Journal Article

Recent Advances in the Management of Mucormycosis: From Bench to Bedside

Ellie J. C. Goldstein, Brad Spellberg, Thomas J. Walsh, Dimitrios P. Kontoyiannis, John Edwards and Ashraf S. Ibrahim

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 12, pages 1743-1751
Published in print June 2009 | ISSN: 1058-4838
Published online June 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/599105
Recent Advances in the Management of Mucormycosis: From Bench to Bedside

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Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mucormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.

Journal Article.  6255 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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