Diagnosis and Treatment of Invasive Mucormycosis
Invasive fungal infections are usually observed in severely immunosuppressed patients. The underlying diseases of mucormycosis include diabetes mellitus and hematological malignancies. Rhino-orbital disease is frequent among patients with diabetes, whereas patients with hematological malignancies of...
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| Published in | Nihon Ishinkin Gakkai Zasshi Vol. 64; no. 3; pp. 77 - 82 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society for Medical Mycology
2023
一般社団法人 日本医真菌学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2434-5229 2434-5237 |
| DOI | 10.11534/ishinkin.23.005 |
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| Abstract | Invasive fungal infections are usually observed in severely immunosuppressed patients. The underlying diseases of mucormycosis include diabetes mellitus and hematological malignancies. Rhino-orbital disease is frequent among patients with diabetes, whereas patients with hematological malignancies often develop pulmonary mucormycosis. The prognosis of mucormycosis is extremely poor, and thus early diagnosis and early treatment start are important. However, diagnosis is difficult as its clinical manifestation is similar with that of aspergillosis. There has been no specific serological test for mucormycosis, and biopsy of the involved lesion should be considered. High-dose (5 mg/kg/day) liposomal amphotericin-B is the first line treatment, while azole antifungals with activity against mucormycosis, such as posaconazole or isavuconazole, can be used for refractory or intolerant cases and when switching to oral treatment. Surgical resection or debridement should be considered, if possible, especially for rhino-orbital disease, soft tissue lesion, and single pulmonary lesion, concomitant with antifungal treatment. In addition, reversal of immune function should be tried, as far as possible. |
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| AbstractList | Invasive fungal infections are usually observed in severely immunosuppressed patients. The underlying diseases of mucormycosis include diabetes mellitus and hematological malignancies. Rhino-orbital disease is frequent among patients with diabetes, whereas patients with hematological malignancies often develop pulmonary mucormycosis. The prognosis of mucormycosis is extremely poor, and thus early diagnosis and early treatment start are important. However, diagnosis is difficult as its clinical manifestation is similar with that of aspergillosis. There has been no specific serological test for mucormycosis, and biopsy of the involved lesion should be considered. High-dose (5 mg/kg/day) liposomal amphotericin-B is the first line treatment, while azole antifungals with activity against mucormycosis, such as posaconazole or isavuconazole, can be used for refractory or intolerant cases and when switching to oral treatment. Surgical resection or debridement should be considered, if possible, especially for rhino-orbital disease, soft tissue lesion, and single pulmonary lesion, concomitant with antifungal treatment. In addition, reversal of immune function should be tried, as far as possible.
侵襲性真菌症は高度な免疫抑制を背景にして発症する．ムーコル症の発症背景としては糖尿病と造血器腫瘍が多い．また，糖尿病患者では鼻脳型が多く，造血器腫瘍患者では肺ムーコル症が多いという特徴がある．ムーコル症の致死率は高く，早期診断，早期治療開始が望まれるが，臨床的にアスペルギルス症と類似しており，特異的な血清検査も存在しないため，確定診断のためには積極的な生検が必要である．高用量（5 mg/kg/day）のアムホテリシンBリポソーム製剤の投与が標準的な治療法である．無効例，不耐容例，奏効後の経口治療への移行例に対してはポサコナゾール，イサブコナゾールなどのムーコル症に活性を有するアゾール系抗真菌薬が候補となる．また，切除可能病変，特に鼻眼脳病変，軟部組織病変，肺単一病変に対しては外科的処置の併用を検討する．