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Drogari-Apiranthitou M, Skiada A, Panayiotides I, Vyzantiadis TA, Poulopoulou A, Christofidou M, Antoniadou A, Roilides E, Iosifidis E, Mamali V, Argyropoulou A, Sympardi S, Charalampaki N, Antonakos N, Mantzana P, Mastora Z, Nicolatou-Galitis O, Orfanidou M, Pana ZD, Pavleas I, Pefanis A, Sakka V, Spiliopoulou A, Stamouli M, Tofas P, Vagiakou E, Petrikkos G. Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports. J Fungi (Basel) 2023; 9:jof9040425. [PMID: 37108880 PMCID: PMC10142618 DOI: 10.3390/jof9040425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. Rhizopus (mostly R. arrhizus) predominated (67.1%), followed by Lichtheimia (8.5%) and Mucor (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (p = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population.
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Risks of mucormycosis in the current Covid-19 pandemic: a clinical challenge in both immunocompromised and immunocompetent patients. Mol Biol Rep 2022; 49:4977-4988. [PMID: 35107737 PMCID: PMC8808276 DOI: 10.1007/s11033-022-07160-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
Mucormycosis, also called "Black Fungus", is a new cause for worry in the current Coronavirus disease 2019 (covid-19) pandemic. Mucormycosis is devasting due to its high rate of morbidity and mortality which is a great cause of concern. Mucormycosis, in general, affects immunocompromised patients including diabetic, people with malignancies, organ and stem cell transplants and people affected with pandemic diseases like covid-19. Diagnosis of Mucormycosis is often delayed either due to clinical complications or misdiagnosed as symptoms of other diseases, especially covid-19. This could delay the treatment protocol which results in the failure of treatment. Mortality rate due to secondary infections in covid-19 patients with uncontrolled diabetics and who are on steroid therapy can soon reach 100% if diagnosis and treatment doesn't happen on timely basis. Risk of Mucormycosis is not just in immunosuppressed patients, but immunocompetent people with late diagnosis are also prone to infection. In view of this, we present a comprehensive review on risks of Mucormycosis in immunocompromised and immunocompetent patients highlighting the epidemiology, forms of Mucormycosis, immune response against Mucorales, difficulties in diagnosis and challenges in treatment of Mucormycosis, with emphasis on covid-19 associated Mucormycosis. Importantly, we have discussed the precautions and care to effectively manage Mucormycosis in immunocompromised and immunocompetent patients. Thus, current review helps clinicians in understanding various risk factors in both immunocompromised (especially covid-19 patients) and immunocompetent patients which is critical in managing Mucormycosis in current covid-19 pandemic.
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Kumar Debata P, Keshari Panda S, Dash A, Mohanty R, Narayan Mallick B, Tadu D, G Nath V, Sahoo A. "An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon's perspective". Int J Surg Case Rep 2015; 10:248-51. [PMID: 25732524 PMCID: PMC4429949 DOI: 10.1016/j.ijscr.2015.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Mucormycosis caused by order mucorales, an ubiquitous saprophytic mold found in soil and organic matter worldwide, is a rare but invasive opportunistic fungal infection. Gastrointestinal mucormycosis is the most uncommon clinical presentation being particularly rare, accounted for 4-7% of all cases. PRESENTATION OF CASE We report an unusual presentation of mucormycosis of ascending colon that was simulating carcinoma colon. DISCUSSION GI mucormycosis most commonly involves the stomach (57.5%), followed by the colon (32.3%) and the ileum (6.9%). Initial presentations may be abdominal pain and distension, fever, and diarrhoea. Colonic mucormycosis presenting as a mass with altered bowel habit, melena and abdominal pain in our case is extremely difficult to differentiate it from carcinoma colon. A definitive diagnosis of mucormycosis is almost always ascertained by histopathological evidence of fungal invasion of tissue. CONCLUSION Knowing these unusual presentations of this disease, surgeon need to maintain a high index of suspicion and perform timely and appropriate diagnostic evaluation to improve patient outcome. Prompt diagnosis, reversal of predisposing conditions, and aggressive surgical debridement remain cornerstones of therapy for this deadly disease.
