title: Mucormycosis: a new concern in the transplant ward?
abstract: OBJECTIVE
  This study focuses on the epidemiology and management of mucormycosis in hematopoietic stem cell transplant patients, a life-threatening mold infection whose incidence has increased over the past decades.
  
  
  RESULTS
  Mucormycosis may occur in hematopoietic stem cell transplant recipients with severe graft-versus-host disease, steroids, neutropenia, iron overload, diabetes, and malnutrition, or those who received antifungals not active against Mucorales. Its incidence in allogeneic hematopoietic stem cell transplant is around 0.3%. As Mucorales are not susceptible to voriconazole and candins, and as mucormycosis often mimics aspergillosis, it is extremely important to have a precise diagnostic to correctly manage the patient. The reversed halo sign on chest computed tomography has been associated to mucormycosis in neutropenic patients, but is not pathognomonic. Direct fungal identification is crucial. Molecular approaches are developed that may be extremely useful for early diagnosis.
  
  
  CONCLUSIONS
  Although randomized trials are quite impossible to run, due to the rarity of the disease, the recent numerous data have allowed the elaboration of European guidelines for the management of mucormycosis. Lipid formulations of amphotericin B, and especially liposomal amphotericin B at high doses (5-10 mg/kg/day), are the standard treatment, combined with surgery and control of favoring factors. The prognosis is poor, and any delay in the initiation of therapy may impact on outcome.
authors.affiliation: aHematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) bParis-Est Créteil University (UPEC), Créteil cParasitology-Mycology Laboratory, Groupe hospitalier Lariboisière Saint-Louis Fernand Widal dUniversité Paris-Diderot, Sorbonne Paris Cité eInstitut Pasteur, Unité de mycologie moléculaire, CNRS URA3012, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Robin
authors.forename: Alexandre
authors.initials: A
authors.lastname: Alanio
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D009091:Mucormycosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents