Mucormycosis

Mucormycosis is an emerging and frequently lethal fungal infection caused by the Mucorales family, with Rhizopus, Mucor, and Lichtheimia, accounting for > 90% of all cases (1):

• Rhizopus species are the dominant cause of mucormycosis in the entire world, responsible for >70% of all cases of mucormycosis (1)

Mucormycosis:

• is a rapidly progressive, invasive fungal infection that affects patients who are severely immunocompromised, as well as patients with diabetes and persons with immunocompetence who have major trauma
• manifests in several clinical forms, including sino-orbital, rhinocerebral, sinopulmonary, gastrointestinal, cutaneous, musculoskeletal, osteoarticular, and disseminated mucormycosis, as well as single-organ disease
  • inhalation of spores from the environment causes rhino-orbital/cerebral, sino-pulmonary mucormycosis, the two most common disease manifestations
  • cutaneous mucormycosis is the disease’s third most prevalent presentation, and it is usually the consequence of inoculation of Mucorales spores to skin/subcutaneous tissues following severe trauma or abrasions on the skin
• although mucormycosis is often lethal, early intervention reduces mortality
  • successful treatment depends on early detection and staging of the disease, timely initiation of antifungal therapy, surgical resection of infected tissue, reversal of immunodeficiencies, and correction of metabolic abnormalities
    • note that cultures are often negative in tissues (up to 55-75%) as is often immunohistochemistry (IHC)/in situ hybridisation (1)
    • diagnosis relies on culturing the organism from normally sterile body locations and/or tissue histology because there is currently no serology test for the diagnosis of the organism (1)
  • reversal of underlying poor prognostic factors, such as neutropenia, hyperglycemia, low threshold of suspicion and early initiation of effective antifungal therapy and in selected cases, surgical debridement of affected tissues, and antifungal therapy, are the cornerstones in the management
  • liposomal amphotericin B is the preferred agent for initial antifungal therapy, with oral triazoles as alternative agents (2)

References:

1. Binder U, Maurer E, Lass-Flörl C. Mucormycosis--from the pathogens to the disease. Clin Microbiol Infect. 2014 Jun;20 Suppl 6:60-6.
2. Kontoyiannis DP, Walsh TJ. Mucormycosis.N Engl J Med 2026;394:684-698.