Morphology: Aseptate (or pauciseptate) hyaline mold with broad, ribbon-like hyphae branching at WIDE (~90°) angles. Distinguishable from Aspergillus by lack of septation.
Typical drugs
- #1Amphotericin B (liposomal)— First-line: 5–10 mg/kg/d. SURGICAL DEBRIDEMENT mandatory.
- #2Isavuconazole— FDA-approved for mucormycosis; alternative or step-down.
- #3Posaconazole— Salvage / step-down; delayed-release tablets preferred.
Empiric therapy when resistant
ALWAYS pair antifungals with aggressive surgical debridement — this is the single most important intervention. Reverse hyperglycemia / DKA. Isavuconazole or posaconazole as step-down.
Resistance mechanisms
Target alteration
INTRINSIC resistance to voriconazole, fluconazole, itraconazole, and echinocandins
Example: Voriconazole prophylaxis is a classic risk factor for breakthrough mucormycosis.
Resistance notes
INTRINSIC pan-azole resistance except isavuconazole and posaconazole. INTRINSIC echinocandin resistance. Voriconazole-selected breakthrough is a hallmark presentation in heme/onc.
Pearls
Risk factors: uncontrolled diabetes (esp. DKA — iron-loaded environment), iron overload (deferoxamine), hematologic malignancy, voriconazole prophylaxis breakthrough, COVID-associated mucormycosis (CAM, India). Rhino-orbital-cerebral / pulmonary / cutaneous (post-trauma) / GI / disseminated. Time-sensitive: every hour of delay increases mortality. Surgery + amphotericin + reverse predisposing factors = the pillars.
References
- ESCMID-ECMM Mucormycosis Guidelines (2019)