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

O. A. Cornely; S. Arikan-Akdagli; E. Dannaoui; A. H. Groll; K. Lagrou; A. Chakrabarti; F. Lanternier; L. Pagano; A. Skiada; M. Akova; M. C. Arendrup; T. Boekhout; A. Chowdhary; M. Cuenca-Estrella; T. Freiberger; J. Guinea; J. Guarro; S. de Hoog; W. Hope; E. Johnson; S. Kathuria; M. Lackner; C. Lass-Flörl; O. Lortholary; J. F. Meis; J. Meletiadis; P. Muñoz; M. Richardson; E. Roilides; A. M. Tortorano; A. J. Ullmann; A. van Diepeningen; P. Verweij; G. Petrikkos

doi:10.1111/1469-0691.12371

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

O. A. Cornely, S. Arikan-Akdagli, E. Dannaoui, A. H. Groll, K. Lagrou, A. Chakrabarti, F. Lanternier, L. Pagano, A. Skiada, M. Akova, M. C. Arendrup, T. Boekhout, A. Chowdhary, M. Cuenca-Estrella, T. Freiberger, J. Guinea, J. Guarro, S. de Hoog, W. Hope, E. JohnsonS. Kathuria, M. Lackner, C. Lass-Flörl, O. Lortholary, J. F. Meis, J. Meletiadis, P. Muñoz, M. Richardson, E. Roilides, A. M. Tortorano, A. J. Ullmann, A. van Diepeningen, P. Verweij, G. Petrikkos

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Abstract

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 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4 × 200 mg/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. © 2014 European Society of Clinical Microbiology and Infectious Diseases.

Original language	English
Pages (from-to)	5-26
Number of pages	21
Journal	Clinical Microbiology and Infection
Volume	20
Issue number	3
DOIs	https://doi.org/10.1111/1469-0691.12371
Publication status	Published - 2014

Keywords

Diagnosis
Fungal infection
Guideline
Mucormycosis
Mycosis
Prophylaxis
Treatment
Zygomycosis

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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, T., Guinea, J., Guarro, J., de Hoog, S., Hope, W., ... Petrikkos, G. (2014). ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clinical Microbiology and Infection, 20(3), 5-26. https://doi.org/10.1111/1469-0691.12371

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title = "ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013",

abstract = "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 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4 × 200 mg/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. {\textcopyright} 2014 European Society of Clinical Microbiology and Infectious Diseases.",

keywords = "Diagnosis, Fungal infection, Guideline, Mucormycosis, Mycosis, Prophylaxis, Treatment, Zygomycosis",

author = "Cornely, {O. A.} and S. Arikan-Akdagli and E. Dannaoui and Groll, {A. H.} and K. Lagrou and A. Chakrabarti and F. Lanternier and L. Pagano and A. Skiada and M. Akova and Arendrup, {M. C.} and T. Boekhout and A. Chowdhary and M. Cuenca-Estrella and T. Freiberger and J. Guinea and J. Guarro and {de Hoog}, S. and W. Hope and E. Johnson and S. Kathuria and M. Lackner and C. Lass-Fl{\"o}rl and O. Lortholary and Meis, {J. F.} and J. Meletiadis and P. Mu{\~n}oz and M. Richardson and E. Roilides and Tortorano, {A. M.} and Ullmann, {A. J.} and {van Diepeningen}, A. and P. Verweij and G. Petrikkos",

year = "2014",

doi = "10.1111/1469-0691.12371",

language = "English",

volume = "20",

pages = "5--26",

journal = "Clinical Microbiology and Infection",

issn = "1469-0691",

publisher = "Elsevier BV",

number = "3",

}

Cornely, OA, Arikan-Akdagli, S, Dannaoui, E, Groll, AH, Lagrou, K, Chakrabarti, A, Lanternier, F, Pagano, L, Skiada, A, Akova, M, Arendrup, MC, Boekhout, T, Chowdhary, A, Cuenca-Estrella, M, Freiberger, T, Guinea, J, Guarro, J, de Hoog, S, Hope, W, Johnson, E, Kathuria, S, Lackner, M, Lass-Flörl, C, Lortholary, O, Meis, JF, Meletiadis, J, Muñoz, P, Richardson, M, Roilides, E, Tortorano, AM, Ullmann, AJ, van Diepeningen, A, Verweij, P & Petrikkos, G 2014, 'ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013', Clinical Microbiology and Infection, vol. 20, no. 3, pp. 5-26. https://doi.org/10.1111/1469-0691.12371

TY - JOUR

T1 - ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013

AU - Cornely, O. A.

AU - Arikan-Akdagli, S.

AU - Dannaoui, E.

AU - Groll, A. H.

AU - Lagrou, K.

AU - Chakrabarti, A.

AU - Lanternier, F.

AU - Pagano, L.

AU - Skiada, A.

AU - Akova, M.

AU - Arendrup, M. C.

AU - Boekhout, T.

AU - Chowdhary, A.

AU - Cuenca-Estrella, M.

AU - Freiberger, T.

AU - Guinea, J.

AU - Guarro, J.

AU - de Hoog, S.

AU - Hope, W.

AU - Johnson, E.

AU - Kathuria, S.

AU - Lackner, M.

AU - Lass-Flörl, C.

AU - Lortholary, O.

AU - Meis, J. F.

AU - Meletiadis, J.

AU - Muñoz, P.

AU - Richardson, M.

AU - Roilides, E.

AU - Tortorano, A. M.

AU - Ullmann, A. J.

AU - van Diepeningen, A.

AU - Verweij, P.

AU - Petrikkos, G.

PY - 2014

Y1 - 2014

N2 - 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 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4 × 200 mg/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. © 2014 European Society of Clinical Microbiology and Infectious Diseases.

AB - 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 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4 × 200 mg/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. © 2014 European Society of Clinical Microbiology and Infectious Diseases.

KW - Diagnosis

KW - Fungal infection

KW - Guideline

KW - Mucormycosis

KW - Mycosis

KW - Prophylaxis

KW - Treatment

KW - Zygomycosis

U2 - 10.1111/1469-0691.12371

DO - 10.1111/1469-0691.12371

M3 - Article

SN - 1469-0691

VL - 20

SP - 5

EP - 26

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 3

ER -

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

Abstract

Keywords

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