Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Abstract

Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement

Posaconazole Prophylaxis in Experimental Systemic Zygomycosis

“…Nevertheless, even with aggressive therapy, the rate of mortality is often above 50% (4, 6). It is clear that new strategies for the treatment of zygomycosis are urgently needed.Posaconazole (POS) is a new broad-spectrum triazole with activity against many filamentous fungal pathogens, including zygomycetes (3,8,11,13,14). Experimental infection models and clinical data showed that POS might be useful for the treatment of zygomycosis (3,11,14).…”

“…The zygomycetes most commonly identified as etiologic agents of human diseases are Rhizopus species, Rhizomucor species, Mucor species, and Absidia species (13). The invasive forms of zygomycosis cause angioinvasion, followed by progressive, necrotic, and generally fatal infections in immunocompromised hosts, such as diabetic patients with ketoacidosis, neutropenic patients, patients taking corticosteroids, and subjects with burns or iron overload (4,6,7,12,13). The standard therapy for these life-threatening infections consists of removal of the predisposing factors, widespread surgical debridement, and high doses of intravenous amphotericin B (AMB) (13).…”

Primary mucormycosis of abdominal wall: A rare fungal infection in a immunocompetent patient

“…It is Fig. 4 After the infection was controlled with systemic antifungal therapy, she underwent final debridement and split skin graft on the wound as shown also now established that iron metabolism plays a central role and iron chelation using deferiprone is a promising novel therapeutic strategy for refractory mucormycosis [14].…”

Fatal massive hemoptysis: An autopsy study

“…1 With fall in blood pH, there is an increased release of iron from transferrin that enhances hyphal growth. 2 Chakrabarti et al, 2006 in their retrospective study of 178 cases of invasive mucormycosis (54.5% rhino-orbito-cerebral, 14.6% cutaneous, 9.0% disseminated, 8.4% gastrointestinal, 6.7% each of renal and pulmonary mucormycosis) showed that 73.6% of cases had uncontrolled diabetes mellitus. 3 Our patient was also a case of diabetes with poor compliance that lead to uncontrolled hyperglycemia and ketoacidosis.…”