Publication details

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013

Authors	CORNELY O.A. ARIKAN- AKDAGLI S. DANNAOUI E. GROLL A.H. LAGROU K. CHAKRABARTI A. LANTERNIER F. PAGANO L. SKIADA A. AKOVA M. ARENDRUP M.C. BOEKHOUT T. CHOWDHARY A. CUENCA- ESTRELLA M. FREIBERGER Tomáš GUINEA J. GUARRO J. DE HOOG S. HOPE W. JOHNSON E. KATHURIA S. LACKNER M. LASS- FLÖRL C. LORTHOLARY O. MEIS J.F. MELATIADIS J. MUNOZ P. RICHARDSON M. ROILIDES E. TORTORANO A.M. ULLMANN A.J. VAN DIEPENINGEN A. VERWEIJ P. PETRIKKOS G.
Year of publication	2014
Type	Article in Periodical
Magazine / Source	Clinical Microbiology and Infection
MU Faculty or unit	Central European Institute of Technology
Citation
Web	http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12371/pdf
Doi	http://dx.doi.org/10.1111/1469-0691.12371
Field	Microbiology, virology
Keywords	LIPOSOMAL AMPHOTERICIN-B; INVASIVE FUNGAL-INFECTIONS; ORBITAL-CEREBRAL MUCORMYCOSIS; IN-VITRO SUSCEPTIBILITIES; FRAGMENT LENGTH POLYMORPHISM; HEMATOLOGY-ONCOLOGY PATIENTS; ORGAN TRANSPLANT RECIPIENTS; DESORPTION IONIZATION-TIME;
Attached files	ZVV_2014_072_1198044_ESCMID_and_ECMM_joint_clinical_guidelines.pdf
Description	These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Pathogen identification to species level by molecular methods and susceptibility testing are strongly recommended to establish epidemiological knowledge. The recommendation for guiding treatment based on MICs is supported only marginally. Imaging is strongly recommended to determine the extent of disease. To differentiate mucormycosis from aspergillosis in haematological malignancy and stem cell transplantation recipients, identification of the reverse halo sign on computed tomography is advised with moderate strength. For adults and children we strongly recommend surgical debridement in addition to immediate first-line antifungal treatment with liposomal or lipid-complex amphotericin B with a minimum dose of 5mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4x200mg/day. Reversal of predisposing conditions is strongly recommended, i.e. using granulocyte colony-stimulating factor in haematological patients with ongoing neutropenia, controlling hyperglycaemia and ketoacidosis in diabetic patients, and limiting glucocorticosteroids to the minimum dose required. We recommend against using deferasirox in haematological patients outside clinical trials, and marginally support a recommendation for deferasirox in diabetic patients. Hyperbaric oxygen is supported with marginal strength only. Finally, we strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.