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

Mucormycosis ECMM MSG Global Guideline Writing Group

doi:10.1016/S1473-3099(19)30312-3

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

Mucormycosis ECMM MSG Global Guideline Writing Group

131 Citations (Scopus)

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.

Original language	English
Journal	Lancet Infectious Diseases
Volume	19
Issue number	12
Pages (from-to)	e405-e421
ISSN	1473-3099
DOIs	https://doi.org/10.1016/S1473-3099(19)30312-3
Publication status	Published - Dec 2019

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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. / Mucormycosis ECMM MSG Global Guideline Writing Group.

In: Lancet Infectious Diseases, Vol. 19, No. 12, 12.2019, p. e405-e421.

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Mucormycosis ECMM MSG Global Guideline Writing Group 2019, '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 Infectious Diseases, vol. 19, no. 12, pp. e405-e421. https://doi.org/10.1016/S1473-3099(19)30312-3

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title = "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",

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.",

author = "Cornely, {Oliver A} and Ana Alastruey-Izquierdo and Dorothee Arenz and Chen, {Sharon C A} and Eric Dannaoui and Bruno Hochhegger and Martin Hoenigl and Jensen, {Henrik E} and Katrien Lagrou and Lewis, {Russell E} and Mellinghoff, {Sibylle C} and Mervyn Mer and Pana, {Zoi D} and Danila Seidel and Sheppard, {Donald C} and Roger Wahba and Murat Akova and Alexandre Alanio and Al-Hatmi, {Abdullah M S} and Sevtap Arikan-Akdagli and Hamid Badali and Ronen Ben-Ami and Alexandro Bonifaz and St{\'e}phane Bretagne and Elio Castagnola and Methee Chayakulkeeree and Colombo, {Arnaldo L} and Corzo-Le{\'o}n, {Dora E} and Lubos Drgona and Groll, {Andreas H} and Jesus Guinea and Claus-Peter Heussel and Ibrahim, {Ashraf S} and Kanj, {Souha S} and Nikolay Klimko and Michaela Lackner and Frederic Lamoth and Fanny Lanternier and Cornelia Lass-Floerl and Dong-Gun Lee and Thomas Lehrnbecher and Lmimouni, {Badre E} and Mihai Mares and Georg Maschmeyer and Meis, {Jacques F} and Joseph Meletiadis and Morrissey, {C Orla} and Marcio Nucci and Rita Oladele and Livio Pagano and {Mucormycosis ECMM MSG Global Guideline Writing Group}",

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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

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AU - Nucci, Marcio

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AU - Mucormycosis ECMM MSG Global Guideline Writing Group

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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

SN - 1473-3099

VL - 19

SP - e405-e421

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

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