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Review
. 2024 Dec;56(1):2396570.
doi: 10.1080/07853890.2024.2396570. Epub 2024 Sep 2.

Epidemiology, pathogenesis, clinical characteristics, and treatment of mucormycosis: a review

Mei Liang  1 , Jian Xu  1 , Yanan Luo  1 , Junyan Qu  1
Affiliations
Review

Epidemiology, pathogenesis, clinical characteristics, and treatment of mucormycosis: a review

Mei Liang et al. Ann Med. 2024 Dec.

Abstract

Aim: This review aims to summarize the epidemiology, etiology, pathogenesis, clinical manifestations, and current diagnostic and therapeutic approaches for mucormycosis. The goal is to improve understanding of mucormycosis and promote early diagnosis and treatment to reduce mortality.

Methods: A comprehensive literature review was conducted, focusing on recent studies and data on mucormycosis. The review includes an analysis of the disease's epidemiology, etiology, and pathogenesis, as well as current diagnostic techniques and therapeutic strategies.

Results: Mucormycosis is increasingly prevalent due to the growing immunocompromised population, the COVID-19 pandemic, and advances in detection methods. The pathogenesis is closely associated with the host immune status, serum-free iron levels, and the virulence of Mucorales. However, the absence of typical clinical manifestations complicates diagnosis, leading to missed or delayed diagnoses and higher mortality.

Conclusion: An enhanced understanding of the epidemiology, pathogenesis, and clinical presentation of mucormycosis, along with the adoption of improved diagnostic and therapeutic approaches, is essential for reducing mortality rates associated with this opportunistic fungal infection. Early diagnosis and prompt treatment are critical to improving patient outcomes.

Keywords: COVID-19; Mucormycosis; clinical characteristics; therapeutic strategy.

Plain language summary

The incidence of mucormycosis has increased following the COVID-19 pandemic.The presence of the halo sign and reverse halo sign may indicate the onset of pulmonary mucormycosis.Early implementation of molecular diagnostic methods, such as mNGS and qPCR, may improve the early diagnosis rate of mucormycosis.Isavuconazole and posaconazole can also be considered as first-line treatments for the initial management of mucormycosis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
The pathogenesis of COVID-19-associated mucormycosis. Illustration: After binding to the ACE2 and GPR78 receptors expressed on the surface of oropharyngeal epithelial cells, SARS-CoV-2 induces cell death and the release of inflammatory mediators, damaging epithelial cells. This leads to the disruption of intercellular connections and dysfunction of epithelial cell function, establishing favorable conditions for the invasion of mucormycosis cells. Furthermore, the virus itself, by damaging the human blood glucose regulation system, can result in hyperglycemia, which is exacerbated by corticosteroids used to treat COVID-19. Hyperglycemia induces the upregulation of GPR78 expression on epithelial cells, increasing their susceptibility to mucormycosis invasion. Additionally, impairment of the immune system by COVID-19, such as a reduction in CD4+/CD8+ T-cell counts and dysfunction resulting in decreased expression of cytokines such as IFN-γ and TNF, weakens resistance to Mucorales and renders individuals susceptible to infection.
Figure 2.
Figure 2.
Diagnostic pathway of mucormycosis. Comments: For individuals at high risk, proactive measures following this protocol are recommended. Even in individuals without underlying disease, suspected mucormycosis can be diagnosed early by referring to this protocol.
See this image and copyright information in PMC

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