Clinical Syndromes: Mucormycosis

  • Aigner Maria
  • Lass-Flörl Cornelia


Mucormycosis has emerged as an important fungal infection with high morbidity and mortality. The genera Rhizopus, Lichtheimia, and Mucor are most often recovered from clinical specimens and are ubiquitous in nature, but their precise ecology remains to be determined. Cases with mucormycosis have been reported from all over the world, and seasonal variation is possible. Israel reported that 16 of 19 rhino-orbitocerebral mucormycosis cases occurred in autumn [1], and in Japan, 6 of 7 pulmonary mucormycosis cases developed from August to September [2]. However, others report invasive cases all of the year [3–7]. There are several factors that limit our ability to accurately determine the exact incidence of mucormycosis. First, these infections are not reportable; the risk varies widely in different populations, and the proof of diagnosis is extremely difficult to obtain. Mucormycosis remains an uncommon disease, even in high-risk patients, and represents between 4 and 23% of all fungal infections in patients at risk [3–5]. Postmortem evaluation showed mucormycosis being 10–50-fold less frequent than candidiasis or aspergillosis with a frequency of 1–5 cases per 10,000 autopsies [3–7]. The epidemiology of mucormycosis varies between developed and developing countries. In developed countries the disease is most often seen in patients with hematological malignancies undergoing chemotherapy or who received allogeneic stem cell transplants (HSCT) [8]. Roden et al. compiled 929 cases of mucormycosis and displayed an increasing proportion of immunocompromised patients with mucormycosis in the 1980s and 1990s [9]. The registry of the European Confederation of Medical Mycology Working Group recorded 230 cases between 2005 and 2007 and found patients with hematological malignancies (44%), trauma (15%), HSCT (9%), and diabetes mellitus (9%) being infected [10]. Similar data were obtained by a French analysis comprising 101 cases of mucormycoses (60 proven and 41 probable cases), mostly in men (58%) older than >50 years (mean age, 50.7 ± 19.9 years). The incidence increased from 0.7 cases per 1 million in 1997 to 1.2 cases per 1 million in 2006 (P < 0.001) [11]. An active population-based surveillance study from California calculated an annual incidence of mucormycosis of 1.7 cases per 1 million individuals (∼500 cases per year) [12]. An incidence of 0.43 cases per 1 million inhabitants or 0.62 cases per 100,000 hospital admissions was rated for Spain [13]. In developing countries, especially in India, mucormycosis occurs mainly in patients with uncontrolled diabetes or trauma [14, 15].


  1. 1.
    Talmi YP, Goldschmied-Reouven A, Bakon M et al (2002) Rhino-orbital and rhino-orbitocerebral mucormycosis. Otolaryngol Head Neck Surg 127:22–31PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Funada H, Matsuda T (1996) Pulmonary mucormycosis in a hematology ward. Intern Med 35:540–544PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Kume H, Yamazaki T, Abe M et al (2003) Increase in aspergillosis and severe mycotic infection in patients with leukemia and MDS: comparison of the data from the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997. Path Intern 53:744–750CrossRefGoogle Scholar
  4. 4.
    Chamilos G, Luna M, Lewis RE et al (2006) Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica 91:986–989PubMedPubMedCentralGoogle Scholar
  5. 5.
    Hotchi M, Okada M, Nasu T (1980) Present state of fungal infections in autopsy cases in Japan. Am J Clin Pathol 74:410–416PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Tietz HJ, Brehmer D, Janisch W, Martin H (1998) Incidence of endomycoses in the autopsy material of the Berlin Charité Hospital. Mycoses 41:81–85PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Yamazaki T, Kume H, Murase S et al (1999) Epidemiology of visceral mycoses: analysis of data in annual of the pathological autopsy cases in Japan. J Clin Microbiol 37:1732–1738PubMedPubMedCentralGoogle Scholar
  8. 8.
    Spellberg B, Edwards J Jr, Ibrahim A (2005) Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev 18:556–569PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Roden MM, Zaoutis TE, Buchanan WL et al (2005) Epidemiology and outcome of mucormycosis: a review of 929 reported cases. Clin Infect Dis 41:634–653PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Skiada A, Pagano L, Groll A et al (2007) Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 17:1859–1867CrossRefGoogle Scholar
  11. 11.
