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Mucormycosis

Chapter 224 | Part 5: Infectious Diseases · Part 5 – Infectious Diseases: Fungal · Chapter 224


Key Clinical Points

  1. Caused by Mucorales fungi; highly invasive with high mortality (>90% in disseminated disease).
  2. Lipid amphotericin B (LAmB) is the first-line therapy except for mild localized disease.
  3. Surgical debridement is critical for improving outcomes.
  4. Key risk factors include hyperglycemia, acidosis, and iron overload (especially from deferoxamine).
  5. Histopathology shows characteristic broad, ribbon-like, nonseptate hyphae branching at right angles.
  6. Distinguished from aspergillosis by morphology; voriconazole may exacerbate mucormycosis.
  7. Rapid reversal of hyperglycemia and acidosis is critical for patient survival.
  8. Commonly involves rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated sites.

DEFINITION & CLASSIFICATION

Definition (Harrison's 22e): Mucormycosis is caused by fungi of the order Mucorales (subphylum Mucoromycotina).Clinical Behavior: Highly invasive and relentlessly progressive; results in higher morbidity/mortality than many other infections. • Mortality Rates: - Disseminated disease: >90% mortality. - Comparison to Aspergillosis: Invasive aspergillosis has 30–70% mortality if treated vs. 100% if missed.


EPIDEMIOLOGY

High-Risk Populations: - Patients with diabetes mellitus - Transplant recipients - Neutropenic patients - Patients on corticosteroids • Emerging Trends: Pandemic-associated cases linked to high-dose steroids in diabetic COVID-19 patients. • Geographic/Contextual Factors: - Higher incidence in India pre-pandemic. - Disseminated disease more common in itraconazole/voriconazole prophylaxis recipients. • Infection Routes: Cutaneous infections occur via trauma or medical devices.


ETIOLOGY & PATHOPHYSIOLOGY

Pathogens: Seven Mucorales families cause disease; Rhizopus species are most common in the Western Hemisphere. • Risk Factors: - Uncontrolled diabetes - Phagocytic defects - Iron overload (especially from deferoxamine use) • Mechanism of Virulence: - DKA enhances virulence via β-hydroxybutyrate and free iron. - Hyperglycemia promotes infection through multiple mechanisms, including GRP78 receptor upregulation.

Taxonomy of Fungi Causing Mucormycosis

Primary Pathogens: - Mucoraceae: Rhizopus oryzae, R. delemar, R. microsporus, Rhizomucor pusillus, Mucor, Actinomucor - Lichtheimiaceae: Lichtheimia corymbifera (formerly Absidia) - Cunninghamellaceae: Cunninghamella - Others: Thamnidiaceae (Cokeromyces), Mortierellaceae (Mortierella), Saksenaceae (Saksena), Apophysomyces, Syncephalastraceae (Syncephalastrum). • Table 224-1: Lists the primary families and associated genera (e.g., Mucoraceae includes Rhizopus; Lichtheimiaceae includes Lichtheimia).


CLINICAL FEATURES

Primary Syndromes: - Rhino-orbital-cerebral - Pulmonary - Cutaneous - Gastrointestinal - Disseminated

Rhino-Orbital-Cerebral Disease: - Most common in diabetics. - Progression: Facial pain/numbness → conjunctival swelling → proptosis, chemosis, ophthalmoplegia → black necrotic eschar. - Critical Finding: Cavernous sinus thrombosis (ominous if bilateral).

Pulmonary Disease: - Symptoms: Dyspnea, cough, hemoptysis. - Imaging: CT is superior to X-ray; shows lobar consolidation, nodules, and cavities.

Cutaneous Disease: - Source: Trauma or medical devices. - Presentation: Necrotizing fasciitis. - Prognosis: ~80% mortality if untreated.

Gastrointestinal Disease: - Population: Historically in neonates; now common in immunocompromised adults. - Symptoms: Abdominal pain, bleeding, perforation.

