Mucormycosis is an important invasive fungal disease that is difficult to diagnose and treat, and has a high mortality rate. To improve the diagnosis and treatment of mucormycosis by clinicians, the Medical Mycology Society of Chinese Medicine and Education Association engaged multidisciplinary experts to compile this expert consensus. This consensus refers to the latest international guidelines for diagnosis and treatment of mucormycosis, combined with the characteristics and treatment needs of mucormycosis in China and covers the following eight aspects to provide reference for Chinese clinicians: pathogenic agents, high-risk factors, clinical types, imaging manifestations, etiological diagnosis, clinical diagnosis, treatment, and prevention.
Humans ; Mucormycosis/drug therapy* ; Consensus ; China

Objective: To investigate the clinical features, diagnosis,treatment and prognosis of children with acute lymphoblastic leukemia complicated with mucormycosis, and to improve the understanding of the disease. Methods: The clinical data of 3 children with acute lymphoblastic leukemia (ALL) complicated with mucormycosis treated at the First Affiliated Hospital of Zhengzhou University between October 2020 and January 2021 were analyzed retrospectively. Literature search and review covered the China national knowledge infrastructure, Wanfang database and Pubmed using the keywords of "acute lymphoblastic leukemia" and "mucormycosis" up to June 2021. Results: Case 1, a 12-year-old boy, was diagnosed with ALL, developed fever and chest pain during induction therapy. The Metagenomic next-generation sequencing (mNGS) testing of alveolar perfusion fluid suggested infection with Rhizopus oryzae. Amphotericin B combined with posaconazole was applied and amphotericin B was removed after improvement. Bone destruction was indicated by CT. Amphotericin B was applied again. Case 2, a 4-year-old boy, with a history of pallor and tetter, was diagnosed with ALL. He developed cough and fever during induction therapy. mNGS of blood suggested infection with Rhizomucor pusillus. Amphotericin B combined with voriconazole was applied, but the situation was not significantly improved. The disseminated infection occurred. Amphotericin B combined with posaconazole was applied and vacuum sealing drainage was performed. Case 3, a 2-year-old girl, was diagnosed with ALL, developed fever and cough during induction therapy. Rhizomucor pusillus was indicated by mNGS. Amphotericin B combined with posaconazole was used, and posaconazole was stopped after improvement. Follow-up until June 2021, the condition of the 3 children improved. There was no recurrent Mucor infection, and the primary hematopathy was in complete remission. According to the literature, 7 reports were found in Chinese journals, while 17 reports were found in English literature, 25 cases have been reported. Among a total of 28 children, 11 cases rhino-orbito-cerebral mucormycosis, four pulmonary mucormycosis, 2 cutaneous mucormycosis, 2 gastrointestinal mucormycosis and 9 disseminated mucormycosis. There were 17 cases developed infection during induction chemotherapy, 8 cases during maintenance therapy, 3 cases after hematopoietic stem cell transplantation. Voriconazole was used in 15 cases; 19 cases were treated with combined surgery, 7 cases were treated with drugs only, 2 cases were untreated; 21 cases showed improvement after treatment. Death occurred in seven cases. Conclusions: ALL complicated with mucormycosis often occurs in the stage of induction therapy. The clinical features lacked specificity, mNGS can help find the pathogen and provide evidence for diagnosis. Surgical treatment also could be combined when necessary, which is helpful to improve the prognosis.
Amphotericin B/therapeutic use* ; Antifungal Agents/therapeutic use* ; Child ; Child, Preschool ; Female ; Humans ; Male ; Mucormycosis/drug therapy* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy* ; Retrospective Studies

Aspergillosis ; Humans ; Mucor ; Mucormycosis/drug therapy*

OBJECTIVE: To investigate the clinical features, treatment and prognosis of patients with hematological diseases complicated with mucor infection. METHODS: The risk factors, clinical features, treatment regimen and prognosis of 18 hematological disease patients with mucor infection diagnosed by histopathology in our center from April 2014 to June 2020 were retrospectively analyzed. RESULTS: Thirteen males and five females, with an average age of 30 (13－54) years old, were diagnosed as mucor infection by histopathological examination at the site of infection, including 16 cases of mucor infection alone and 2 cases of mucor + aspergillus mixed infection. There were 12 cases with malignant hematological disease and 6 cases with severe aplastic anemia, all of whom with long-term agranulocytosis, and their clinical manifestations and imaging findings were not specific. The common sites of infection were sinuses and lungs, and some patients showed multiple systemic manifestations. The remission status of hematological diseases and recovery of immune function showed an impact on the prognosis. All the patients were treated with amphotericin B liposome combined with posaconazole, and 15 patients were treated with surgery combined with antifungal drugs, 9 of whom were effective and 6 were ineffective, while intravenous administration in 3 cases was ineffective. CONCLUSION It is difficult to diagnose hematological disease complicated with mucor infection. After early diagnosis, prognosis can be improved by amelioration of primary state and combination of drugs and surgery.
Adolescent ; Adult ; Antifungal Agents/therapeutic use* ; Female ; Hematologic Diseases/complications* ; Humans ; Male ; Middle Aged ; Mucormycosis/drug therapy* ; Prognosis ; Retrospective Studies ; Young Adult