    Bitar D, Van Cauteren D, Lanternier F et al (2009) Increasing incidence of zygomycosis (mucormycosis), France 1997-2006. Emerg Infect Dis 15:1395–1401PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Rees JR, Pinner RW, Hajjeh RA et al (1998) The epidemiological features of invasive mycotic infections in the San Francisco Bay area 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis 27:1138–1147PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Torres Narbona M, Guinea J, Martinez-Alarcon J et al (2007) Impact of mucormycosis on microbiology overload: a survey study in Spain. J Clin Microbiol 45:2051–2053PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Prabhu RM, Patel R (2004) Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 10:31–47PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Chakrabarti A, Das A, Mandal J et al (2006) The rising trend of invasive mucormycosis in patients with uncontrolled diabetes mellitus. Med Mycol 44:335–342PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Buzina W, Braun H, Freudenschuss K et al (2003) Fungal biodiversity – as found in nasal mucus. Med Mycol 41:149–161PubMedPubMedCentralGoogle Scholar
  17. 17.
    Ribes JA, Vanover-Sams CL, Baker DJ (2000) Zygomycetes in human diseases. Clin Microbiol Rev 13:236–301PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Petrikkos GL, Skiada A, Sambatakou H et al (2003) Mucormycosis: ten year experience in a tertiary-care centre in Greece. Eur J Clin Microbiol Infect Dis 22:753–756PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Antoniadou A (2009) Outbreaks of mucormycosis in hospitals. Clin Microbiol Infect 15:55–59PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Cheng VC, Chan JF, Ngan AH et al (2009) Outbreak of intestinal infection due to Rhizopus microsporus. J Clin Microbiol 47:2834–2843PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Gonzalez CE, Rinaldi MG, Sugar AM (2002) Mucormycosis. Infect Dis Clin N Am 16:895–914CrossRefGoogle Scholar
  22. 22.
    Rogers TR (2008) Treatment of mucormycosis: current and new options. J Antimicrob Chemother 61:35–39CrossRefGoogle Scholar
  23. 23.
    Goodman NL, Rinaldi MG (1991) Agents of mucormycosis. In: Balows A, Hausler WJ, Herrmann KL, Isenberg HD, Shadoomy HJ (eds) Manual of clinical microbiology, 5th edn. ASM Press, Washington, pp 674–692Google Scholar
  24. 24.
    Lopes JO, Pereira DV, Streher LA et al (1995) Cutaneous mucormycosis caused by Absidia corymbifera in a leukemic patient. Mycopathologia 130:89–92PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Stas KJF, Louwagie GLH, Van Damme BJC et al (1996) Isolated mucormycosis in a bought living unrelated kidney transplant. Transpl Int 9:600–602PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Zaoutis TE, Roilides E, Chiou CC et al (2007) Mucormycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis J 26:723–727PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Tedder M, Spratt JA, Anstadt MP et al (1994) Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg 57:1044–1050PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Gupta KL, Khullar DK, Behera D et al (1998) Pulmonary mucormycosis presenting as fatal massive haemoptysis in a renal transplant recipient. Nephrol Dial Transplant 13:3258–3260PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Kitabayashi A, Hirokawa M, Yamaguchi A, Takatsu H, Miura AB (1998) Invasive pulmonary mucormycosis with rupture of the thoracic aorta. Am J Hematol 58:326–329PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Passamonte PM, Dix JD (1985) Nosocomial pulmonary mucormycosis with fatal massive hemoptysis. Am J Med Sci 289:65–68PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Connor BA, Anderson RJ, Smith JW (1979) Mucor mediastinitis. Chest 75:525–526PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Hsu JW, Chiang CD (1996) A case report of novel roentgenographic finding in pulmonary mucormycosis: thickening of the posterior tracheal band. Kaohsiung J Med Sci 12:595–600PubMedPubMedCentralGoogle Scholar
  33. 33.
