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Clinical Microbiology Reviews, July 2005, p. 556-569, Vol. 18, No. 3
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.3.556-569.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Brad Spellberg,1,2* John Edwards Jr.,1,2 and Ashraf Ibrahim1,2

Department of Medicine, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, California ,1 David Geffen School of Medicine at UCLA, Los Angeles, California2

Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement.

* Corresponding author. Mailing address: Division of Infect. Dis., Harbor-UCLA Medical Center, 1124 West Carson St. RB2, Torrance, CA 90502. Phone: (310) 222-5381. Fax: (310) 782-2016. E-mail: bspellberg{at}labiomed.org.

Clinical Microbiology Reviews, July 2005, p. 556-569, Vol. 18, No. 3
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.3.556-569.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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