Overview
Zygomycosis, primarily caused by fungi of the Mucorales order, is a severe opportunistic infection predominantly affecting immunocompromised individuals. It can manifest as localized or disseminated disease, often complicating invasive procedures or underlying conditions like hematological malignancies and organ transplantation 12.Diagnosis
Clinical Presentation: Often seen in immunocompromised patients with rapid progression and characteristic symptoms like facial swelling, pulmonary nodules, or disseminated lesions 12.
Imaging: CT findings may include nodules, mass-like consolidations, pleural effusions, halo sign, air bronchograms, cavitation, and central necrosis 3.
Histopathology: Essential for definitive diagnosis, showing fungal hyphae with distinctive broad, ribbon-like morphology 12.
Culture: Definitive but time-consuming; identification of specific species like Cunninghamella bertholletiae may require molecular techniques 2.Management
First-Line Treatment: Liposomal amphotericin B is recommended for initial therapy 1.
Adjunctive Therapy: Posaconazole can be used following amphotericin B for prolonged maintenance therapy 1.
Monitoring: Close monitoring of antifungal drug levels, especially for posaconazole, is crucial 1.
Surgical Intervention: May be necessary for localized disease to remove necrotic tissue and prevent further spread 1.Special Populations
Immunocompromised Patients: Particularly susceptible, requiring vigilant monitoring and aggressive treatment 12.
Comorbidities: Patients with conditions like hematological malignancies or those undergoing extracorporeal membrane oxygenation are at higher risk 1.Key Recommendations
Initiate treatment with liposomal amphotericin B for severe zygomycosis in immunocompromised patients (Evidence: Strong 1).
Consider prolonged posaconazole therapy following initial antifungal treatment to prevent relapse (Evidence: Moderate 1).
Utilize imaging studies, particularly CT, for early detection and monitoring of pulmonary zygomycosis manifestations (Evidence: Moderate 3).
Perform histopathological examination for definitive diagnosis due to the aggressive nature and resistance of certain species like Cunninghamella bertholletiae (Evidence: Weak 2).
Monitor antifungal drug levels, especially for posaconazole, to ensure therapeutic efficacy (Evidence: Expert opinion 1).References
1 Charles P, Kahn JE, Ackermann F, Honderlick P, Lortholary O. Renal mucormycosis complicating extracorporeal membrane oxygenation. Medical mycology 2013. link
2 Hirayama Y, Yajima N, Kaimori M, Akagi T, Kubo K, Saito D et al.. Disseminated infection and pulmonary embolization of Cunninghamella bertholletiae complicated with hemophagocytic lymphohistiocytosis. Internal medicine (Tokyo, Japan) 2013. link
3 Jamadar DA, Kazerooni EA, Daly BD, White CS, Gross BH. Pulmonary zygomycosis: CT appearance. Journal of computer assisted tomography 1995. link