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Affiliation(s)
| | | | - Atmaranjan Dash
- Department of General Surgery, SCB Medical College, Cuttack, Odisha 753003, India.
| | - Ramakant Mohanty
- Department of General Surgery, SCB Medical College, Cuttack, Odisha 753003, India
| | | | - Debabrata Tadu
- Department of General Surgery, SCB Medical College, Cuttack, Odisha 753003, India.
| | - Vivek G Nath
- Department of General Surgery, SCB Medical College, Cuttack, Odisha 753003, India.
| | - Abhinash Sahoo
- Department of General Surgery, SCB Medical College, Cuttack, Odisha 753003, India.
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Su H, Thompson GR, Cohen SH. Hepatic mucormycosis with abscess formation. Diagn Microbiol Infect Dis 2012; 73:192-4. [DOI: 10.1016/j.diagmicrobio.2012.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/25/2012] [Accepted: 02/27/2012] [Indexed: 11/29/2022]
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Yang TU, Kim SH, Choi BK, Lee SW, Park JH, Hong KW, Kim IS, Seo YB, Choi CW, Kim WJ. Hepatic and Small Bowel Mucormycosis after Chemotherapy in a Patient with Acute Myeloid Leukemia: A Case Report and Literature Review. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tae Un Yang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sun Hwa Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byeong Kwang Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Wook Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joo Hee Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Wook Hong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - In Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yu Bin Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Li KW, Wen TF, Li GD. Hepatic mucormycosis mimicking hilar cholangiocarcinoma: A case report and literature review. World J Gastroenterol 2010; 16:1039-42. [PMID: 20180248 PMCID: PMC2828593 DOI: 10.3748/wjg.v16.i8.1039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mucormycosis is a rare but invasive opportunistic fungal infection associated with a high mortality rate, and normally occurs in immunocompromised patients. In this report, we describe an immunocompetent patient suffering from hepatic mucormycosis secondary to adrenal mucormycosis, which masquerades as hilar cholangiocarcinoma. After surgical procedure and treatment with amphotericin B and itraconazole, the patient recovered well and had a 2-year infection-free survival. To our knowledge, this special clinical manifestation of hepatic infection as well as adrenal mucormycosis has not been reported to date. Meanwhile, this is the first case of an immunocompetent patient with both adrenal and hepatic mucormycosis who has been treated successfully.
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Chacko B, David VG, Tamilarasi V, Deepti AN, John GT. Pulmonary Mucormycosis in a Nondiabetic Renal Allograft Recipient Successfully Managed by Medical Therapy Alone. Transplantation 2007; 83:1656-7. [PMID: 17589353 DOI: 10.1097/01.tp.0000266581.35950.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grandin W, Dessieux T, Hounfodji P, Viquesnel G, Ouchikhe A, Gérard JL. Mucormycose pulmonaire chez un patient polytraumatisé. ACTA ACUST UNITED AC 2006; 25:521-4. [PMID: 16531002 DOI: 10.1016/j.annfar.2005.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 12/20/2005] [Indexed: 11/25/2022]
Abstract
Mucormycosis are opportunist infections occurring usually among predisposed patients. We report a case of an 18-year-old male with a severe thoracic trauma who developed an Absidia infection on his contused pulmonary parenchyma, without presenting the usual risk factors (diabetes mellitus, immunodeficiency). The early diagnosis using bronchoscopy has probably improved the outcome by allowing a faster treatment. After 18-months, the infectious process resolved thanks to a combination of a medical treatment composed of high-dose amphotericin B lipid formulation, itraconazole and a complementary surgical treatment.
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Affiliation(s)
- W Grandin
- Département d'Anesthésie-Réanimation Chirurgicale-Samu, Centre Hospitalier Régional et Universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41:634-53. [PMID: 16080086 DOI: 10.1086/432579] [Citation(s) in RCA: 1834] [Impact Index Per Article: 96.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 04/18/2005] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. METHODS We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. RESULTS The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). CONCLUSIONS Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
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Affiliation(s)
- Maureen M Roden
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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A Patient With Cerebral Zygomycosis Cured With Liposomal Amphotericin B, Caspofungin and Ciprofloxacin Without Intracranial Surgery. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2004. [DOI: 10.1097/01.idc.0000104899.16995.b2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petrikkos G, Skiada A, Sambatakou H, Toskas A, Vaiopoulos G, Giannopoulou M, Katsilambros N. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis 2003; 22:753-6. [PMID: 14605941 DOI: 10.1007/s10096-003-1035-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Presented here are the results of a retrospective analysis of all mucormycoses infections recorded at a tertiary hospital in Greece during the last 10 years. A total of 24 patients were identified, 15 male and 9 female, with ages ranging from 37 to 80 years. Twelve of the patients had soft tissue infections (2 with concomitant pulmonary infections), and 12 had rhinocerebral infections. Transmission could be traced in two cases; to nitroglycerin patches in one patient and to a lemon-tree-thorn scratch in the other. Among the 17 patients who underwent surgery, 11 survived. All seven patients on whom surgery was not performed died. Rapid diagnosis and treatment of mucormycosis are essential for patient survival. The severity of the patient's underlying condition, the degree of immunosuppression, and prompt surgical treatment are the most important factors contributing to the outcome.
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Affiliation(s)
- G Petrikkos
- Laiko General Hospital, First Department of Propaedeutic Medicine, Infectious Diseases Laboratory G.K. Daikos, Athens University, 17 Agiou Thoma Street, 115 27 Athens, Greece.
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Serna JH, Wanger A, Dosekun AK. Successful treatment of mucormycosis peritonitis with liposomal amphotericin B in a patient on long-term peritoneal dialysis. Am J Kidney Dis 2003; 42:E14-7. [PMID: 12955706 DOI: 10.1016/s0272-6386(03)00797-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 42-year-old man, with a history of immunoglobulin A nephropathy, underwent a living-related kidney transplant. Allograft function progressively deteriorated secondary to chronic rejection and recurrence of IgA nephropathy, and he returned to peritoneal dialysis after 5 years of the transplant. Fifteen months after the discontinuation of immunosuppressive therapy, Eschericia coli peritonitis developed, which was treated with ceftazidime intraperitoneally; he received fluconazole as prophylactic antifungal therapy during this period. After completing his course of treatment, abdominal pain occurred with an increased peritoneal fluid white blood cell count. Peritoneal fluid cultures were negative. He received broad-spectrum antibiotics and fluconazole with no appreciable response. After removal of the Tenckoff catheter, peritoneal fluid cultures grew a zygomycete. The patient was treated with liposomal amphotericin B (AmBisome) intravenously for 6 weeks. He had episodes of recurrent intraabdominal abscesses requiring surgical drainage and antibiotics. A second course of liposomal amphotericin B was administered for histopathologic evidence of filamentous fungal recurrence. After 5 months, the patient remains well without any evidence of infection.
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Affiliation(s)
- Jorge H Serna
- Department of Renal Diseases and Hypertension, University of Texas Health Science Center at Houston, Houston, TX, USA
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Kofteridis DP, Karabekios S, Panagiotides JG, Bizakis J, Kyrmizakis D, Saridaki Z, Gikas A. Successful treatment of rhinocerebral mucormycosis with liposomal amphotericin B and surgery in two diabetic patients with renal dysfunction. J Chemother 2003; 15:282-6. [PMID: 12868556 DOI: 10.1179/joc.2003.15.3.282] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The zygomycetes are a class of fungi that can cause a variety of infections in humans. Rhinocerebral mucormycosis is a rare disease and usually affects diabetic or immunosuppressed patients. The disease progresses rapidly and is usually fatal despite aggressive surgical and medical therapy. We report the management of two cases of rhino-sinusal and orbital mucormycosis in diabetic patients on treatment with corticosteroids, and mild renal impairment, successfully treated with a combination of aggressive surgical debridement and liposomal amphotericin B.
