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 A Cornely, Ana Alastruey-izquierdo, Dorothee Arenz, Sharon C A Chen, Eric Dannaoui, Bruno Hochhegger, Martin Hoenigl, Henrik E Jensen, Katrien Lagrou, Russell E Lewis, Sibylle C Mellinghoff, Mervyn Mer, Zoi D Pana, Danila Seidel, Donald C Sheppard, Roger Wahba, Murat Akova, Alexandre Alanio, Abdullah M S Al-hatmi, Sevtap Arikan-akdagliHamid Badali, Ronen Ben-ami, Alexandro Bonifaz, Stéphane Bretagne, Elio Castagnola, Methee Chayakulkeeree, Arnaldo L Colombo, Dora E Corzo-león, Lubos Drgona, Andreas H Groll, Jesus Guinea, Claus-peter Heussel, Ashraf S Ibrahim, Souha S Kanj, Nikolay Klimko, Michaela Lackner, Frederic Lamoth, Fanny Lanternier, Cornelia Lass-floerl, Dong-gun Lee, Thomas Lehrnbecher, Badre E Lmimouni, Mihai Mares, Georg Maschmeyer, Jacques F Meis, Joseph Meletiadis, C Orla Morrissey, Marcio Nucci, Rita Oladele, Livio Pagano, Alessandro Pasqualotto, Atul Patel, Zdenek Racil, Malcolm Richardson, Emmanuel Roilides, Markus Ruhnke, Seyedmojtaba Seyedmousavi, Neeraj Sidharthan, Nina Singh, János Sinko, Anna Skiada, Monica Slavin, Rajeev Soman, Brad Spellberg, William Steinbach, Ban Hock Tan, Andrew J Ullmann, Jörg J Vehreschild, Maria J G T Vehreschild, Thomas J Walsh, P Lewis White, Nathan P Wiederhold, Theoklis Zaoutis, Arunaloke Chakrabarti

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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). The author group based in 17 time zones, relied on electronic media including video tutorial on methodology, and central document repository with several daily updates.
Signs and symptoms of mucormycosis depend on organ patterns and underlying conditions. 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.
Original languageEnglish
JournalThe Lancet Infectious Diseases
Early online date4 Nov 2019
Publication statusPublished - 2019


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