Brazilian task force for the management of mucormycosis

Abstract

Background: Mucormycosis is a rare but life‑threatening fungal infection that has shown an increased incidence in Brazil, especially during the COVID‑19 pandemic.

Objective: To provide an evidence‑based, context‑specific guideline for the diagnosis and management of mucormycosis within the Brazilian healthcare system.

Clinical features: Rhino‑orbito‑cerebral disease predominates, followed by pulmonary, cutaneous, gastrointestinal and disseminated forms; delayed recognition dramatically increases mortality.

Epidemiology: The global incidence of mucormycosis is increasing, particularly among patients with diabetes mellitus, hematologic malignancies, transplantation, and corticosteroid exposure. The most frequently isolated species is Rhizopus arrhizus, and regional variations in species distribution may be present. In Brazil, comprehensive epidemiological data remain scarce.

Treatment: Early, aggressive surgical debridement plus induction with liposomal amphotericin B (5-10 mg/kg/day) followed by isavuconazole or posaconazole is recommended; strict control of hyperglycemia and immunosuppression is essential.

Conclusion: Standardized national guidance, improved rapid diagnostics, systematic surveillance and equitable drug availability are critical to reduce Brazil's mucormycosis burden.

Keywords: Isavuconazole; Liposomal amphotericin B; Ministry of health; Mucormycosis; Surgical debridement; Task force.

Fig. 1

Diagnostic pathway and classification criteria for mucormycosis.

Fig. 2

Steps for the management of mucormycosis in Brazil. ALT, Alanine Aminotransferase; AST, Aspartate Aminotranferase; BDG, Beta-d-Glucan; CNS, Central Nervous System; CRP, C-Reactive Protein; CT, Computed Tomography; GM, Galactomanan; l-AmB, Liposomal Amphotericin B; MRI, Magnetic Resonance Imaging; PT, Prothrombin Time; TTPA, Activated Partial Thromboplastin Time.