Although definitive diagnosis requires a positive culture from a sterile site, a positive culture from a nonsterile site (e.g., sputum or bronchoalveolar lavage [BAL] fluid) in a pt with a consistent clinical history should prompt treatment pending confirmation of the diagnosis.
- The fact that only ~50% of pts have positive cultures is due, in part, to the organisms' being killed by the tissue homogenization required for preparation of culture.
- The laboratory should be notified that mucormycosis is being considered so that tissue sections instead of tissue homogenates can be cultured.
Treatment: Mucormycosis - The successful treatment of mucormycosis requires four steps: (1) early diagnosis; (2) reversal of underlying predisposing risk factors, if possible; (3) surgical debridement; and (4) prompt antifungal therapy.
- AmB (AmB deoxycholate, 1-1.5 mg/kg qd; or liposomal AmB, 5-10 mg/kg qd) is preferred.
- - Limited retrospective data suggest that combinations of echinocandins and liposomal AmB may be more effective.
- - Although posaconazole has in vitro activity against Mucorales, few clinical data support its use.
- - Initial clinical trials suggest that liposomal AmB combined with deferasirox (an iron chelator that is fungicidal for clinical isolates of Mucorales; 20 mg/kg PO qd for 2-4 weeks) results in improved survival rates.
- - Treatment should be continued until (1) resolution of clinical signs and symptoms of infection, (2) resolution or stabilization of residual radiographic signs of disease on serial imaging, and (3) resolution of underlying immunosuppression.
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