Mucormycosis is an invasive fungal infection caused by filamentous fungi of the Mucoraceae family. The genera most commonly responsible are Mucor or Rhizopus. The disease occurs mostly in association with diabetic ketoacidosis. Mucormycosis has an extremely high death rate even when aggressive surgery is done. Death rates range from 25-85% depending on the body area involved. In addition to debridement , we mostly require extensive use of antifungals either single drug/ combination .
The management of mucormycosis is based on multiple interventions occurring simultaneously, or with different timing and intensity. The basic principles of mucormycosis treatment include risk stratification for severity of the diseases, and intense attempts for early, clinical and laboratory diagnosis; timely initiation of an effective antifungal therapy (monotherapy or combination therapy) along with aggressive surgical debridement of necrotic lesions; reverse of immunosuppression (discontinuation of chemotherapy and increase of neutrophils), and when feasible control of the underlying medical condition. Early diagnosis and prompt therapeutic intervention may prevent progressive tissue invasion and its sequelae, may also reduce the need for extensive surgery and subsequent deformity, and may improve survival.Only amphotericin B (AMB) and its lipid formulations, and recently isavuconazole have been studied as first-line therapy for mucormycosis. On the contrary, posaconazole has been mainly studied as salvage therapy.Among triazole antifungals, fluconazole, itraconazole, and voriconazole have little or no activity against Mucorales. Newer triazoles, namely posaconazole and isavuconazole, have better in vitro activity against Mucorales and clinical data supporting their use in mucormycosis.
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