Mucormycosis is a rare but fatal disease and usually affects the rhinocerebrum, lungs, traumatic wounds or surgical sites. Vertebral osteomyelitis due to mucormycosis is very rare, with only three cases caused by mucormycosis since 1970 being reported, and none in Korea. Here, we present a case of vertebral osteomyelitis caused by mucormycosis in a 67-year-old woman, having type 2 diabetes mellitus for 10 years, who was in complete remission from acute leukemia after chemotherapy 3 years previously.
Aged ; Amphotericin B ; Diabetes Mellitus, Type 2 ; Drug Therapy ; Female ; Humans ; Korea ; Leukemia ; Lung ; Mucormycosis* ; Osteomyelitis* ; Spine ; Wounds and Injuries

Adult ; Anti-Infective Agents ; Humans ; Lung Diseases ; diagnosis ; drug therapy ; Male ; Mucormycosis ; diagnosis ; drug therapy ; Tuberculosis, Lymph Node ; diagnosis ; drug therapy ; Young Adult

PURPOSE: To report a case of rhino-orbital mucormycosis successfully treated by posaconazole salvage therapy after a surgical intervention combined with amphotericin B treatment. CASE SUMMARY: A 57-year-old female with uncontrolled diabetes mellitus presented to our department with left periorbital swelling and pain for 3 days. At initial presentation, complete ptosis, complete external ophthalmoplegia, and exophthalmos of 6 mm were observed in the left eye. Pupillary reflex was absent in the left eye. Orbital magnetic resonance imaging showed left focal maxillary sinusitis and left posterior orbital inflammatory infiltration with left optic nerve involvement. Nasal endoscopic examination showed black eschar in both nasal cavities. Histopathological examination of the involved nasal cavities showed non-septated fungal hyphae with blunt-angle branching, thus rhino-orbital mucormycosis was diagnosed. The patient underwent a lid-sparing subtotal exenteration, wide endonasal debridement of the nasal necrotic tissues, and intravenous injections of amphotericin B for 7 weeks. The patient continued to receive oral posaconazole salvage therapy for 6 months and was successfully treated. At the 44-month follow-up, recurrence was not observed, and the patient is wearing a new type of silicone oculofacial prosthesis. CONCLUSIONS: Rhino-orbital mucormycosis is an aggressive, opportunistic fungal infection that is life-threatening despite exenteration and amphotericin B treatment. Sequential use of oral posaconazole as salvage therapy may be helpful for a successful treatment.
Amphotericin B* ; Debridement ; Diabetes Mellitus ; Exophthalmos ; Female ; Follow-Up Studies ; Humans ; Hyphae ; Injections, Intravenous ; Magnetic Resonance Imaging ; Maxillary Sinus ; Maxillary Sinusitis ; Middle Aged ; Mucormycosis* ; Nasal Cavity ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Prostheses and Implants ; Recurrence ; Reflex, Pupillary ; Salvage Therapy ; Silicones

Mucormycosis (formerly known as zygomycosis) is a life-threatening opportunistic mycosis that infects a broad range of hosts with qualitative or quantitative defects in innate immunity. The overall mortality rate of pulmonary mucormycosis is above 70%. The prognosis and outcome of pulmonary mucormycosis have not improved significantly over the last decade, mainly because of difficulty in early diagnosis and the limited activity of current antifungal agents against members of the order Mucorales. We report a case of pulmonary mucormycosis treated successfully with posaconazole as salvage therapy. We suggest that posaconazole may be considered as an alternative therapeutic approach in patients with invasive pulmonary mucormycosis who are unable to tolerate surgical treatment.
Antifungal Agents ; Early Diagnosis ; Humans ; Immunity, Innate ; Mortality ; Mucorales ; Mucormycosis* ; Prognosis ; Salvage Therapy*

Posaconazole is a new oral triazole with broad-spectrum antifungal activity. Posaconazole has also shown a significant advantage of preventing invasive fungal infection compared to fluconazole or itraconazole in patients with prolonged neutropenia. Indeed, posaconazole has been commonly used for antifungal prophylaxis in patients undergoing remission induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. We experienced a case of fatal mucormycosis despite posaconazole prophylaxis. To our knowledge, this is the first reported case of fatal breakthrough mucormycosis in a patient receiving posaconazole prophylaxis during remission induction chemotherapy in Korea. This case demonstrated that breakthrough fungal infection can occurs in patients receiving posaconazole prophylaxis because of its limited activity against some mucorales.
Drug Therapy ; Fluconazole ; Humans ; Itraconazole ; Korea ; Leukemia, Myeloid, Acute* ; Mucorales ; Mucormycosis* ; Myelodysplastic Syndromes ; Neutropenia ; Remission Induction

Child, Preschool ; Female ; Humans ; Male ; Mucormycosis ; drug therapy ; etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; Remission Induction