Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections

Pham, David; Howard‐Jones, Annaleise R.; Sparks, Rebecca; Stefani, Maurizio; Sivalingam, Varsha; Halliday, Catriona; Beardsley, Justin; Chen, Sharon C.‐A.

doi:10.3390/jof9060659

Cited by 12 publications

(5 citation statements)

References 248 publications

(340 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Imaging examinations should be appropriate to the site of concern and include brain CT scan or magnetic resonance imaging (MRI), chest/abdomen CT scan, and endoscopic procedures. Definitive diagnosis is confirmed when there is a culture isolation of the Rhizopus microsporus complex, positive polymerase chain reaction (PCR) in tissues or BAL, or presence of Mucorales hyphae in biopsy [7,9,10].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

Pereira,

Neves,

Ruão

et al. 2024

Cureus

View full text Add to dashboard Cite

Coronavirus disease 2019 is often linked to a broad range of opportunistic bacterial and fungal infections. The second wave of the COVID-19 pandemic has witnessed an unprecedented surge in mucormycosis cases, predominantly in India, while the disease remained relatively rare in Europe. The authors describe the case of a 62-year-old female patient admitted to the hospital for consolidation therapy with chemotherapy as a part of the treatment protocol for acute myeloid leukemia. During hospitalization, she was diagnosed with nosocomial COVID-19, which later progressed to respiratory deterioration. COVID-19 with bacterial superinfection was presumed, leading to the initiation of empirical antibiotic therapy. A bronchoscopy was performed several days later due to a lack of improvement, revealing an infection by the Rhizopus microsporus complex. Despite antifungal treatment, the patient experienced an unfavorable clinical course and ultimately died. Given the high index of suspicion required to diagnose pulmonary mucormycosis, which can lead to delays in appropriate treatment and increase the burden of disease, the authors are aiming to enhance its awareness.

show abstract

Section: Discussionmentioning

confidence: 99%

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

Pereira,

Neves,

Ruão

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…The specificity of both assays was excellent (100% for panfungal and 96.6% for seminested). Both assays demonstrated greater sensitivity in FFPE tissue samples exhibiting angioinvasion, perhaps reflective of the higher fungal burden in specimens with documented angioinvasion [ 32 ]. Even among sites with angioinvasion, seminested assays had a higher sensitivity than the panfungal approach (91.7% vs 81.3%), which is not surprising because the panfungal target (internal transcribed spacer 2 region) is roughly twice the length of nested PCR targets.…”

Section: Discussionmentioning

confidence: 99%

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

Ellis,

Shaikh,

Carson

et al. 2024

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but they have limitations. We previously evaluated a panfungal polymerase chain reaction assay, which was 83% sensitive and 99% specific for angioinvasive IFIs. Herein, we evaluated three less resource-intensive semi-nested assays targeting clinically-relevant fungi in the order Mucorales and genera Aspergillus and Fusarium. Methods Formalin-fixed paraffin-embedded tissue (FFPE) specimens from a multicenter trauma IFI cohort (2009-2014) were used. Cases were U.S. military personnel injured in Afghanistan with histopathologic IFI evidence. Controls were patients with similar injury patterns and no laboratory IFI evidence (negative culture and histopathology). Semi-nested assays specific to Mucorales (V4/V5 regions of 18S rDNA), Aspergillus (mitochondrial tRNA), and Fusarium (internal transcribed spacer [ITS]/28A regions of DNA) were compared to a panfungal assay amplifying the ITS2 region of rDNA and to histopathology. Results Specimens from 92 injury sites (62 subjects) were compared to control specimens from 117 injuries (101 subjects). We observed substantial agreement between the semi-nested and panfungal assays overall, especially for the order Mucorales. Moderate agreement was observed at the genus-level for Aspergillus and Fusarium. When compared with histopathology, sensitivity and specificity of semi-nested assays were 67.4% and 96.6% respectively (sensitivity increased to 91.7% when restricted to sites with angioinvasion). Conclusion Prior studies of semi-nested molecular diagnostics have focused on culture-negative samples from immunocompromised patients. Our findings underscore the utility of the semi-nested approach in diagnosing soft-tissue IFIs using FFPE samples, especially with angioinvasion.

show abstract

“…However, its time-consuming nature and high false-negative rate limit its utility, with a sensitivity of only 25% (14). This can be attributed to several reasons, such as the grinding or homogenization of tissue specimens, which can destroy the delicate hyphae of mucor; the presence of genera that require special culture conditions; recent or ongoing therapy with an anti-fungal effective against Mucorales; or even a lack of expertise (6). Pathologic evaluation of biopsy specimens can provide a more definitive diagnosis, but obtaining tissue biopsies is not feasible for vulnerable AML patients (15).…”

Section: Discussionmentioning

confidence: 99%

Invasive splenic mucormycosis due to Rhizopus microsporus during chemotherapy for acute monocytic leukemia: a case report and literature review

Peng,

Wei,

Wang

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

Mucormycosis is a rare opportunistic fungal infection associated with high mortality that typically occurs in immunocompromised patients. It is difficult to diagnose owing to non-specific clinical manifestations, the serologic index, imaging features, and the limitations of diagnostic methods. The incidence of invasive splenic mucormycosis is extremely rare, with only a few cases documented in the literature. We report a survival case of invasive splenic mucormycosis involving the liver caused by Rhizopus microsporus in a patient during consolidation therapy for acute monocytic leukemia (AML-M5). The patient initially presented with recurrent fever and splenomegaly accompanied by multiple focal hypodensities unresponsive to empiric anti-infective treatment. Splenic mucormycosis was diagnosed by Contrast-Enhanced Ultrasonography (CEUS) and metagenomic next-generation sequencing (mNGS). However, surgical intervention carries a high risk due to the progressive involvement of the liver in invasive splenic mucormycosis. Fortunately, monotherapy with amphotericin B was effective, and the patient underwent allo-HSCT. This case aims to emphasize the importance of utilizing mNGS and CEUS for the timely diagnosis of mucormycosis to help clinicians identify splenic mucormycosis and initiate appropriate therapy as soon as possible to improve therapeutic efficacy and prognosis.

show abstract

Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections

Cited by 12 publications

References 248 publications

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

Invasive splenic mucormycosis due to Rhizopus microsporus during chemotherapy for acute monocytic leukemia: a case report and literature review

Contact Info

Product

Resources

About