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Zygomycosis Follow-up

  • Author: Jose A Vazquez, MD, FACP, FIDSA; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Aug 12, 2015

Further Outpatient Care

Once the patient is stabilized and no further surgical procedures are planned, discharge the patient home on antifungal therapy with follow-up visits every 2-4 weeks.

Monitor patients on amphotericin B products at least biweekly for adverse effects and toxicity (eg, CBC counts, electrolytes, BUN, serum creatinine).


Further Inpatient Care

Inpatient care of mucormycosis is frequently prolonged because of the severe nature of the illness.

Patients with mucormycosis frequently undergo multiple surgical procedures in an attempt to eradicate devitalized tissue.

Antifungals are generally provided parenterally for a period of several months to achieve cure.


Inpatient & Outpatient Medications

Because of the severity of the infection, most patients with mucormycosis undergo inpatient care for most of their treatment. If patient is clinically stable, the infection appears controlled, and the gastrointestinal tract is functional, he or she may be switched to oral posaconazole and discharged home with close monitoring for efficacy and toxicity.



Transfer patients to the service that can care for serious infections (eg, neurosurgery, otorhinolaryngology, infectious diseases, ophthalmology).

Transfer patients with altered mental status to an appropriate critical care unit.



Control blood sugar in patients with diabetes mellitus.

Control metabolic acidosis.

Eliminate risk factors such as neutropenia and immune modulators.

Closely monitor patients on deferoxamine therapy.



Invasive mucormycosis frequently spreads to adjacent organ systems (ie, osteomyelitis), including sinuses and adjacent bones.

The ocular globe is frequently affected, which may cause blindness.

Cavernous sinus thrombosis with cranial nerve palsies and extension of infection into the brain and meningitis is a possibility.

Brain abscess and CNS infarction with ischemia and necrosis may occur.

Pulmonary infiltrates, cavitary lesions, and life-threatening pulmonary hemorrhages are possible.

Gastrointestinal hemorrhages may result from gastrointestinal perforation and may lead to peritonitis and sepsis.



The prognosis of mucormycosis depends on several factors, including the infection site, rapidity of diagnosis, and type and severity of immunosuppression.

The overall mortality rate among patients with mucormycosis is approximately 50%, although rhinocerebral and gastrointestinal forms of the infection carry a mortality rate of approximately 85%. Mortality rates are high because of the difficulty in establishing the diagnosis and the lack of adequate antifungal therapy. By the time a diagnosis of mucormycosis is confirmed, it has frequently spread via either local invasion with extensive tissue destruction or widely disseminated infection.


Patient Education

Inform patients and family members that this is an extremely serious condition with a poor prognosis (high morbidity and mortality rate) unless aggressive action is taken early.

Contributor Information and Disclosures

Jose A Vazquez, MD, FACP, FIDSA Professor of Medicine, Section Chief, Division of Infectious Diseases, Department of Medicine, Georgia Regents University

Jose A Vazquez, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Mycological Society of the Americas, International Society for Human and Animal Mycology, HIV Medicine Association, Michigan Infectious Disease Society, National Foundation for Infectious Diseases, Mycological Society of America, Immunocompromised Host Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Allergan; Astellas; Pfizer<br/>Received research grant from: Merck; Astellas<br/>Received grant/research funds from Merck for independent contractor; Received honoraria from Forest for speaking and teaching; Received honoraria from Astellas for speaking and teaching; Received consulting fee from Cidara for consulting.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Gary L Gorby, MD Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences

Disclosure: Nothing to disclose.

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A 45-year-old woman with poorly controlled diabetes mellitus with facial and periorbital swelling due to zygomycosis. She was unable to open her right eye upon admission.
Material from the periorbital tissue of a woman with poorly controlled diabetes mellitus with facial and periorbital swelling due to zygomycosis is stained with periodic acid-Schiff stain (X 560). The material demonstrates the classic appearance of irregularly shaped broad hyphae with right-angle branching (arrow).
A CT scan of the head of a patient with zygomycosis shows involvement of the paranasal sinuses and periorbital soft tissues.
A 60-year-old woman with diabetes mellitus and 5 days post operative from resection of a benign pituitary tumor. The lesion developed over the surgical scar. Biopsy of lesion demonstrated invasive cutaneous mucormycosis.
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