TY - JOUR

T1 - Global guideline for the diagnosis and management of mucormycosis

T2 - an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

AU - Cornely, Oliver A

AU - Alastruey-Izquierdo, Ana

AU - Arenz, Dorothee

AU - Chen, Sharon C A

AU - Dannaoui, Eric

AU - Hochhegger, Bruno

AU - Hoenigl, Martin

AU - Jensen, Henrik E

AU - Lagrou, Katrien

AU - Lewis, Russell E

AU - Mellinghoff, Sibylle C

AU - Mer, Mervyn

AU - Pana, Zoi D

AU - Seidel, Danila

AU - Sheppard, Donald C

AU - Wahba, Roger

AU - Akova, Murat

AU - Alanio, Alexandre

AU - Al-Hatmi, Abdullah M S

AU - Arikan-Akdagli, Sevtap

AU - Badali, Hamid

AU - Ben-Ami, Ronen

AU - Bonifaz, Alexandro

AU - Bretagne, Stéphane

AU - Castagnola, Elio

AU - Chayakulkeeree, Methee

AU - Colombo, Arnaldo L

AU - Corzo-León, Dora E

AU - Drgona, Lubos

AU - Groll, Andreas H

AU - Guinea, Jesus

AU - Heussel, Claus-Peter

AU - Ibrahim, Ashraf S

AU - Kanj, Souha S

AU - Klimko, Nikolay

AU - Lackner, Michaela

AU - Lamoth, Frederic

AU - Lanternier, Fanny

AU - Lass-Floerl, Cornelia

AU - Lee, Dong-Gun

AU - Lehrnbecher, Thomas

AU - Lmimouni, Badre E

AU - Mares, Mihai

AU - Maschmeyer, Georg

AU - Meis, Jacques F

AU - Meletiadis, Joseph

AU - Morrissey, C Orla

AU - Nucci, Marcio

AU - Oladele, Rita

AU - Pagano, Livio

AU - Mucormycosis ECMM MSG Global Guideline Writing Group

N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

U2 - 10.1016/S1473-3099(19)30312-3

DO - 10.1016/S1473-3099(19)30312-3

M3 - Review

C2 - 31699664

VL - 19

SP - e405-e421

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 12

ER -