背景の免疫不全状態についても可能な限りの改善を図る． Invasive fungal infections are usually observed in severely immunosuppressed patients. The underlying diseases of mucormycosis include diabetes mellitus and hematological malignancies. Rhino-orbital disease is frequent among patients with diabetes, whereas patients with hematological malignancies often develop pulmonary mucormycosis. The prognosis of mucormycosis is extremely poor, and thus early diagnosis and early treatment start are important. However, diagnosis is difficult as its clinical manifestation is similar with that of aspergillosis. There has been no specific serological test for mucormycosis, and biopsy of the involved lesion should be considered. High-dose (5 mg/kg/day) liposomal amphotericin-B is the first line treatment, while azole antifungals with activity against mucormycosis, such as posaconazole or isavuconazole, can be used for refractory or intolerant cases and when switching to oral treatment. Surgical resection or debridement should be considered, if possible, especially for rhino-orbital disease, soft tissue lesion, and single pulmonary lesion, concomitant with antifungal treatment. In addition, reversal of immune function should be tried, as far as possible. |
| Author | Kanda, Yoshinobu |
| Author_FL | 神田 善伸 |
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| Author_xml | – sequence: 1 fullname: Kanda, Yoshinobu organization: Division of Hematology, Jichi Medical University |
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| References | 24） Cumpston A, Caddell R, Shillingburg A, Lu X, Wen S, Hamadani M, Craig M, Kanate AS: Superior serum concentrations with posaconazole delayed-release tablets compared to suspension formulation in hematological malignancies. Antimicrob Agents Chemother 59: 4424–4428, 2015. 38） Chakrabarti A, Das A, Mandal J, Shivaprakash MR, George VK, Tarai B, Rao P, Panda N, Verma SC, Sakhuja V: The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol 44: 335–342, 2006. 26） Kontoyiannis DP, Lewis RE: How I treat mucormycosis. Blood 118: 1216–1224, 2011. 19） Cornely OA, Alastruey-Izquierdo A, Arenz D, et al: 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. Lancet Infect Dis 19: e405-e421, 2019. 29） Pagano L, Cornely OA, Busca A, et al: Combined antifungal approach for the treatment of invasive mucormycosis in patients with hematologic diseases: a report from the SEIFEM and FUNGISCOPE registries. Haematologica 98: e127–e130, 2013. 36） Singh N, Aguado JM, Bonatti H, et al: Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome. J Infect Dis 200: 1002–1011, 2009. 16） Shoham S, Magill SS, Merz WG, Gonzalez C, Seibel N, Buchanan WL, Knudsen TA, Sarkisova TA, Walsh TJ: Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol 48: 511–517, 2010. 14） Larkin JA, Montero JA: Efficacy and safety of amphotericin B lipid complex for zygomycosis. Infections in Medicine 20: 201–206, 2003. 7） Chamilos G, Lewis RE, Kontoyiannis DP: Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 47: 503–509, 2008. 11） Skiada A, Pagano L, Groll A, et al: 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: 1859–1867, 2011. 18） Cornely OA, Arikan-Akdagli S, Dannaoui E, et al: ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20 (Suppl 3): 5–26, 2014. 32） Reed C, Bryant R, Ibrahim AS, Edwards J Jr, Filler SG, Goldberg R, Spellberg B: Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis 47: 364–371, 2008. 2） Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ: Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 41: 634–653, 2005. 15） Walsh TJ, Goodman JL, Pappas P, Bekersky I, Buell DN, Roden M, Barrett J, Anaissie EJ: Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. Antimicrob Agents Chemother 45: 3487–3496, 2001. 23） Pham AN, Bubalo JS, Lewis JS 2nd: Comparison of posaconazole serum concentrations from haematological cancer patients on posaconazole tablet and oral suspension for treatment and prevention of invasive fungal infections. Mycoses 59: 226–233, 2016. 27） Góralska K, Blaszkowska J, Dzikowiec M: Neuroinfections caused by fungi. Infection 46: 443–459, 2018. 31） Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B: Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother 52: 1556–1558, 2008. 4） Donnelly JP, Chen SC, Kauffman CA, et al: Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 71: 1367–1376, 2020. 17） Lanternier F, Poiree S, Elie C, et al: Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis. J Antimicrob Chemother 70: 3116–3123, 2015. 10） Pagano L, Offidani M, Fianchi L, Nosari A, Candoni A, Picardi M, Corvatta L, DʼAntonio D, Girmenia C, Martino P, Del Favero A: Mucormycosis in hematologic patients. Haematologica 89: 207–214, 2004. 1） Togano T, Suzuki Y, Nakamura F, Tse W, Kume H: Epidemiology of visceral mycoses in patients with acute leukemia and myelodysplastic syndrome: analyzing the national autopsy database in Japan. Med Mycol 59: 50–57, 2021. 25） Marty FM, Ostrosky-Zeichner L, Cornely OA, et al: Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 16: 828–837, 2016. 39） Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE: Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg 57: 1044–1050, 1994. 9） Cornely OA, Maertens J, Bresnik M, et al: Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 44: 1289–1297, 2007. 30） Gebremariam T, Gu Y, Singh S, Kitt TM, Ibrahim AS: Combination treatment of liposomal amphotericin B and isavuconazole is synergistic in treating experimental mucormycosis. J Antimicrob Chemother 76: 2636–2639, 2021. 12） Rüping MJ, Heinz WJ, Kindo AJ, et al: Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother 65: 296–302, 2010. 22） van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP: Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases. Clin Infect Dis 42: e61–e65, 2006. 6） Harada N, Kimura SI, Gomyo A, et al: Surgical resection for persistent localized pulmonary fungal infection prior to allogeneic hematopoietic stem cell transplantation: analysis of six cases. J Infect Chemother 26: 175–180, 2020. 5） Legouge C, Caillot D, Chrétien ML, Lafon I, Ferrant E, Audia S, Pagès PB, Roques M, Estivalet L, Martin L, Maitre T, Bastie JN, Dalle F: The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin Infect Dis 58: 672–678, 2014. 3） Hoenigl M, Seidel D, Carvalho A, et al: The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe 3: e543–e552, 2022. 21） Krishnan-Natesan S, Manavathu EK, Alangaden GJ, Chandrasekar PH: A comparison of the fungicidal activity of amphotericin B and posaconazole against Zygomycetes in vitro. Diagn Microbiol Infect Dis 63: 361–364, 2009. 20） Almyroudis NG, Sutton DA, Fothergill AW, Rinaldi MG, Kusne S: In vitro susceptibilities of 217 clinical isolates of zygomycetes to conventional and new antifungal agents. Antimicrob Agents Chemother 51: 2587–2590, 2007. 8） Skiada A, Lanternier F, Groll AH, Pagano L, Zimmerli S, Herbrecht R, Lortholary O, Petrikkos GL; European Conference on Infections in Leukemia: Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica 98: 492–504, 2013. 28） Bellmann R, Smuszkiewicz P: Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection 45: 737–779, 2017. 37） Mohindra S, Mohindra S, Gupta R, Bakshi J, Gupta SK: Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses 50: 290–296, 2007. 13） Ibrahim AS, Gebremariam T, Husseiny MI, Stevens DA, Fu Y, Edwards JE Jr, Spellberg B: Comparison of lipid amphotericin B preparations in treating murine zygomycosis. Antimicrob Agents Chemother 52: 1573–1576, 2008. 34） Kyvernitakis A, Torres HA, Jiang Y, Chamilos G, Lewis RE, Kontoyiannis DP: Initial use of combination treatment does not impact survival of 106 patients with haematologic malignancies and mucormycosis: a propensity score analysis. Clin Microbiol Infect 22: 811.e1–811.e8, 2016. 33） Abidi MZ, Sohail MR, Cummins N, et al: Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: a comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies. Mycoses 57: 687–698, 2014. 40） Spellberg B, Ibrahim AS, Chin-Hong PV, Kontoyiannis DP, Morris MI, Perfect JR, Fredricks D, Brass EP: The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) study: a randomized, double-blinded, placebo-controlled trial. J Antimicrob Chemother 67: 715–722, 2012. 35） Miller MA, Molina KC, Gutman JA, et al: Mucormycosis in hematopoietic cell transplant recipients and in patients with hematological malignancies in the era of new antifungal agents. Open Forum Infect Dis 8: ofaa646, 2021. |
