Mucormycosis treated with posaconazole: review of 96 case reports.
Mucormycosis is an emerging invasive fungal infection, primarily affecting immunocompromised patients. The disease is difficult to diagnose and mortality reaches 40% even if treated adequately. Depending on site of infection and risk factors, surgical debridement in combination with systemically active antifungal drugs are the mainstay treatment strategies. Lipid-based amphotericin B is the treatment of choice for first-line therapy while posaconazole may be a promising alternative. We performed a PubMed search on reports of patients with mucormycosis treated with posaconazole. From 2003 to 2011, 96 cases have been published. Diagnosis was based on histology alone in 2 (2.1%) and microbiological evidence in 67 (69.8%), while no data on the diagnostic approach was reported in 27 (28.1%) patients. The most frequent pathogens were Rhizopus spp. (31.2%), followed by Mucor spp. (14.6%). The site of infection was predominantly rhino-orbital (38.5%, of which 43% also had central nervous system [CNS] involvement), followed by disseminated disease (22.1%). A complete response was achieved in 62 (64.6%), partial response in 7 (7.3%) patients, and stable disease in 1 (1%). Overall mortality was 24% (lacking data for three patients). In published case reports on posaconazole treatment for mucormycosis, the drug was frequently and successfully used in combination or as second line therapy.
1st Department of Internal Medicine, University of Cologne, Cologne, Germany. Janne.Vehreschild@ctuc.de
Joerg J
JJ
Vehreschild
Andrea
A
Birtel
Maria J G T
MJ
Vehreschild
Blasius
B
Liss
Fedja
F
Farowski
Matthias
M
Kochanek
Michal
M
Sieniawski
Angela
A
Steinbach
Kerstin
K
Wahlers
Gerd
G
Fätkenheuer
Oliver A
OA
Cornely
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy*; D016879:Salvage Therapy; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole