Approach Considerations
Mucormycosis is often life threatening. A combination of a high index of suspicion with prompt diagnosis and medical and surgical care are vital in the management of mucormycosis. [11] Patients' survival rates also depend on resolution of their underlying condition. If mucormycosis progresses and if the underlying condition remains uncontrolled, death usually ensues.
Care of a pediatric patient with mucormycosis should involve several pediatric subspecialists, depending on the patient's underlying risk factors and the extent of disease. Therefore, if the child has an underlying malignancy, the following physicians should be involved in the child's care: oncologist, infectious disease specialist, surgeon (ear, nose, and throat [ENT] specialist and neurosurgeon, if the patient has rhinocerebral disease), and critical care specialists.
Clinical Management
Underlying comorbidities such as hyperglycemia, acidosis in diabetic patients, nutritional problems, neutropenia, lymphopenia, and immunosuppression must be addressed.
The drug of choice for treating mucormycosis is amphotericin B, with a dosage of 1-1.5 mg/kg/d. Liposomal amphotericin B at dosages higher than these have also been used to treat disseminated disease. [12, 13] Some authors have suggested doses as high as 10-15 mg/kg. A term neonate who was diagnosed with facial mucormycosis after liver and small bowel transplantation survived after wide excision and 26 weeks of treatment with liposomal amphotericin B. [14]
Azoles (eg, fluconazole, itraconazole) are not helpful in the treatment of mucormycosis. Among relatively new triazoles, posaconazole is effective against mucormycosis. This agent has an oral formulation and undergoes liver metabolism. Posaconazole may be effective compared with other azoles against molds, including mucormycosis. [15, 16] Studies are being conducted to evaluate combination antifungal therapies.
Hyperbaric oxygen has been noted to reduce the morbidity and mortality when given in combination with medical and surgical therapy, with a 50% survival rate. [17]
Surgical Intervention
Surgical debridement should be undertaken early in the course of the illness, especially in cases of rhinocerebral mucormycosis. Instilling amphotericin B into abscess cavities after debridement has been suggested. Repeat surgery may be necessary to effectively eliminate all necrotic tissue in patients who survive. Reconstructive surgery is inevitable for those who have disfigurement due to severe rhinocerebral mucormycosis.
Long-Term Monitoring
Close observation of patients who were treated and who survived the acute mucormycosis infection is important, because chronic manifestation of mucormycosis or late sequelae is possible.
In patients with rhinocerebral mucormycosis, cerebral abscess formation, cavernous sinus thrombosis, and thromboembolism of the internal carotid artery should be suspected as complications.
Studies in adults have demonstrated some benefit with the use of high-efficiency particulate air (HEPA) filters and different chelating agents instead of deferoxamine to decrease the risk of mucormycosis.
No method to prevent mucormycosis is recognized.
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Black eschar on the skin of an immunocompromised patient.
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Mucormycosis with broad, aseptate hyphae (hematoxylin and eosin, original magnification ×40).
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Angioinvasion (hematoxylin and eosin, original magnification ×10).
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Perineural invasion (hematoxylin and eosin, original magnification ×20).