| References_xml | – reference: 7） Chamilos G, Lewis RE, Kontoyiannis DP: Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 47: 503–509, 2008. – reference: 32） Reed C, Bryant R, Ibrahim AS, Edwards J Jr, Filler SG, Goldberg R, Spellberg B: Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis 47: 364–371, 2008. – reference: 14） Larkin JA, Montero JA: Efficacy and safety of amphotericin B lipid complex for zygomycosis. Infections in Medicine 20: 201–206, 2003. – reference: 25） Marty FM, Ostrosky-Zeichner L, Cornely OA, et al: Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 16: 828–837, 2016. – reference: 24） Cumpston A, Caddell R, Shillingburg A, Lu X, Wen S, Hamadani M, Craig M, Kanate AS: Superior serum concentrations with posaconazole delayed-release tablets compared to suspension formulation in hematological malignancies. Antimicrob Agents Chemother 59: 4424–4428, 2015. – reference: 3） Hoenigl M, Seidel D, Carvalho A, et al: The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe 3: e543–e552, 2022. – reference: 11） Skiada A, Pagano L, Groll A, et al: 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: 1859–1867, 2011. – reference: 5） Legouge C, Caillot D, Chrétien ML, Lafon I, Ferrant E, Audia S, Pagès PB, Roques M, Estivalet L, Martin L, Maitre T, Bastie JN, Dalle F: The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin Infect Dis 58: 672–678, 2014. – reference: 31） Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B: Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother 52: 1556–1558, 2008. – reference: 33） Abidi MZ, Sohail MR, Cummins N, et al: Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: a comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies. Mycoses 57: 687–698, 2014. – reference: 4） Donnelly JP, Chen SC, Kauffman CA, et al: Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 71: 1367–1376, 2020. – reference: 22） van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP: Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases. Clin Infect Dis 42: e61–e65, 2006. – reference: 10） Pagano L, Offidani M, Fianchi L, Nosari A, Candoni A, Picardi M, Corvatta L, DʼAntonio D, Girmenia C, Martino P, Del Favero A: Mucormycosis in hematologic patients. Haematologica 89: 207–214, 2004. – reference: 8） Skiada A, Lanternier F, Groll AH, Pagano L, Zimmerli S, Herbrecht R, Lortholary O, Petrikkos GL; European Conference on Infections in Leukemia: Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica 98: 492–504, 2013. – reference: 21） Krishnan-Natesan S, Manavathu EK, Alangaden GJ, Chandrasekar PH: A comparison of the fungicidal activity of amphotericin B and posaconazole against Zygomycetes in vitro. Diagn Microbiol Infect Dis 63: 361–364, 2009. – reference: 40） Spellberg B, Ibrahim AS, Chin-Hong PV, Kontoyiannis DP, Morris MI, Perfect JR, Fredricks D, Brass EP: The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) study: a randomized, double-blinded, placebo-controlled trial. J Antimicrob Chemother 67: 715–722, 2012. – reference: 6） Harada N, Kimura SI, Gomyo A, et al: Surgical resection for persistent localized pulmonary fungal infection prior to allogeneic hematopoietic stem cell transplantation: analysis of six cases. J Infect Chemother 26: 175–180, 2020. – reference: 35） Miller MA, Molina KC, Gutman JA, et al: Mucormycosis in hematopoietic cell transplant recipients and in patients with hematological malignancies in the era of new antifungal agents. Open Forum Infect Dis 8: ofaa646, 2021. – reference: 12） Rüping MJ, Heinz WJ, Kindo AJ, et al: Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother 65: 296–302, 2010. – reference: 23） Pham AN, Bubalo JS, Lewis JS 2nd: Comparison of posaconazole serum concentrations from haematological cancer patients on posaconazole tablet and oral suspension for treatment and prevention of invasive fungal infections. Mycoses 59: 226–233, 2016. – reference: 30） Gebremariam T, Gu Y, Singh S, Kitt TM, Ibrahim AS: Combination treatment of liposomal amphotericin B and