Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

Abstract

Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.

Keywords

MeSH Terms

Affiliated Institutions

• Mohammed V University MA
• Assistance Publique – Hôpitaux de Paris FR
• Alfred Health AU
• Monash University AU
• Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases DE
• Amrita Institute of Medical Sciences and Research Centre IN
• Singapore General Hospital SG
• Istituti di Ricovero e Cura a Carattere Scientifico IT
• Medical University of Graz AT
• University of Copenhagen DK
• University of Aberdeen GB
• Weill Cornell Medicine US
• Aristotle University of Thessaloniki GR
• University of Bologna IT
• Manchester University NHS Foundation Trust GB
• North-Western State Medical University named after I.I. Mechnikov RU
• The University of Sydney AU
• Post Graduate Institute of Medical Education and Research IN
• Hospital General Dr. Manuel Gea Gonzalez MX
• Hôpital Fernand-Widal FR
• KU Leuven BE
• American University of Beirut Medical Center LB
• University of the Witwatersrand ZA
• University Hospital Münster DE
• Siriraj Hospital TH
• Wellcome Trust GB
• University Hospital Cologne DE
• Erasmus MC NL
• Canisius-Wilhelmina Ziekenhuis NL
• Children's Hospital of Philadelphia US
• University of Lagos NG
• National Institute of Allergy and Infectious Diseases US
• Public Health Wales GB
• Duke Medical Center US
• Unified Szent István and Szent László Hospital HU
• University of California, San Diego US
• Universidade Federal do Rio de Janeiro BR
• Instituto de Salud Carlos III ES
• Institut Pasteur FR
• "Ion Ionescu de la Brad" Iasi University of Life Sciences RO
• German Center for Infection Research DE
• Westmead Hospital AU
• Radboud University Medical Center NL
• Laiko General Hospital of Athens GR
• Heidelberg University DE
• University of Lausanne CH
• Radboud University Nijmegen NL
• Université Paris Cité FR
• Johannesburg Hospital ZA
• UCLA Medical Center US
• Hospital General Universitario Gregorio Marañón ES
• The University of Melbourne AU
• University Hospital Heidelberg DE
• University of California, Los Angeles US
• University of Manchester GB
• University of Cologne DE
• Klinikum Ernst von Bergmann DE
• Peter MacCallum Cancer Centre AU
• Centre National de la Recherche Scientifique FR
• Mazandaran University of Medical Sciences IR
• New York Hospital Queens US
• Università Cattolica del Sacro Cuore IT
• Mahidol University TH
• The Lundquist Institute US
• University of California System US
• Westerdijk Fungal Biodiversity Institute NL
• P. D. Hinduja Hospital and Medical Research Centre IN
• Universidade Federal de Ciências da Saúde de Porto Alegre BR
• McGill University CA
• Institute of Haematology and Blood Transfusion CZ
• Cornell University US
• Hacettepe University TR
• Hôpital Européen Georges-Pompidou FR
• Goethe University Frankfurt DE
• Comenius University Bratislava SK
• LAC+USC Medical Center US
• Universitätsklinikum Würzburg DE
• The University of Texas Health Science Center at San Antonio US
• Universidad Complutense de Madrid ES
• Innsbruck Medical University AT
• Pontifícia Universidade Católica do Rio Grande do Sul BR
• Presbyterian Hospital US
• Care Institute of Medical Sciences IN
• National Institutes of Health US
• Hospital General de México MX
• University of Pittsburgh Medical Center US
• Tel Aviv University IL
• NewYork–Presbyterian Hospital US
• Ministry of Health OM
• Istituto Giannina Gaslini IT
• Hippocration General Hospital GR
• IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola IT
• VA Pittsburgh Healthcare System US
• Universidade Federal de São Paulo BR
• University of Southern California US
• Catholic University of Korea KR
• National and Kapodistrian University of Athens GR

Related Publications