Disseminated and Miscellaneous Forms: - Sites: Brain (most common), bones, trachea, kidneys, scalp (kerion), teeth. - Mortality: >90% in disseminated disease.


DIFFERENTIAL DIAGNOSIS

Fungal Pathogens: - Aspergillosis - Fusariosis - Scedosporiosis - Dematiaceous fungi - Entomophthoromycoses (Basidiobolus/Conidiobolus) — distinguished by culture. • Bacterial/Other: - Bacterial orbital cellulitis - Klebsiella rhinoscleroma - Tolosa-Hunt syndrome.


DIAGNOSTIC APPROACH

  1. Initial Identification:
  2. Definitive diagnosis: Culture from sterile site OR histopathology showing aseptate hyphae.
  3. Probable diagnosis: Nonsterile cultures + clinical/radiographic evidence.
  4. Histopathology (Preferred):
  5. Biopsy with PAS or hematoxylin-eosin staining; most effective for identifying broad, ribbon-like, nonseptate hyphae (Figure 224-1).
  6. Molecular Testing:
  7. PCR: Not FDA-approved but may aid in diagnosis.

MANAGEMENT & TREATMENT

Core Management Pillars: 1. Early therapy 2. Surgical debridement (improves outcomes significantly) 3. Reverse risk factors (e.g., hyperglycemia, acidosis) 4. Treat underlying malignancy.

Antifungal Therapy Strategy: - First-line: Lipid amphotericin B (LAmB) for most cases; AmB deoxycholate only for mild localized disease. - CNS Disease: Dose escalation required (LAmB 7.5–10 mg/kg). - Monitoring: Avoid iron administration and limit RBC transfusions.

Specific Antifungal Options (Table 224-2): - AmB deoxycholate: 1.0–1.5 mg/kg once daily (standard); 5–10 mg/kg (less nephrotoxic, better CNS penetration). - ABLC: 5 mg/kg once daily (less nephrotoxic than AmB deoxycholate; consider with echinocandins). - Isavuconazole: 200 mg q8h imes 6 then daily (FDA approved, useful if septate mold vs. mucormycosis is unclear). - Posaconazole: 200 mg four times per day (lower blood levels than isavuconazole; salvage therapy only). - Combination Therapy: - Echinocandins: Synergistic in murine models; better outcomes in rhino-orbital-cerebral cases. - Lipid polyene + azole (posaconazole or isavuconazole): Standard doses, but no evidence of superiority over monotherapy.


PROGNOSIS & COMPLICATIONS

Mortality: - >90% in disseminated disease. - Poor outcomes associated with: Brain involvement, endophthalmitis, or endocarditis. • Critical Intervention: Rapid reversal of hyperglycemia and acidosis is essential for survival.


SPECIAL POPULATIONS

Drug Interactions/Selection: - Voriconazole: May exacerbate mucormycosis; avoid if mucormycosis is suspected. - Isavuconazole: Consider in cases where septate mold vs. mucormycosis is not yet established. • Complex Cases: - Dual infection with septate molds possible in immunocompromised patients. - Multidisciplinary care required for complex presentations.


KEY PEARLS & HIGH-YIELD POINTS

Morphology is Key: Histopathology showing broad, ribbon-like, nonseptate hyphae with wide-angle branching distinguishes Mucorales from Aspergillus. • Don't Delay: Do not delay chemotherapy for mucormycosis; antifungals only temporize the condition. • Rapid Action: Mortality is extremely high in disseminated disease; rapid reversal of metabolic derangements (hyperglycemia/acidosis) is a priority. • Avoid Iron: Avoid iron administration and limit RBC transfusions to prevent fungal growth.


