Breaking the Mold: A Review of Mucormycosis and Current Pharmacological Treatment Options.
To review the current literature for the pathogenesis of mucormycosis, discuss diagnostic strategies, and evaluate the efficacy of polyenes, triazoles, and echinocandins as pharmacological treatment options.



An electronic literature search was conducted in PubMed using the MESH terms Rhizopus, zygomycetes, zygomycosis, Mucorales and mucormycosis, with search terms amphotericin B, micafungin, anidulafungin, caspofungin, extended infusion amphotericin B, liposomal amphotericin B, combination therapy, triazole, posaconazole, isavuconazole, diagnosis, and clinical manifestations.



Studies written in the English language from January 1960 to March 2016 were considered for this review article. All search results were reviewed, and the relevance of each article was determined by the authors independently.



Mucormycosis is a rare invasive fungal infection with an exceedingly high mortality and few therapeutic options. It has a distinct predilection for invasion of endothelial cells in the vascular system, which is likely important in dissemination of disease from a primary focus of infection. Six distinct clinical syndromes can occur in susceptible hosts, including rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated, and miscellaneous infection.



Diagnosis of mucormycosis is typically difficult to make based on imaging studies, sputum culture, bronchoalveolar lavage culture, or needle aspirate. Surgical debridement prior to dissemination of infection improves clinical outcomes. Surgery combined with early, high-dose systemic antifungal therapy yields greater than a 1.5-fold increase in survival rates. The Mucorales are inherently resistant to most widely used antifungal agents. Amphotericin B is appropriate for empirical therapy, whereas posaconazole and isavuconazole are best reserved for de-escalation, refractory cases, or patients intolerant to amphotericin B.
Wingate University, Hendersonville, NC, USA t.riley@wingate.edu.
Treavor T
TT
Riley
University of Alabama at Birmingham, AL, USA.
Christina A
CA
Muzny
University of Mississippi Medical Center, Jackson, MS, USA.
Edwin
E
Swiatlo
Comprehensive Pharmacy Services, Woodstock, GA, USA.
Davey P
DP
Legendre
D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077336:Caspofungin; D003646:Debridement; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D055666:Lipopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009090:Mucorales / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D009091:Mucormycosis / Q000188:drug therapy* / Q000382:microbiology; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014774:Virulence
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D009570:Nitriles; D011725:Pyridines; D014230:Triazoles; C068538:liposomal amphotericin B; C508735:isavuconazole; C101425:posaconazole; D000666:Amphotericin B; D000077612:Anidulafungin; D000077336:Caspofungin; D000077551:Micafungin
Mucorales; amphotericin B; isavuconazole; posaconazole