also occur after ingesting nonnutritional substances (pica). Regarding cutaneous disease, nonsterile tape and contaminated wooden splints have caused wound infections.[5, 6] Such cases are associated with trauma/surgery, the presence of a preexisting wound or line, or both. Additionally, natural disasters (after hurricanes, tsunamis, or tornados) may be associated with wound infections due to mucormycosis and should be considered in the setting of a necrotic-appearing wound or poor response to antibiotic treatment.[7, 8, 9]

When spores are deposited in the nasal turbinates, rhinocerebral disease develops (see Rhinocerebral Mucormycosis); when spores are inhaled into the lungs, pulmonary disease develops; when ingested, GI disease ensues; and when the agents are introduced through abraded skin, cutaneous disease develops.

The right eye of an immunocompetent man who sustai The right eye of an immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Note the proptosis. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
The right eye of an immunocompetent man who sustai The right eye of an immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Chemosis is shown in this photograph. Internal and external ophthalmoplegia, no light perception, and afferent pupil defect were present, which is consistent with orbital apex syndrome. (Courtesy of A. Allworth, MD, Brisbane, Australia.)

Mucoraceae are molds in the environment that become hyphal forms in tissues. Once the spores begin to grow, fungal hyphae invade blood vessels, producing tissue infarction, necrosis, and thrombosis. Neutrophils are the key host defense against these fungi; thus, individuals with neutropenia or neutrophil dysfunction (diabetes, steroid use) are at highest risk.[10] Few cases of mucormycosis have been reported in patients with acquired immunodeficiency syndrome (AIDS), suggesting that the host defense against this infection is not primarily mediated by cellular immunity.

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Epidemiology

United States statistics

Based on anatomic localization, mucormycosis can be classified as 1 of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations.[11] Rhinocerebral disease is the most common form in the United States, accounting for more than half of the cases. Most cases occur among severely immunocompromised persons. Mucormycosis has been reported in immunocompetent individuals, mostly after traumatic inoculation of fungal spores, but this is rare.

Mucormycosis is extremely rare, and its incidence is difficult to calculate accurately. Further, since mucormycosis is not a reportable disease, the true incidence is unknown, but an estimated 500 cases occur in the United States annually.[1]

A review of mucormycosis cases at one US cancer center found that 0.7% of patients had mucormycosis at autopsy and that 20 patients per 100,000 admissions had the disease.[12] The 1-year cumulative incidence of mucormycosis has been estimated at approximately 4 cases per 1000 stem cell transplantations and 0.6 case per 1000 organ transplantations, accounting for 7% and 2% of all fungal infections in these populations, respectively.[13]

The incidence of mucormycosis appears to be increasing secondary to rising numbers of immunocompromised persons. Further, there are increasing reports of breakthrough mucormycosis in the setting of antifungal prophylaxis or treatment (eg, voriconazole, echinocandins) that is effective against most fungi (eg, Aspergillus) but not mucormycosis.

Additionally, several cases of cutaneous mucormycosis due to the Mucormycete Apophysomyces trapezi­formis were described among wound-injured victims from a tornado.[8, 14, 15]

International statistics

Descriptions of mucormycosis appear to be increasing, perhaps given higher numbers of persons at risk.[16] Mucormycosis was found in 1% of patients with acute leukemia in an Italian multicenter review.[17]

A related disease, entomophthoramycosis, is rare in the United States but is most commonly found in Africa, Southeast Asia, Australia, and Central America. Entomophthoramycosis consists of 2 diseases: conidiobolomycosis (caused by Conidiobolus infection) and basidiobolomycosis (caused by Basidiobolus infection). Conidiobolomycosis presents as a painless, firm, subcutaneous mass that primarily involves the head and face, whereas basidiobolomycosis involves the trunk and/or extremities. In contrast with mucormycosis, entomophthoramycosis is associated with a lower mortality rate and usually affects immunocompetent hosts.

No racial or age factors that predispose people to mucormycosis exist, and a patient's sex is not likely to affect the occurrence of mucormycosis, because the underlying conditions are the major predisposing factors. Reviews of cases from single institutions show an equal sex distribution; however, a review of all published cases of pulmonary mucormycosis performed by Lee et al showed a male-to-female ratio of 3:1.[18]

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Prognosis

Rhinocerebral disease causes significant morbidity in patients who survive, because treatment usually requires extensive, and often disfiguring, facial surgery.

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%. Pulmonary and gastrointestinal (GI) diseases carry an even higher mortality rate, because these forms are typically diagnosed late in the disease course. 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.

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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

Nancy F Crum-Cianflone, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Mark T Duffy, MD, PhD Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Ronald A Greenfield, MD Professor, Department of Internal Medicine, 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; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of 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.

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kimberly G Yen, MD Associate Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine

Kimberly G Yen, MD is a member of the following medical societies: American Academy of Ophthalmology and American Association of Pediatric Ophthalmology & Strabismus (AAPOS)

Disclosure: Nothing to disclose.

Michael T Yen, MD Associate Professor of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Medical Director, BCM Ambulatory Surgery Center, Program Director, ASOPRS Fellowship, Baylor College of Medicine

Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

References
  1. Kontoyiannis DP, Lewis RE. Agents of mucormycosis and Entomophthoramycosis. Mandell GL, Bennett GE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone; 2010. 3257-69.

  2. Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis. 2012 Feb. 54 Suppl 1:S8-S15. [Medline].

  3. Mohindra S, Mohindra S, Gupta R, Bakshi J, Gupta SK. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses. 2007 Jul. 50(4):290-6. [Medline].

  4. Rahman A, Akter K, Hossain S, Rashid HU. Rhino-orbital mucourmycosis in a non-immunocompromised patient. BMJ Case Rep. 2. 2013 Feb 6. 013:doi:pii: bcr2012007863.

  5. Lalayanni C, Baliakas P, Xochelli A, Apostolou C, Arabatzis M, Velegraki A. Outbreak of cutaneous zygomycosis associated with the use of adhesive tape in haematology patients. J Hosp Infect. 2012 Jul. 81(3):213-5. [Medline].

  6. Rammaert B, Lanternier F, Zahar JR, Dannaoui E, Bougnoux ME, Lecuit M. Healthcare-associated mucormycosis. Clin Infect Dis. 2012 Feb. 54 Suppl 1:S44-54. [Medline].

  7. Andresen D, Donaldson A, Choo L, et al. Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet. 2005 Mar 5-11. 365(9462):876-8. [Medline].

  8. Neblett Fanfair R, Benedict K, Bos J, Bennett SD, Lo YC, Adebanjo T. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med. 2012 Dec 6. 367(23):2214-25. [Medline].

  9. Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev Anti Infect Ther. 2012 Jan. 10(1):95-104. [Medline].

  10. Roilides E, Kontoyiannis DP, Walsh TJ. Host defenses against zygomycetes. Clin Infect Dis. 2012 Feb. 54 Suppl 1:S61-6. [Medline].

  11. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012 Feb. 54 Suppl 1:S23-34. [Medline].

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

  13. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010 Apr 15. 50(8):1091-100. [Medline].

  14. Fatal fungal soft-tissue infections after a tornado. Center for Disease Control and Prevention. Mortal.Wkly Rep. 2011. 60:992.

  15. Green JP, Karras DJ. Update on emerging infections: news from the Centers for Disease Control and Prevention. Notes from the field: fatal fungal soft-tissue infections after a tornado--Joplin, Missouri, 2011. Ann Emerg Med. 2012 Jan. 59(1):53-5. [Medline].

  16. Bitar D, Van Cauteren D, Lanternier F, Dannaoui E, Che D, Dromer F. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis. 2009 Sep. 15(9):1395-401. [Medline].

  17. 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. 1997 Nov. 99(2):331-6. [Medline].

