TY - JOUR
T1 - Recent advances in the management of mucormycosis
T2 - from bench to bedside
AU - Spellberg, Brad
AU - Walsh, Thomas J.
AU - Kontoyiannis, Dimitrios P.
AU - Edwards, J. John
AU - Ibrahim, Ashraf S.
N1 - Funding Information:
Mucormycosis typically occurs in patients with diabetes mellitus, patients who have received organ or hematopoietic stem cell transplant (HSCT), patients with neutropenia, or patients with malignancy [2, 3]. The incidence of mucormycosis appears to be increasing [4], particularly in certain oncology centers [2, 5–7]. For decades, the mortality rate of mucormycosis has remained ⩾40% despite aggressive surgical and polyene antifungal therapy [2, 3, 8]. In particular, patients with hematologic malignancy or HSCT recipients have mortality rates in excess of 65% and 90%, respectively [2, 4, 6, 7]. However, as a result of recent translational research, funded by the US National
PY - 2009/6/15
Y1 - 2009/6/15
N2 - Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mu- cormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.
AB - Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mu- cormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.
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U2 - 10.1086/599105
DO - 10.1086/599105
M3 - Review article
C2 - 19435437
AN - SCOPUS:66949141526
SN - 1058-4838
VL - 48
SP - 1743
EP - 1751
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -