ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis 2013

Cornely, Oliver A.; Arıkan-Akdağlı, Sevtap; Dannaoui, Éric; Groll, Andreas H.; Lagrou, Katrien; Chakrabarti, Arunaloke; Lanternier, Fanny; Pagano, Livio; Skiada, Anna; Akova, Murat; Arendrup, Maiken Cavling; Boekhout, Teun; Chowdhary, Anuradha; Cuenca‐Estrella, Manuel; Freiberger, Tomáš; Guinea, Jesús; Guarro, Josep; Hoog, Sybren de; Hope, William; Johnson, Elizabeth; Kathuria, Shallu; Lackner, Michaela; Lass‐Flörl, Cornelia; Lortholary, Olivier; Meis, Jacques F.; Meletiadis, Joseph; Muñóz, Patricia; Richardson, Malcolm; Roilides, Emmanuel; Tortorano, Anna Maria; Ullmann, Andrew J.; Diepeningen, Anne van; Verweij, Paul E.; Petrikkos, George

doi:10.1111/1469-0691.12371

Cited by 610 publications

(632 citation statements)

References 202 publications

(310 reference statements)

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“…This research agenda on IFI focuses on the more frequent diseases, namely invasive candidiasis and invasive aspergillosis in non-neutropenic patients, but not on the so-called ultra-orphan fungal infections that may be as rare as less than 1 in 1 million population, e.g., mucormycosis or trichosporonosis [1]. This article aims to highlight open questions and gaps in our knowledge and understanding of epidemiology, risk factors, use of diagnostic tools, and antifungal compounds.…”

Section: Introductionmentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: Introductionmentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…Due to nonspecific clinical presentation, a high index of suspicious is always required, a clinician must keep this entity in mind especially in diabetic patients and pursue invasive testing early to establish a prompt diagnosis. The European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology ESCMID and ECMM Joint, clinical guidelines strongly recommend direct microscopy, histopathology and culture for the diagnosis (11). The diagnosis of PM is more difficult than other fungal infections and histopathology is more sensitive than cultures (1).…”

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confidence: 99%

“…Medical therapy includes lipid formulation of amphotericin B and posaconazole as step-down or as salvage therapy (11,15). Surgical intervention improves the overall prognosis (16), even in hematopoietic disorder patients (17).…”

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confidence: 99%

Chronic pulmonary mucormycosis: an emerging fungal infection in diabetes mellitus

et al. 2017

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A 60-year-old diabetic female presented with fever and productive cough with hemoptysis for two months. There was no significant past medical or surgical history. Crackles were audible at right middle and lower part of chest. Rest of the physical examination was unremarkable.On laboratory investigations, total leucocyte count (TLC) was 13.1×10 9 /L with 73.6% neutrophil, potassium (K) was 5.5 mg/dL, creatinine was 1.1 mg/dL. Glycated hemoglobin (HbA1c) was 13.1%. Serial chest X-rays showed persistent homogenous consolidation in right lower lung ( Figure 1A). So computed tomographic (CT) scan chest was done which showed a consolidation with cavitary lesion in right middle lobe ( Figure 1B). Fibreoptic bronchoscopy revealed anthracosis of right middle lobe, biopsy and bronchoalveolar lavage (BAL) was taken. BAL was negative for acid fast bacilli (AFB), fungal smear showed numerous aseptate hyphae which later failed to grow. Histopathology revealed large collections of aseptate hyphae infiltrating the lung parenchyma, periodic acidSchiff and Gomori methenamine silver stains were positive suggestive of pulmonary Mucor (Figure 2A,B). She was started on amphotericin B deoxycholate 1.5 mg/kg/dose and underwent right middle lobectomy. Patient remained well and discharged home on amphotericin. She received a total cumulative dose of 3 grams of amphotericin B deoxycholate. Her medications were adjusted to achieve good glycaemic control and showed significant improvement on clinic follow ups. Case 2A 60-year-old diabetic female presented with history of cough and fever for one month. She had taken multiple antibiotics without any improvement. Crackles were audible in left middle to lower part of chest. Complete blood count (CBC) showed TLC of 11.8×10 9 /L with 68.8% neutrophils.Random blood sugar was 284 mg/dL and HbA1c was 11.4%. Chest X-ray showed left hilar soft tissue mass with perihilar infiltrates (Figure 3A). High-resolution CT chest for mucormycosis, with rhino-orbital-cerebral involvement as a common presentation. Pulmonary mucormycosis (PM) although a rare presentation in diabetic patients but is associated with high mortality and morbidity. An early diagnosis of PM is difficult, due to rarity of the disease and clinical and radiological features resembling tuberculosis (TB) which is common in Pakistan. Here we present three cases of chronic PM in patients with diabetes and with no other apparent risk factors.

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“…Among 18 out of 22 patients who received antifungal treatment, 11 survived (Gomes et al, 2011). Surgical debridement in addition to liposomal amphotericin B at a minimum dose of 5 mg kg 21 day 21 remains the treatment of choice for mucormycosis (Cornely et al, 2014). Our patient was managed by surgical treatment and liposomal amphotericin B treatment.…”

Section: Discussionmentioning

confidence: 82%

Isolation and identification of Rhizomucor pusillus from rhinofacial mucormycosis in a diabetic patient

et al. 2014

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ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis 2013

Cited by 610 publications

References 202 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Chronic pulmonary mucormycosis: an emerging fungal infection in diabetes mellitus

Isolation and identification of Rhizomucor pusillus from rhinofacial mucormycosis in a diabetic patient

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