Zygomycosis Treatment & Management

  • Author: Jose A Vazquez, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 17, 2011
 

Medical Care

  • Take aggressive surgical measures to débride affected tissue. Without early and aggressive therapy, zygomycosis is almost always fatal.
  • Take aggressive measures to control the underlying condition.
    • Correct hyperglycemia and ketoacidosis to improve outcome.
    • Correct neutropenia with granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) to improve outcome.
  • Institute early and appropriate antifungal administration.
  • If possible, discontinue steroids or deferoxamine.
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Surgical Care

  • The mainstay of treatment for any form of zygomycosis is early and aggressive surgical removal of all infected tissue.
  • Remove as much devitalized tissue as possible and consider wide surgical debridement, if feasible.
  • Patients with zygomycosis frequently require numerous surgical procedures to eradicate all infected and necrotic material.
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Consultations

  • Infectious disease specialist
  • Surgeon
  • Otorhinolaryngologist
  • Gastroenterologist
  • Pulmonologist
  • Ophthalmologist
  • Neurosurgeon
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Contributor Information and Disclosures
Author

Jose A Vazquez, MD, FACP, FIDSA  Consulting Staff, Division of Infectious Diseases, Henry Ford Hospital; Professor, Department of Internal Medicine, Wayne State University School of Medicine

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 Immunocompromised Host Society, and Medical Mycology Society of the Americas

Disclosure: pfizer Grant/research funds Independent contractor; Merck Grant/research funds Independent contractor; Pfizer Honoraria Speaking and teaching; Astellas Grant/research funds Independent contractor; Strativa Honoraria Speaking and teaching

Specialty Editor Board

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, and New York Academy of Sciences

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

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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.

References

  1. Kwon-Chung KJ, Bennett JE. Mucormycosis. In: Cann C, ed. Medical Mycology. Lea & Febiger; 1992:524-59.

  2. Rippon JW. Zygomycosis. In: Wonsiewicz M, ed. Medical Mycology. The Pathogenic Fungi and the Pathogenic Actinomycetes. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998:681-713.

  3. 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].

  4. 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].

  5. Kauffman CA. Zygomycosis: reemergence of an old pathogen. Clin Infect Dis. Aug 15 2004;39(4):588-90. [Medline].

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

  7. Gonzalez CE, Rinaldi MG, Sugar AM. Zygomycosis. Infect Dis Clin North Am. Dec 2002;16(4):895-914, vi. [Medline].

  8. Petrikkos G, Skiada A, Sambatakou H, et al. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis. Dec 2003;22(12):753-6. [Medline].

  9. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. Sep 1 2005;41(5):634-53. [Medline].

  10. Ibrahim AS, Edwards JE, Filler SG. Zygomycosis. In: Dismukes WE, Pappas PG, Sobel JD, eds. Clinical Mycology. First ed. New York: Oxford University Press; 2003:241-251.

  11. Thomson SR, Bade PG, Taams M, et al. Gastrointestinal mucormycosis. Br J Surg. Aug 1991;78(8):952-4. [Medline].

  12. Lass-Flörl C, Resch G, Nachbaur D, Mayr A, Gastl G, Auberger J, et al. The value of computed tomography-guided percutaneous lung biopsy for diagnosis of invasive fungal infection in immunocompromised patients. Clin Infect Dis. Oct 1 2007;45(7):e101-4. [Medline].

  13. Sun QN, Fothergill AW, McCarthy DI, et al. In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother. May 2002;46(5):1581-2. [Medline].

  14. Dannaoui E, Meletiadis J, Mouton JW, et al. In vitro susceptibilities of zygomycetes to conventional and new antifungals. J Antimicrob Chemother. Jan 2003;51(1):45-52. [Medline].

  15. Herbrecht R. Posaconazole: a potent, extended-spectrum triazole anti-fungal for the treatment of serious fungal infections. Int J Clin Pract. Jun 2004;58(6):612-24. [Medline].

  16. 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. Apr 1 2006;42(7):e61-5. [Medline].

 
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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.
 
 
 
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