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

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

  20. Gamaletsou MN, Sipsas NV, Roilides E, Walsh TJ. Rhino-orbital-cerebral mucormycosis. Curr Infect Dis Rep. 2012 Aug. 14(4):423-34. [Medline].

  21. Johnson JB, Affolter KE, Samadder NJ. A Rare Cause of Hematochezia: Colon Mucormycosis. Clin Gastroenterol Hepatol. 2012 Aug 28. [Medline].

  22. Chawla N, Reddy SJ, Agrawal M. Ileocolic mucormycosis causing intestinal obstruction. Indian J Med Microbiol. 2012 Jul-Sep. 30(3):373-4. [Medline].

  23. Polo JR, Luno J, Menarguez C, Gallego E, Robles R, Hernandez P. Peritoneal mucormycosis in a patient receiving continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1989 Mar. 13(3):237-9. [Medline].

  24. Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis. 2012 Feb. 54 Suppl 1:S55-60. [Medline].

  25. Millon L, Larosa F, Lepiller Q, Legrand F, Rocchi S, Daguindeau E. Quantitative PCR detection of circulating DNA in serum for early diagnosis of mucormycosis in immunocompromised patients. Clin Infect Dis. 2013 Feb 18. [Medline].

  26. Bernal-Martínez 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 Jan. 19(1):E1-7. [Medline].

  27. Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011 Aug 4. 118(5):1216-24. [Medline].

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

  29. Wahba H, Truong MT, Lei X, Kontoyiannis DP, Marom EM. Reversed halo sign in invasive pulmonary fungal infections. Clin Infect Dis. 2008 Jun 1. 46(11):1733-7. [Medline].

  30. Skiada A, Lanternier F, Groll AH, Pagano L, Zimmerli S, Herbrecht R. Diagnosis and treatment of mucormycosis in patients with haematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica. 2012 Sep 14. [Medline].

  31. Spellberg B, Ibrahim A, Roilides E, et al. Combination therapy for mucormycosis: why, what, and how?. Clin Infect Dis. 2012 Feb. 54 Suppl 1:S73-8. [Medline].

  32. Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009 Jun 15. 48(12):1743-51. [Medline]. [Full Text].

  33. Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B. Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother. 2008 Apr. 52(4):1556-8. [Medline]. [Full Text].

  34. Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases?. Leuk Lymphoma. 2004 Jul. 45(7):1351-60. [Medline].

  35. Walsh TJ, Goodman JL, Pappas P, Bekersky I, Buell DN, Roden M. 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 Dec. 45(12):3487-96. [Medline].

  36. Almannai M, Imran H, Estrada B, Siddiqui AH. Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole and Hyperbaric Oxygen Therapy. Pediatr Hematol Oncol. 2013 Feb 27. [Medline].

  37. 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. 2008 Feb. 51(2):302-6. [Medline].

  38. Vehreschild JJ, Birtel A, Vehreschild MJ, Liss B, Farowski F, Kochanek M. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol. 2012 Aug 24. [Medline].

  39. 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].

  40. Ashkenazi-Hoffnung L, Bilavsky E, Avitzur Y, Amir J. Successful treatment of cutaneous zygomycosis with intravenous amphotericin B followed by oral posaconazole in a multivisceral transplant recipient. Transplantation. 2010 Nov 27. 90(10):1133-5. [Medline].

  41. Yoon YK, Kim MJ, Chung YG, Shin IY. Successful treatment of a case with rhino-orbital-cerebral mucormycosis by the combination of neurosurgical intervention and the sequential use of amphotericin B and posaconazole. J Korean Neurosurg Soc. 2010 Jan. 47(1):74-7. [Medline]. [Full Text].

  42. National Institutes of Health. Isavuconazole in the treatment of renally impaired aspergillosis and rare fungi. NLM identifier: NCT00634049. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00634049. Accessed: April 2, 2015.