    Rubin SA, Chaljub G, Winer-Muram HT, Flicker S (1992) Pulmonary mucormycosis: a radiographic and clinical spectrum. J Thorac Imaging 7:85–90PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    McAdams HP, Rosado de Christenson M, Strollo DC, Path EF Jr (1997) Pulmonary mucormycosis: radiologic findings in 32 cases. Am J Roentgenol 168:1541–1548CrossRefGoogle Scholar
  35. 35.
    Dykhuizen RS, Kerr KN, Soutar RL (1994) Air crescent sign and fatal haemoptysis in pulmonary mucormycosis. Scand J Infect Dis 26:498–501PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Funada H, Misawa T, Nakao S et al (1984) The air crescent sign of invasive pulmonary mucormycosis in acute leukemia. Cancer 53:2721–2723PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Chamilos G, Marom EM, Lewis RE, Lionakis MS, Kontoyiannis DP (2005) Predictors of pulmonary mucormycosis versus invasive pulmonary aspergillosis in patients with cancer. Clin Infect Dis 41:60–66PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Wahba H, Truong MT, Lei X, Kontoyiannis DP, Marom EM (2008) Reversed halo sign in invasive pulmonary fungal infections. Clin Infect Dis 46:1733–1737PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Meyer RD, Rosen P, Armstrong D (1972) Phycomycosis complicating leukemia and lymphoma. Ann Intern Med 77:871–879PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Hosseini SM, Borghei P (2005) Rhinocerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngol 262:932–938PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Orguc S, Yuceturk AV, Demir MA, Goktan C (2005) Rhinocerebral mucormycosis: perineural spread via the trigeminal nerve. J Clin Neurosci 12:484–486PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Franquet T, Gimenez A, Hidalgo A (2004) Imaging of opportunistic fungal infections in immunocompromised patient. Eur J Radiol 51:130–138PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Garces P, Mueller D, Trevenen C (1994) Rhinocerebral mucormycosis in a child with leukemia: CT and MR findings. Pediatr Radiol 24:50–51PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Oliveira-Neto MP, Da Silva M, Monteiro PCF et al (2006) Cutaneous mucormycosis in a young, immunocompetent girl. Med Mycol 44:567–570PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Hampson FG, Ridgway EJ, Feeley K, Reilly JT (2005) A fatal case of disseminated mucormycosis associated with the use of blood glucose self-monitoring equipment. J Infect 51:e269–e272PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Hocker TL, Wada DA, Bridges A, El-Azhary R (2010) Disseminated mucormycosis heralded by a subtle cutaneous finding. Dermatol Online J 16:3PubMedPubMedCentralGoogle Scholar
  47. 47.
    Rubin AI, Grossman ME (2004) Bull’s-eye cutaneous infarct of mucormycosis: a bedside diagnosis confirmed by touch preparation. J Am Acad Dermatol 51:996–1001PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Kerr OA, Bong C, Wallis C, Tidman MJ (2004) Primary cutaneous mucormycosis masquerading as pyoderma gangrenosum. Br J Dermatol 150:1212–1234PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Diven SC, Angel CA, Hawkins HK, Rowen JL, Shattuck KE (2004) Intestinal mucormycosis due to Absidia corymbifera mimicking necrotizing enterocolitis in a preterm neonate. J Perinatol 24:794–796PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Mitchell SD, Gray J, Morgan ME et al (1996) Nosocomial infection with Rhizopus microsporus in preterm infants: association with wooden tongue depressors. Lancet 348:441–443PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Michalak DM, Cooney DR, Rhodes KH, Telander RL, Kleinberg F (1980) Gastrointestinal mucormycoses in infants and children: a cause of gangrenous intestinal cellulitis and perforation. J Pediatr Surg 15:320–324PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Garg PK, Gupta N, Gautam V, Hadke NS (2008) Gastric mucormycosis: unusual cause of gastric perforation in an immunocompetent patient. South Med J 101:449–450PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Bittencourt AL, Ayala MA, Ramos EA (1979) A new form of abdominal mucormycosis different from mucormycosis: report of two cases and review of the literature. Am J Trop Med Hyg 28:564–569PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Oliver MR, Van Voorhis WC, Boeckh M et al (1996) Hepatic mucormycosis in a bone marrow transplant recipient who ingested naturopathic medicine. Clin Infect Dis 22:521–524PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Ismail MH, Hodkinson HJ, Setzen G, Sofianos C, Hale MJ (1990) Gastric mucormycosis. Trop Gastroenterol 11:103–105PubMedPubMedCentralGoogle Scholar
  56. 56.