Reference Tables

TABLE 223-3 Treatment of Aspergillosis a INDICATION Invasive disease b

Harrison's 22e, p.1717

INDICATION PRIMARY TREATMENT PRECAUTIONS SECONDARY TREATMENT COMMENTS
Invasive diseaseb Voriconazole,
isavuconazole,
posaconazole
Drug interactions (especially
with voriconazole)c
AmB, caspofungin,
micafungin
As primary therapy, azoles have a 20% higher
response rate than AmB. Therapeutic drug
monitoring is recommended for voriconazole and
isavuconazole in ICU patients.
Posaconazole tablet,
itraconazole solution
SUBA-itraconazole
Vincristine, cyclophosphamide
interaction
Micafungin, aerosolized
AmB
Single aspergilloma Surgical resection Multicavity disease: poor
outcome of surgery, medical
therapy preferable
Itraconazole, voriconazole,
intracavity AmB
Single large cavities with an aspergilloma are
best resected. Relapse reduced by pre- and
perioperative antifungal therapy.
Voriconazole,
itraconazole
Poor absorption of itraconazole
capsules with proton pump
inhibitors or H blockers
2
Posaconazole, IV AmB, IV
micafungin
ABPA/SAFS (“fungal
asthma”)
Itraconazole Some glucocorticoid
interactions, including with
inhaled formulations
Voriconazole, posaconazole,
inhaled AmB
Long-term therapy is helpful in most cases. No
evidence indicates whether therapy modifies
progression to bronchiectasis/fibrosis.
224 Mucormycosis
Brad Spellberg, Ashraf S. Ibrahim

TABLE 224-1 Taxonomy of Fungi Causing Mucormycosis (Subphylum Mucoromycotina, Order Mucorales) FAMILY Mucoraceae

Harrison's 22e, p.1718

FAMILY GENUS (SPECIES LISTED FOR SOME)
Mucoraceae Rhizopus oryzae
Rhizopus delemar
Rhizopus microsporus
Rhizomucor
Mucor
Actinomucor
Cunninghamellaceae Cunninghamella
Mortierellaceae Mortierella
Syncephalastraceae Syncephalastrum

TABLE 224-2 Antifungal Options for the Treatment of Mucormycosis a DRUG First-Line Antifungal Therapy AmB deoxycholate

Harrison's 22e, p.1721

DRUG RECOMMENDED DOSAGE ADVANTAGES AND SUPPORTING STUDIES DISADVANTAGES
First-Line Antifungal Therapy
AmB deoxycholate 1.0–1.5 mg/kg once per day • >5 decades of clinical experience
• Inexpensive
• FDA approved for treatment of mucormycosis
• Highly toxic
• Poor CNS penetration
5–10 mg/kg once per day • Less nephrotoxic than AmB deoxycholate
• Better CNS penetration than AmB deoxycholate or
ABLC
• Better outcomes than with AmB deoxycholate in
murine models and a retrospective clinical review
ABLC 5 mg/kg once per day • Less nephrotoxic than AmB deoxycholate
• Murine and retrospective clinical data suggest benefit
of combination therapy with echinocandins
• Expensive
• Possibly less efficacious than LAmB for
CNS infection
Second-Line/Salvage Option
200 mg of isavuconazole
(372 mg of isavuconazonium
sulfate), load q8h × 6 followed by
once-daily dosing
• Efficacy similar to that of LAmB in mouse models
• FDA approved for treatment of mucormycosis
• May be a rational empirical option when septate mold
vs mucormycosis is not yet established
Posaconazole 200 mg four times per day • In vitro activity against the Mucorales, with lower
MICs than isavuconazole
• Retrospective data for salvage therapy in
mucormycosis
• Substantially lower blood levels than
isavuconazole
• No data on initial therapy for
mucormycosis, and no evidence for
posaconazole in combination with other
therapy
• Experience limited, potential use for
salvage therapy
Combination Therapyb
Standard echinocandin doses • Favorable toxicity profile
• Synergistic in murine disseminated mucormycosis
• Retrospective clinical data suggest superior outcomes
for rhino-orbital-cerebral mucormycosis.
Lipid polyene plus
azole (posaconazole or
isavuconazole)
Standard doses • Favorable toxicity profile • Limited efficacy data, with no available
evidence of superiority vs monotherapy
Standard doses • Maximal aggressiveness