Emerging diagnostic and therapeutic options for treating mucormycosis

Introduction: Early diagnosis and treatment of mucormycosis remain challenges in clinical practice. Diagnosis typically involves direct tissue sampling and histopathologic examination, which may take days to confirm. Recently, nucleic acid amplification and hybridization has emerged as an adjunctive modality in the diagnosis of mucormycosis. Areas covered: Nested, semi-nested, and multiplex PCR have tremendous potential for the rapid and reliable diagnosis of invasive fungal infections, but are not routinely used in clinical practice. Here, we review technological hurdles to widespread implementation as well as novel therapeutic options for the treatment of mucormcyosis. These include combination therapy, novel drug targets that draw on structure-activity relationships, and alternative drug development pathways, which rely on pharmacodynamics modeling. Expert opinion: Mucormycosis is an uncommon yet life-threatening infection, and robust, prospective, randomized clinical trials to define optimal therapeutic strategies are an ongoing challenge for investigators. Advantageous strategies include crossover designs, multicenter collaboration, well-defined contemporaneous control populations, data sharing, and refinement of clinically relevant and biologically tenable endpoints. Support is also needed to bolster the development of novel antifungal agents to treat mucormycosis and other orphan mycoses.