    Geramizadeh B, Modjalal M, Nabai S et al (2007) Gastrointestinal mucormycosis: a report of three cases. Mycopathologia 164:35–38PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Echo A, Hovsepian RV, Shen GK (2005) Localized cecal mucormycosis following renal transplantation. Transpl Infect Dis 7:68–70PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Virk SS, Singh RP, Arora AS, Grewal JS, Puri H (2004) Gastric mucormycosis – an unusual cause of massive upper gastrointestinal bleed. Indian J Gastroenterol 23:146–147PubMedPubMedCentralGoogle Scholar
  59. 59.
    Azadeh B, McCarthy DO, Dalton A, Campbell F (2004) Gastrointestinal mucormycosis: two case reports. Histopathology 44:298–300PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Park YS, Lee JD, Kim TH et al (2002) Gastric mucormycosis. Gastrointest Endosc 56:904–905PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Siu KL, Lee WH (2004) A rare cause of intestinal perforation in an extreme low birth weight infant – gastrointestinal mucormycosis: a case report. J Perinatol 24:319–321PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Cherney CL, Chutuape A, Fikrig MK (1999) Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review. Am J Gastroenterol 94:252–256PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Liu MF, Chen FF, Hsiue TR, Liu CC (2000) Disseminated mucormycosis simulating cerebrovascular disease and pulmonary alveolar haemorrhage in a patient with systemic lupus erythematosus. Clin Rheumatol 19:311–314PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Tomita T, Ho H, Allen M, Diaz J (2005) Mucormycosis involving lungs, heart and brain, superimposed on pulmonary edema. Pathol Int 55:202–205PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Fujii T, Takata N, Katsutani S, Kimura A (2003) Disseminated mucormycosis in an acquired immunodeficiency syndrome (AIDS) patient. Intern Med 42:129–130PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Richardson MD, Warnock DW (2003) Mucormycosis. In: Richardson MD, Warnock DW (eds) Fungal infection diagnosis and management. Blackwell, Oxford, pp 230–240CrossRefGoogle Scholar
  67. 67.
    Ingram CW, Sennesh J, Cooper JN, Perfect JR (1989) Disseminated mucormycosis: report of four cases and review. Rev Infect Dis 11:741–754PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Virmani R, Connor DH, McAllister HA (1982) Cardiac mucormycosis: a report of five patients and review of 14 previously reported cases. Am J Clin Pathol 78:42–47PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    McNab AA, McKelvie P (1997) Iron overload is a risk factor for mucormycosis. Arch Ophthalmol 115:919–921PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Sanchez-Recalde A, Merino JL, Dominguez F et al (1999) Successful treatment of prosthetic aortic valve mucormycosis. Chest 116:1818–1820PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Levy E, Bia MJ (1995) Isolated renal mucormycosis: case report and review. J Am Soc Nephrol 5:2014–2019PubMedPubMedCentralGoogle Scholar
  72. 72.
