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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

by Wahba, Roger , Spellberg, Brad , Hoenigl, Martin , Slavin, Monica , Maschmeyer, Georg , Morrissey, C Orla , Ullmann, Andrew J , Mellinghoff, Sibylle C , Kanj, Souha S , Wiederhold, Nathan P , Lewis, Russell E , Pagano, Livio , Castagnola, Elio , Lass-Floerl, Cornelia , Akova, Murat , Lehrnbecher, Thomas , Chen, Sharon C A , Groll, Andreas H , Racil, Zdenek , Chayakulkeeree, Methee , Klimko, Nikolay , Lamoth, Frederic , Steinbach, William , Colombo, Arnaldo L , Guinea, Jesus , Arenz, Dorothee , White, P Lewis , Corzo-León, Dora E , Al-Hatmi, Abdullah M S , Chakrabarti, Arunaloke , Vehreschild, Jörg J , Roilides, Emmanuel , Lee, Dong-Gun , Badali, Hamid , Lagrou, Katrien , Drgona, Lubos , Tan, Ban Hock , Patel, Atul , Sheppard, Donald C , Pana, Zoi D , Oladele, Rita , Seidel, Danila , Sidharthan, Neeraj , Dannaoui, Eric , Soman, Rajeev , Lackner, Michaela , Meletiadis, Joseph , Bretagne, Stéphane , Arikan-Akdagli, Sevtap , Cornely, Oliver A , Meis, Jacques F , Singh, Nina , Sinko, János , Vehreschild, Maria J G T , Bonifaz, Alexandro , Pasqualotto, Alessandro , Hochhegger, Bruno , Alanio, Alexandre , Mer, Mervyn , Walsh, Thomas J , Ibrahim, Ashraf S , Alastruey-Izqui

in Abdomen / Amphotericin B / Consortia / Diabetes / Diagnosis / Diagnostic systems / Disease control / Disease Management / Epidemiology / Fungal infections / Fungi / Hematology / Humans / Infections / Infectious diseases / Intravenous administration / Life Sciences / Lipids / Medical diagnosis / Medical prognosis / Medical research / Morbidity / Mortality / Mucormycosis / Mucormycosis - diagnosis / Mucormycosis - epidemiology / Mucormycosis - microbiology / Mucormycosis - therapy / Mycology / Mycosis / Pathogens / Patients / Pattern recognition / Posaconazole / Rare diseases / Resource management / Risk factors / Surgery / Systematic review / Toxicity / Triazoles

2019

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Journal Article

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

Wahba, Roger,

Spellberg, Brad,

Hoenigl, Martin,

Slavin, Monica,

Maschmeyer, Georg,

Morrissey, C Orla,

Ullmann, Andrew J,

Mellinghoff, Sibylle C,

Kanj, Souha S,

Wiederhold, Nathan P,

Lewis, Russell E,

Pagano, Livio,

Castagnola, Elio,

Lass-Floerl, Cornelia,

Akova, Murat,

Lehrnbecher, Thomas,

Chen, Sharon C A,

Groll, Andreas H,

Racil, Zdenek,

Chayakulkeeree, Methee,

Klimko, Nikolay,

Lamoth, Frederic,

Steinbach, William,

Colombo, Arnaldo L,

Guinea, Jesus,

Arenz, Dorothee,

White, P Lewis,

Corzo-León, Dora E,

Al-Hatmi, Abdullah M S,

Chakrabarti, Arunaloke,

Vehreschild, Jörg J,

Roilides, Emmanuel,

Lee, Dong-Gun,

Badali, Hamid,

Lagrou, Katrien,

Drgona, Lubos,

Tan, Ban Hock,

Patel, Atul,

Sheppard, Donald C,

Pana, Zoi D,

Oladele, Rita,

Seidel, Danila,

Sidharthan, Neeraj,

Dannaoui, Eric,

Soman, Rajeev,

Lackner, Michaela,

Meletiadis, Joseph,

Bretagne, Stéphane,

Arikan-Akdagli, Sevtap,

Cornely, Oliver A,

Meis, Jacques F,

Singh, Nina,

Sinko, János,

Vehreschild, Maria J G T,

Bonifaz, Alexandro,

Pasqualotto, Alessandro,

Hochhegger, Bruno,

Alanio, Alexandre,

Mer, Mervyn,

Walsh, Thomas J,

Ibrahim, Ashraf S,

Alastruey-Izqui

2019

Overview

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.

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Elsevier Ltd,Elsevier Limited,New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001

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