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Review
. 2019 Dec;19(12):e405-e421.
doi: 10.1016/S1473-3099(19)30312-3. Epub 2019 Nov 5.

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  1 Ana Alastruey-Izquierdo  2 Dorothee Arenz  3 Sharon C A Chen  4 Eric Dannaoui  5 Bruno Hochhegger  6 Martin Hoenigl  7 Henrik E Jensen  8 Katrien Lagrou  9 Russell E Lewis  10 Sibylle C Mellinghoff  3 Mervyn Mer  11 Zoi D Pana  12 Danila Seidel  3 Donald C Sheppard  13 Roger Wahba  14 Murat Akova  15 Alexandre Alanio  16 Abdullah M S Al-Hatmi  17 Sevtap Arikan-Akdagli  18 Hamid Badali  19 Ronen Ben-Ami  20 Alexandro Bonifaz  21 Stéphane Bretagne  16 Elio Castagnola  22 Methee Chayakulkeeree  23 Arnaldo L Colombo  24 Dora E Corzo-León  25 Lubos Drgona  26 Andreas H Groll  27 Jesus Guinea  28 Claus-Peter Heussel  29 Ashraf S Ibrahim  30 Souha S Kanj  31 Nikolay Klimko  32 Michaela Lackner  33 Frederic Lamoth  34 Fanny Lanternier  35 Cornelia Lass-Floerl  33 Dong-Gun Lee  36 Thomas Lehrnbecher  37 Badre E Lmimouni  38 Mihai Mares  39 Georg Maschmeyer  40 Jacques F Meis  41 Joseph Meletiadis  42 C Orla Morrissey  43 Marcio Nucci  44 Rita Oladele  45 Livio Pagano  46 Alessandro Pasqualotto  47 Atul Patel  48 Zdenek Racil  49 Malcolm Richardson  50 Emmanuel Roilides  12 Markus Ruhnke  51 Seyedmojtaba Seyedmousavi  52 Neeraj Sidharthan  53 Nina Singh  54 János Sinko  55 Anna Skiada  56 Monica Slavin  57 Rajeev Soman  58 Brad Spellberg  59 William Steinbach  60 Ban Hock Tan  61 Andrew J Ullmann  62 Jörg J Vehreschild  63 Maria J G T Vehreschild  64 Thomas J Walsh  65 P Lewis White  66 Nathan P Wiederhold  67 Theoklis Zaoutis  68 Arunaloke Chakrabarti  69 Mucormycosis ECMM MSG Global Guideline Writing Group
Affiliations
Review

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 et al. Lancet Infect Dis. .

Abstract

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). 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.

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