Treatment of mucormycosis in transplant patients: role of surgery and of old and new antifungal agents

• Published in: Current opinion in infectious diseases Vol. 29; no. 4; p. 340
• Main Authors: Chitasombat, Maria N, Kontoyiannis, Dimitrios P
• Format: Journal Article
• Language: English
• Published: United States 01.08.2016
• Subjects: Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; DNA, Fungal - analysis; Humans; Mucorales - genetics; Mucormycosis - drug therapy; Mucormycosis - surgery; Nitriles - therapeutic use; Opportunistic Infections - drug therapy; Opportunistic Infections - surgery; Pyridines - therapeutic use; Salvage Therapy; Transplant Recipients; Triazoles - therapeutic use
• ISSN: 1473-6527
• DOI: 10.1097/QCO.0000000000000277

Mucormycosis is an opportunistic mold infection whose management is difficult, as there is a paucity of evidence-based data. We summarize the latest advances in diagnosis and management of mucormycosis in transplant recipients. There is promise for improvement in nonculture-based diagnostics with new biomarkers of Mucorales DNA that can be used for early diagnosis, and monitoring of response. Antifungal treatment consists of high-dose lipid formulations of amphotericin B or isavuconazole as the first-line therapy and posaconazole as salvage therapy. The new, pharmacokinetically more reliable formulations of posaconazole (intravenous, extended-release tablets) are welcomed improvements. Yet, the role of combination therapy is still uncertain. Surgery had a significant role in selected cases, such as in patients with rhinosinusitis form of mucormycosis, which nowadays can be performed with minimal invasive technique. Mucormycosis remain a life-threatening opportunistic mold infection among transplant patients. Early diagnosis, prompt treatment with effective antifungals in combination with surgery if feasible is essential. Immune adjunct therapy and improvement of early diagnostics are important areas for future research. There are good prospects of progress in diagnostics and management of mucormycosis in transplant patients.