Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

1006 Mucormycosis

differential diagnosis

■Aspergillus, neoplasm, cavernous sinus thrombosis (rhinocerebral

mucormycosis), pulmonary embolism (pulmonary mucormycosis)

management

What to Do First

■Correct the underlying problem!

➣Reverse acidosis in diabetic ketoacidosis (fluids, insulin, elec-

trolyte abnormalities); strive for good glycemic control; discon-

tinue immunosuppressive drugs if possible; await reversal of

neutropenia.

■Start Amphotericin B immediately (see below).

■Call the surgeon to advise on aggressive debridement.

specific therapy

Indications

■Every one, once mucormycosis is suspected; this is a rapidly pro-

gressive disease with fatal consequences.

Treatment Options

■Usually mucormycosis is refractory to medical treatment, necessi-

tating larger doses of Amphotericin B.

■Aggressive surgical debridement is essential; may be cosmetically

disfiguring.

■Repeated surgical intervention is usually needed to resect necrotic

tissue.

■Can reduce to qod dosing if improvement

➣Lipid formulations of Amphotericin may have utility because of

the ability to use higher doses over shorter periods of time

Side Effects & Contraindications

■Amphotericin B

➣Side effects: fevers, chills, nausea, vomiting and headaches; rig-

ors may be prevented by the addition of hydrocortisone 25 mg to

bag, meperidine 25–50 mg may treat rigors; nephrotoxicity; elec-

trolyte disturbance (renal tubular acidosis, hypokalemia, hypo-

magnesemia)

■Contraindications: if Cr 2.5–3.0, may consider giving lipid-based

Amphotericin products

Voriconazole, echinocandins not effective