isavuconazole is synergistic in treating experimental mucormycosis. J Antimicrob Chemother 76: 2636–2639, 2021. – reference: 28） Bellmann R, Smuszkiewicz P: Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection 45: 737–779, 2017. – reference: 26） Kontoyiannis DP, Lewis RE: How I treat mucormycosis. Blood 118: 1216–1224, 2011. – reference: 20） Almyroudis NG, Sutton DA, Fothergill AW, Rinaldi MG, Kusne S: In vitro susceptibilities of 217 clinical isolates of zygomycetes to conventional and new antifungal agents. Antimicrob Agents Chemother 51: 2587–2590, 2007. – reference: 29） Pagano L, Cornely OA, Busca A, et al: Combined antifungal approach for the treatment of invasive mucormycosis in patients with hematologic diseases: a report from the SEIFEM and FUNGISCOPE registries. Haematologica 98: e127–e130, 2013. – reference: 19） Cornely OA, Alastruey-Izquierdo A, Arenz D, et al: 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. Lancet Infect Dis 19: e405-e421, 2019. – reference: 9） Cornely OA, Maertens J, Bresnik M, et al: Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 44: 1289–1297, 2007. – reference: 39） Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE: Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg 57: 1044–1050, 1994. – reference: 34） Kyvernitakis A, Torres HA, Jiang Y, Chamilos G, Lewis RE, Kontoyiannis DP: Initial use of combination treatment does not impact survival of 106 patients with haematologic malignancies and mucormycosis: a propensity score analysis. Clin Microbiol Infect 22: 811.e1–811.e8, 2016. – reference: 38） Chakrabarti A, Das A, Mandal J, Shivaprakash MR, George VK, Tarai B, Rao P, Panda N, Verma SC, Sakhuja V: The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol 44: 335–342, 2006. – reference: 13） Ibrahim AS, Gebremariam T, Husseiny MI, Stevens DA, Fu Y, Edwards JE Jr, Spellberg B: Comparison of lipid amphotericin B preparations in treating murine zygomycosis. Antimicrob Agents Chemother 52: 1573–1576, 2008. – reference: 37） Mohindra S, Mohindra S, Gupta R, Bakshi J, Gupta SK: Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses 50: 290–296, 2007. – reference: 2） Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ: Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 41: 634–653, 2005. – reference: 27） Góralska K, Blaszkowska J, Dzikowiec M: Neuroinfections caused by fungi. Infection 46: 443–459, 2018. – reference: 15） Walsh TJ, Goodman JL, Pappas P, Bekersky I, Buell DN, Roden M, Barrett J, Anaissie EJ: Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. Antimicrob Agents Chemother 45: 3487–3496, 2001. – reference: 16） Shoham S, Magill SS, Merz WG, Gonzalez C, Seibel N, Buchanan WL, Knudsen TA, Sarkisova TA, Walsh TJ: Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol 48: 511–517, 2010. – reference: 36） Singh N, Aguado JM, Bonatti H, et al: Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome. J Infect Dis 200: 1002–1011, 2009. – reference: 1） Togano T, Suzuki Y, Nakamura F, Tse W, Kume H: Epidemiology of visceral mycoses in patients with acute leukemia and myelodysplastic syndrome: analyzing the national autopsy database in Japan. Med Mycol 59: 50–57, 2021. – reference: 17） Lanternier F, Poiree S, Elie C, et al: Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis. J Antimicrob Chemother 70: 3116–3123, 2015. – reference: 18） Cornely OA, Arikan-Akdagli S, Dannaoui E, et al: ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20 (Suppl 3): 5–26, 2014. |
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| SubjectTerms | antifungal agents hematopoietic tumors invasive mycoses mucormycosis ムーコル症 侵襲性真菌症 抗真菌薬 造血器腫瘍 |
| Title | Diagnosis and Treatment of Invasive Mucormycosis |
| URI | https://www.jstage.jst.go.jp/article/ishinkin/64/3/64_23.005/_article/-char/en https://cir.nii.ac.jp/crid/1390015819046487296 |
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| ispartofPNX | Nihon Ishinkin Gakkai Zasshi, 2023, Vol.64(3), pp.77-82 |
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