Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May 19;9(5):592.
doi: 10.3390/jof9050592.

Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies

Nuobing Yang  1   2 , Lining Zhang  1   2 , Sizhou Feng  1   2
Affiliations
Review

Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies

Nuobing Yang et al. J Fungi (Basel). .

Abstract

The incidence rate of invasive mucormycosis (IM) in patients with hematological malignancies (HMs) is increasing year by year, ranging from 0.07% to 4.29%, and the mortality rate is mostly higher than 50%. With the ongoing pandemic of COVID-19, COVID-19-associated mucormycosis (CAM) also became a global health threat. Patients with high risk factors such as active HMs, relapsed/refractory leukemia, prolonged neutropenia may still develop breakthrough mucormycosis (BT-MCR) even under the prophylaxis of Mucorales-active antifungals, and such patients often have higher mortality. Rhizopus spp. is the most common genus associated with IM, followed by Mucor spp. and Lichtheimia spp. Pulmonary mucormycosis (PM) is the most common form of IM in patients with HMs, followed by rhino-orbital-cerebral mucormycosis (ROCM) and disseminated mucormycosis. The prognosis of IM patients with neutrophil recovery, localized IM and receiving early combined medical-surgical therapy is usually better. As for management of the disease, risk factors should be eliminated firstly. Liposome amphotericin B (L-AmB) combined with surgery is the initial treatment scheme of IM. Those who are intolerant to L-AmB can choose intravenous formulations or tablets of isavuconazole or posaconazole. Patients who are refractory to monotherapy can turn to combined antifungals therapy.

Keywords: clinical manifestations; hematological malignancies; high risk factors; invasive mucormycosis; treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of Mucorales organisms causing infection.
Figure 2
Figure 2
Sites of IM in patients with HMs [2,3,7,9,10,11,13,17,19,33,36].
Figure 3
Figure 3
Proportion of various types of IM differentiated by sites in patients with HMs.
See this image and copyright information in PMC

References

    1. Valentine J.C., Morrissey C.O., Tacey M.A., Liew D., Patil S., Ananda-Rajah M. A population-based analysis of attributable hospitalisation costs of invasive fungal diseases in haematological malignancy patients using data linkage of state-wide registry and costing databases: 2009–2015. Mycoses. 2020;63:162–171. doi: 10.1111/myc.13033. - DOI - PubMed
    1. Pagano L., Ricci P., Tonso A., Nosari A., Cudillo L., Montillo M., Cenacchi A., Pacilli L., Fabbiano F., Del Favero A. Mucormycosis in patients with haematological malignancies: A retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto) Br. J. Haematol. 1997;99:331–336. doi: 10.1046/j.1365-2141.1997.3983214.x. - DOI - PubMed
    1. Noorifard M., Sekhavati E., Khoo H.J., Hazraty I., Tabrizi R. Epidemiology and clinical manifestation of fungal infection related to Mucormycosis in hematologic malignancies. J. Med. Life. 2015;8:32–37. - PMC - PubMed
    1. Lewis R.E., Cahyame-Zuniga L., Leventakos K., Chamilos G., Ben-Ami R., Tamboli P., Tarrand J., Bodey G.P., Luna M., Kontoyiannis D.P. Epidemiology and sites of involvement of invasive fungal infections in patients with haematological malignancies: A 20-year autopsy study. Mycoses. 2013;56:638–645. doi: 10.1111/myc.12081. - DOI - PubMed
    1. Dignani M.C. Epidemiology of invasive fungal diseases on the basis of autopsy reports. F1000Prime Rep. 2014;6:81. doi: 10.12703/P6-81. - DOI - PMC - PubMed

LinkOut - more resources