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      Challenges in the management of severe cutaneous mucormycosis: A case of rapid progression in uncontrolled diabetes mellitus with polymicrobial implications

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          Abstract

          Mucormycosis, a rare but life-threatening fungal infection, poses significant challenges in clinical management, particularly in patients with uncontrolled diabetes mellitus. This case report presents the clinical journey of a 44-year-old woman who developed a rapidly progressing Mucorales infection following a domestic knife injury. Her condition, complicated by diabetic ketoacidosis and co-infection with Candida albicans, led to severe hand phlegm and sepsis. Despite aggressive intervention, the infection continued to advance, ultimately resulting in the patient’s demise.

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          Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

          Oliver Cornely, Ana Alastruey-Izquierdo, Dorothee Arenz … (2019)
          Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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            Novel perspectives on mucormycosis: pathophysiology, presentation, and management.

            Brad Spellberg, John Edwards, Ashraf Ibrahim (2005)
            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.
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              Epidemiology and clinical manifestations of mucormycosis.

              George Petrikkos, Anna Skiada, Olivier Lortholary … (2012)
              Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations. The underlying conditions can influence clinical presentation and outcome. This review describes the emerging epidemiology and the clinical manifestations of mucormycosis.
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                Author and article information

                Contributors
                Sara Harrar
                Journal
                Journal ID (nlm-ta): Med Mycol Case Rep
                Journal ID (iso-abbrev): Med Mycol Case Rep
                Title: Medical Mycology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2211-7539
                Publication date PMC-release: 08 March 2024
                Publication date Collection: June 2024
                Publication date (Electronic): 08 March 2024
                Volume: 44
                Electronic Location Identifier: 100643
                Affiliations
                [a ]Parasitology-Mycology Laboratory Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, 40000, Morocco
                [b ]Traumatology-Orthopedy B Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, 40000, Morocco
                Author notes
                [* ]Corresponding author. Harrarsara4@ 123456gmail.com
                Article
                Publisher Item ID: S2211-7539(24)00017-4 Publisher ID: 100643
                DOI: 10.1016/j.mmcr.2024.100643
                PMC ID: 10950793
                PubMed ID: 38516607
                SO-VID: 3a638a0e-fd41-4e57-8e8c-fd74a77a27af
                Copyright © © 2024 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 January 2024
                Date revision received : 19 February 2024
                Date accepted : 1 March 2024
                Categories
                Subject: Case Report

                Keywords: cutaneous mucormycosis,mucorales,candida albicans,diabetes mellitus,diabetic ketoacidosis
                Data availability:
                Keywords: cutaneous mucormycosis, mucorales, candida albicans, diabetes mellitus, diabetic ketoacidosis

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