    Nagy-Agren SE, Chu P, Smith GJ et al (1995) Zygomycosis (mucormycosis) and HIV infection: report of three cases and review. J Acquir Immune Defic Syndr Hum Retrovirol 10:441–449PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Weng DE, Wilson WH, Little R, Walsh TJ (1998) Successful medical management of isolated renal zygomycosis: case report and review. Clin Infect Dis 26:601–605PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Langston C, Roberts DA, Porter GA, Bennett WM (1973) Renal phycomycosis. J Urol 109:941–944PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Melnick JZ, Latimer J, Lee EI, Heinrich WL (1995) Systemic mucormycosis complicating acute renal failure: case report and review of the literature. Ren Fail 17:619–627PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Chkhotua A, Yussim A, Tovar A et al (2001) Mucormycosis of the renal allograft: case report and review of the literature. Transpl Int 14:438–441PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Weng DE, Wilson WH, Little R, Walsh TJ (1998) Successful medical management of isolated renal mucormycosis: case report and review. Clin Infect Dis 26:601–605PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Mishra B, Mandal A, Kumar N (1992) Mycotic prosthetic-valve endocarditis. J Hosp Infect 20:122–125PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Solano T, Atkins B, Tambosis E, Mann S, Gottlieb T (2000) Disseminated mucormycosis due to Saksenaea vasiformis in an immunocompetent adult. Clin Infect Dis 30:942–943PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Zhang R, Zhang JW, Szerlip HM (2002) Endocarditis and hemorrhagic stroke caused by Cunninghamella bertholletiae infection after kidney transplantation. Am J Kidney Dis 40:842–846PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Kalayjian RC, Herzig RH, Cohen AM, Hutton MC (1988) Thrombosis of the aorta caused by mucormycosis. South Med J 81:1180–1182PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Mehta NN, Romanelli J, Sutton MG (2004) Native aortic valve vegetative endocarditis with Cunninghamella. Eur J Echocardiogr 5:156–158PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Gubarev N, Separovic J, Gasparovic V, Jelic I (2007) Successful treatment of mucormycosis endocarditis complicated by pulmonary involvement. Thorac Cardiovasc Surg 55:257–258PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Burke WV, Zych GA (2002) Fungal infection following replacement of the anterior cruciate ligament: a case report. J Bone Joint Surg 84A:449–453CrossRefGoogle Scholar
  85. 85.
    Pierce PP, Wood MB, Roberts GD et al (1987) Saksenaea vasiformis osteomyelitis. J Clin Microbiol 25:933–935PubMedPubMedCentralGoogle Scholar
  86. 86.
    Holtom PD, Obuch AB, Ahlmann ER, Shepherd LE, Patzakis MJ (2000) Mucormycosis of the tibia: a case report and review of the literature. Clin Orthop 381:222–228CrossRefGoogle Scholar
  87. 87.
    Ben-Ami R, Luna M, Lewis RE, Walsh TJ, DP Kontoyiannis DP (2009) A clinicopathological study of pulmonary mucormycosis in cancer patients: extensive angioinvasion but limited inflammatory response. J Infect 59:134–138PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Cornely OA, Arikan-Akdagli S, Dannaoui E et al (2014) ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20:5–26PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Ribes JA, Vanover-Sams CL, Baker DJ (2000) Zygomycetes in human disease. Clin Microbiol Rev 13:236–301PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Lass-Flörl C (2009) Zygomycosis: conventional laboratory diagnosis. Clin Microbiol Infect 5:60–65CrossRefGoogle Scholar
  91. 91.
    Lass-Flörl C, Resch G, Nachbaur D et al (2007) The value of computed tomography-guided percutaneous lung biopsy for diagnosis of invasive fungal infection in immunocompromised patients. Clin Infect Dis 45:e101–e104PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Kontoyiannis DP, Chamilos G, Hassan SA et al (2007) Increased culture recovery of zygomycetes under physiologic temperature conditions. Am J Clin Pathol 127:208–212PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Padhye AA, Ajello L (1988) Simple method of inducing sporulation by Apophysomyces elegans and Saksenaea vasiformis. J Clin Microbiol 26:1861–1863PubMedPubMedCentralGoogle Scholar
  94. 94.