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Affiliation(s)
- D P Kofteridis
- Department of Internal Medicine, University of Crete School of Medicine, University Hospital Heraklion, Crete, Greece.
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Lenane P, Keane CO, Loughlin SO. Mucor mycosis infection presenting as a non-healing ulcer in an immunocompromised patient. Clin Exp Dermatol 2003; 28:157-9. [PMID: 12653703 DOI: 10.1046/j.1365-2230.2003.01187.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mucor mycosis is an uncommon saprophytic opportunistic fungus causing localized cutaneous infection associated with high morbidity and, on dissemination, high mortality. We report the case of an immunocompromised patient with an aggressively progressing, painful non-traumatic ulceration, unresponsive to standard treatment. Deep biopsies for haematoxylin and eosin staining and fungal culture revealed the characteristic broad non-septate irregular hyphae of mucor allowing introduction of the appropriate treatment. Infection with mucor mycosis must be considered in today's medical environment as the number of immunocompromised patients increases.
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Affiliation(s)
- P Lenane
- Dermatology Department, Mater Hospital, Eccles Street, Dublin, Ireland.
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Gallagher JC, Dodds Ashley ES, Drew RH, Perfect JR. Antifungal pharmacotherapy for invasive mould infections. Expert Opin Pharmacother 2003; 4:147-64. [PMID: 12562305 DOI: 10.1517/14656566.4.2.147] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of invasive mould infections is increasing and is associated with significant morbidity and mortality. Among the most prevalent of these infections are those caused by Aspergillus and Fusarium species. Invasive disease caused by moulds frequently presents as a pulmonary infection, but haematogenous infection can occur. Some moulds cause cutaneous disease through either direct inoculation of the skin or secondary spread to the skin after dissemination from another body site. Early diagnosis can often be difficult and, unfortunately, diagnosis occurs late in the course of illness in many cases. Treatment options have historically been limited by the need for intravenous administration (amphotericin B), significant toxicities (amphotericin B), lack of reliable in vitro activity (e.g., amphotericin B in Fusarium and Scedosporium apiospermum infections) and relative lack of clinical experience with newer agents. The recent approval of voriconazole (Vfend, Pfizer) introduces a treatment option that demonstrates both in vitro and in vivo activity against a variety of moulds. With the recent development of the new echinocandin class of antifungal agents and newer broad-spectrum azole antifungal agents with in vitro mould activity, there is a renewed emphasis on fungal treatment strategies. Antimould therapy presents challenges in adverse effect avoidance and management, drug interactions and pharmacoeconomic considerations. Furthermore, combination therapy is being explored with these various new antifungal agents. The administration of an optimal fungicidal therapy early in the course of the illness and control of the underlying disease are vital to prevent complications and mortality from these tenacious mycoses.
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Affiliation(s)
- Jason C Gallagher
- Duke University Medical Center, Division of Infectious Diseases, Box 3353, Durham, NC 27710, USA
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Abstract
Zygomycosis, an uncommon but frequently fatal mycosis caused by fungi of the class Zygomycetes, develops most commonly as an opportunistic disease. Successful therapy involves a combined approach based on early diagnosis, prompt institution of medical therapy, and extensive surgical debridement of all devitalized tissue. Given the rarity of this condition, novel therapeutic strategies have been limited and only tested on an individual basis. The use of high-dose lipid formulations of amphotericin B, prompt reversal of the underlying predisposing condition, and hyperbaric oxygen are the most common strategies that have shown potential value in the treatment of zygomycosis.
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Affiliation(s)
- Corina E Gonzalez
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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