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Part 2: mucormycosis: focus on therapy.

Joseph P Lynch1, George G Zhanel2

  • 1Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Expert Review of Anti-Infective Therapy
|June 10, 2023
PubMed
Summary
This summary is machine-generated.

Mucormycosis (MCR) is a dangerous fungal infection. Lipid formulations of amphotericin B are primary treatment, with oral triazoles as alternatives, alongside surgical intervention and host immune control.

Keywords:
Invasive fungal infectionsMucoralesamphotericin Bisavuconazolemoldmucormycosisposaconazole

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Mucormycosis (MCR) is a rare, life-threatening fungal infection primarily affecting immunocompromised individuals.
  • High mortality rates are associated with invasive and disseminated MCR, though localized cutaneous disease has lower mortality.
  • The rarity of MCR limits the availability of randomized controlled therapeutic trials.

Purpose of the Study:

  • To review and discuss current therapeutic options for mucormycosis.
  • To highlight the role of lipid formulations of amphotericin B (LFAB) as the primary treatment.
  • To explore the utility of oral triazoles (posaconazole, isavuconazole) and surgical debridement in MCR management.

Main Methods:

  • A literature search was conducted on PubMed up to December 2022.
  • Keywords included: invasive fungal infections, mold, mucormycosis, Mucorales, amphotericin B, isavuconazole, and posaconazole.
  • The review focuses on therapeutic strategies for MCR.

Main Results:

  • Lipid formulations of amphotericin B (LFAB) remain the cornerstone of MCR therapy.
  • Oral triazoles (posaconazole, isavuconazole) show potential as step-down therapy or for cases refractory/intolerant to LFAB.
  • Early surgical debridement is crucial as an adjunctive measure for localized invasive disease.

Conclusions:

  • Optimal survival in MCR necessitates controlling underlying conditions like hyperglycemia and neutropenia, and reducing immunosuppression.
  • LFAB is the primary treatment, with triazoles offering alternative or adjunctive roles.
  • Surgical intervention is a critical component in managing localized invasive mucormycosis.