    Kontoyiannis DP, Lionakis MS, Lewis RE et al (2005) Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case–control observational study of 27 recent cases. J Infect Dis 191:1350–1360PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Dolatabadi S, Kolecka A, Versteeg M, de Hoog SG, Boekhout T (2015) Differentiation of clinically relevant Mucorales Rhizopus microsporus and R. arrhizus by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). J Med Microbiol 64:694–701PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Caramalho R, Maurer E, Binder U et al (2015) Etest cannot be recommended for in vitro susceptibility testing of Mucorales. Antimicrob Agents Chemother 59:3663–3665PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Hsiao CR, Huang L, Bouchara J-P et al (2005) Identification of medically important molds by an oligonucleotide array. J Clin Microbiol 43:3760–3768PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Nagao K, Ota T, Tanikawa A et al (2005) Genetic identification and detection of human pathogenic Rhizopus species, a major mucormycosis agent, by multiplex PCR based on internal transcribed spacer region of rRNA gene. J Dermatol Sci 39:23–31PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Larché J, Machouart M, Burton K et al (2005) Diagnosis of cutaneous mucormycosis due to Rhizopus microsporus by an innovative PCR-restriction fragment-length polymorphism method. Clin Infect Dis 41:1362–1365PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Machouart M, Larché J, Burton K et al (2006) Genetic identification of the main opportunistic mucorales by PCR-restriction fragment length polymorphism. J Clin Microbiol 44:805–810PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Nyilasi I, Papp T, Csernetics Á et al (2008) High-affinity iron permease (FTR1) gene sequence-based molecular identification of clinically important Zygomycetes. Clin Microbiol Infect 14:393–397PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Kasai M, Harrington SM, Francesconi A et al (2008) Detection of a molecular biomarker for zygomycetes by quantitative PCR assays of plasma, bronchoalveolar lavage, and lung tissue in a rabbit model of experimental pulmonary zygomycosis. J Clin Microbiol 46:3690–3702PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Spellberg B, Walsh TJ, Kontoyiannis DP et al (2009) Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 48:1743–1751PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Farmakiotis D, Kontoyiannis DP (2016) Mucormycoses. Infect Dis Clin N Am 30:143–163CrossRefGoogle Scholar
  105. 105.
    McCarthy M, Rosengart A, Schuetz AN et al (2014) Mold infections of the central nervous system. N Engl J Med 371:150–160PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Brown RB, Johnson JH, Kessinger JM, Sealy WC (1992) Bronchovascular mucormycosis in the diabetic: an urgent surgical problem. Ann Thorac Surg 53:854–855PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Gonzalez CE, Couriel DR, Walsh TJ (1997) Disseminated zygomycosis in a neutropenic patient: successful treatment with amphotericin B lipid complex and granulocyte colony-stimulating factor. Clin Infect Dis 24:192–196PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Spanakis EK, Aperis G, Mylonakis E (2006) New agents for the treatment of fungal infections: clinical efficacy and gaps in coverage. Clin Infect Dis 43:1060–1068PubMedCrossRefPubMedCentralGoogle Scholar
  109. 109.
    Sun QN, Fothergill AW, McCarthy DI et al (2002) In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother 46:1581–1582PubMedPubMedCentralCrossRefGoogle Scholar
  110. 110.
    Thompson GR, Wiederhold NP (2010) Isavuconazole: a comprehensive review of spectrum of activity of a new triazole. Mycopathologia 170:291–313PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Arendrup MC, Jensen RH, Meletiadis J (2015) In vitro activity of isavuconazole and comparators against clinical isolates of the mucorales order. Antimicrob Agents Chemother 59:7735–7742PubMedPubMedCentralCrossRefGoogle Scholar
  112. 112.
    Noxafil (posaconazole). Highlights of prescribing information. Accessed 18 March 2014
  113. 113.
    Marti FM, Ostrosky-Zeichner L, Cornely OA et al (2016) Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 16:828–837CrossRefGoogle Scholar
  114. 114.
    Cresemba (isavuconazonium sulfate). Highlights of prescribing information. Accessed 9 March 2015
  115. 115.
    Kontoyiannis DP, Lewis RE (2011) How I treat mucormycosis. Blood 118:1216–1224PubMedPubMedCentralCrossRefGoogle Scholar
  116. 116.
    Yohai RA, Bullock JD, Aziz AA, Markert RJ (1994) Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 39:3–22PubMedCrossRefPubMedCentralGoogle Scholar
  117. 117.
    Ferguson BJ, Mitchell TG, Moon R et al (1988) Adjunctive hyperbaric oxygen for treatment of rhinocerebral mucormycosis. Rev Infect Dis 10:551–559PubMedCrossRefPubMedCentralGoogle Scholar
  118. 118.
    Bentur Y, Shupak A, Ramon Y et al (1998) Hyperbaric oxygen therapy for cutaneous/soft-tissue zygomycosis complicating diabetes mellitus. Plast Reconstr Surg 102:822–824PubMedCrossRefPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Division of Hygiene and Medical MicrobiologyMedical University of InnsbruckInnsbruckAustria

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