New Guideline Highlights Emergency Status of Mucormycosis

By David Douglas

November 21, 2019

NEW YORK (Reuters Health) - A new global guideline for diagnosing and managing mucormycosis emphasizes the emergency status of this rare but devastating infection.

"Even if you didn't confirm the diagnosis but you suspect the diagnosis you need a team and you need to act fast!" said lead author Dr. Oliver A. Cornely of University Hospital Cologne, in Germany, in a video released with the guideline.

"Mortality of mucormycosis is high, ranging from 40% to higher than 80%," he added in an email to Reuters Health. "Diagnosis and adequate treatment delayed by six days doubles the mortality rate."

Dr. Cornely and colleagues from 33 countries adopted what they call a "One World One Guideline" approach to analyzing published evidence and providing consensus recommendations on mucormycosis; 51 scientific societies reviewed and endorsed the guidance document.

The recommendations, issued by the European Confederation of Medical Mycology and the Mycoses Study Group Education and Research Consortium, were published online November 4 in The Lancet Infectious Diseases.

Mucormycosis refers to infections caused by fungi of the order Mucorales. In immunocompromised patients, the main route of infection may be through inhalation of sporangiospores causing pulmonary infection.

Cutaneous and soft-tissue mucormycosis, the authors note, are the most common forms of mucormycosis in immunocompetent patients, primarily after skin disruption due to traumatic injury.

The disease is difficult to diagnose, but management does not differ greatly between world regions. Maximizing survival requires rapid diagnostic and therapeutic intervention, including immediate involvement of a multidisciplinary medical, surgical, radiological and laboratory-based team. Patients with suspected mucormycosis should be referred immediately to a facility with the highest care level.

Lower mortality is seen with localized sinus or skin infection, where earlier tissue-based diagnosis is often feasible and surgical debridement may result in cure.

First-line treatment with high-dose liposomal amphotericin B is strongly recommended, the authors say, while intravenous isavuconazole and intravenous or delayed-release oral posaconazole are recommended to a moderate degree. However, "Both triazoles are strongly recommended salvage treatments."

Because of its substantial toxicity, the researchers add, "Amphotericin B deoxycholate is recommended against . . . but may be the only option in resource-limited settings."

Dr. Cornely concluded, "With the mucormycosis guideline we authors intend to increase awareness and to guide mucormycosis management without delay."

SOURCE: https://bit.ly/2Op9OD3

Lancet Infect Dis 2019.

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