  43. van Well GT, van Groeningen I, Debets-Ossenkopp YJ, van Furth AM, Zwaan CM. Zygomycete infection following voriconazole prophylaxis. Lancet Infect Dis. 2005 Sep. 5(9):594. [Medline].

  44. 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. 2007 Apr. 39(7):425-9. [Medline].

  45. Alastruey-Izquierdo A, Castelli MV, Cuesta I, et al. In vitro activity of antifungals against Zygomycetes. Clin Microbiol Infect. 2009 Oct. 15 Suppl 5:71-6. [Medline].

  46. Spellberg B, Ibrahim AS. Recent advances in the treatment of mucormycosis. Curr Infect Dis Rep. 2010 Nov. 12(6):423-9. [Medline]. [Full Text].

  47. Ogawa T, Takezawa K, Tojima I, et al. Successful treatment of rhino-orbital mucormycosis by a new combination therapy with liposomal amphotericin B and micafungin. Auris Nasus Larynx. 2012 Apr. 39(2):224-8. [Medline].

  48. Reed C, Bryant R, Ibrahim AS, Edwards J Jr, Filler SG, Goldberg R. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. 2008 Aug 1. 47(3):364-71. [Medline].

  49. Ribeiro EF, Dos Santos VM, Paixao GT, Cruz LR, Danilow MZ, Campos VF. Mucormycosis in a Patient with Acute Myeloid Leukemia Successfully Treated with Liposomal Amphotericin B Associated with Deferasirox and Hyperbaric Oxygen. Mycopathologia. 2013 Feb 27. [Medline].

  50. Ibrahim AS, Spellberg B, Edwards J Jr. Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis. 2008 Dec. 21(6):620-5. [Medline].

  51. Donnelly JP, Lahav M. Deferasirox as adjunctive therapy for mucormycosis. J Antimicrob Chemother. 2012 Mar. 67(3):519-20. [Medline].

  52. Spellberg B, Ibrahim AS, Chin-Hong PV, Kontoyiannis DP, Morris MI, Perfect JR. The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) study: a randomized, double-blinded, placebo-controlled trial. J Antimicrob Chemother. 2012 Mar. 67(3):715-22. [Medline].

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

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

 
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Postmortem photograph of a woman with diabetes and left rhinocerebral mucormycosis complicating ketoacidosis. Rhizopus oryzae was the causative organism. Note the orbital and facial cellulitis and the black nasal discharge. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
The right eye of an immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Note the proptosis. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
The right eye of an immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Chemosis is shown in this photograph. Internal and external ophthalmoplegia, no light perception, and afferent pupil defect were present, which is consistent with orbital apex syndrome. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
An immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. A surgical field of this patient is shown. Excision of the right orbit, maxillary antrum, nasal cavity, sphenoid sinus, and infratemporal fossa has taken place. The tissue was infarcted. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
An immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Picture of the patient after successful treatment with repeated surgical debridement and high-dose liposomal amphotericin B. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
Histologic findings from an immunocompetent man who sustained a high-pressure water jet injury, resulting in rhinocerebral mucormycosis. Traumatic inoculation of Apophysomyces elegans was the pathogenetic mechanism. Findings show the typical Mucorales hyphae on Grocott methenamine-silver staining. The hyphae are the dark structures with budlike, right-angle hyphae. (Courtesy of A. Allworth, MD, Brisbane, Australia.)
Chest computed tomography (CT) scan showing pulmonary mucormycosis with left basal consolidation and widespread nodules due to Rhizopus oryzae infection. The patient was receiving cytotoxic chemotherapy for myelodysplastic syndrome and had iron overload from numerous blood transfusions.
Chest computed tomography (CT) scan showing pulmonary mucormycosis with left basal consolidation and widespread nodules due to Rhizopus oryzae infection. The patient was receiving cytotoxic chemotherapy for myelodysplastic syndrome and had iron overload from numerous blood transfusions. This CT scan of the patient shows resolution of pulmonary mucormycosis after 5 months of antifungal treatment.
 
 
 
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