Cornely, O. A., Arikan-Akdagli, S., Dannaoui, E., Groll, A. H., Lagrou, K., Chakrabarti, A., Lanternier, F., Pagano, L., Skiada, A., Akova, M., Arendrup, M. C., Boekhout, T., Chowdhary, A., Cuenca-Estrella, M., Freiberger, T., Guinea, J., Guarro, J., de Hoog, S., Hope, W., Johnson, E., Kathuria, S., Lackner, M., Lass-Floerl, C., Lortholary, O., Meis, J. F., Meletiadis, J., Munoz, P., Richardson, M., Roilides, E., Tortorano, A. M., Ullmann, A. J., van Diepeningen, A., Verweij, P. and Petrikkos, G. (2014). ESCMID dagger and ECMM double dagger joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin. Microbiol. Infect., 20. S. 5 - 27. OXFORD: ELSEVIER SCI LTD. ISSN 1469-0691

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Abstract

These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Pathogen identification to species level by molecular methods and susceptibility testing are strongly recommended to establish epidemiological knowledge. The recommendation for guiding treatment based on MICs is supported only marginally. Imaging is strongly recommended to determine the extent of disease. To differentiate mucormycosis from aspergillosis in haematological malignancy and stem cell transplantation recipients, identification of the reverse halo sign on computed tomography is advised with moderate strength. For adults and children we strongly recommend surgical debridement in addition to immediate first-line antifungal treatment with liposomal or lipid-complex amphotericin B with a minimum dose of 5mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4x200mg/day. Reversal of predisposing conditions is strongly recommended, i.e. using granulocyte colony-stimulating factor in haematological patients with ongoing neutropenia, controlling hyperglycaemia and ketoacidosis in diabetic patients, and limiting glucocorticosteroids to the minimum dose required. We recommend against using deferasirox in haematological patients outside clinical trials, and marginally support a recommendation for deferasirox in diabetic patients. Hyperbaric oxygen is supported with marginal strength only. Finally, we strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Cornely, O. A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arikan-Akdagli, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dannaoui, E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Groll, A. H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lagrou, K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chakrabarti, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lanternier, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pagano, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Skiada, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akova, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arendrup, M. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boekhout, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chowdhary, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cuenca-Estrella, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Freiberger, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guinea, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guarro, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Hoog, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hope, W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Johnson, E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kathuria, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lackner, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lass-Floerl, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lortholary, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meis, J. F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meletiadis, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Munoz, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Richardson, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roilides, E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tortorano, A. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ullmann, A. J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Diepeningen, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verweij, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrikkos, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-442073
DOI: 10.1111/1469-0691.12371
Journal or Publication Title: Clin. Microbiol. Infect.
Volume: 20
Page Range: S. 5 - 27
Date: 2014
Publisher: ELSEVIER SCI LTD
Place of Publication: OXFORD
ISSN: 1469-0691
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LIPOSOMAL AMPHOTERICIN-B; IN-VITRO SUSCEPTIBILITIES; ORBITAL-CEREBRAL MUCORMYCOSIS; HEMATOLOGY-ONCOLOGY PATIENTS; ORGAN TRANSPLANT RECIPIENTS; DESORPTION IONIZATION-TIME; INVASIVE FUNGAL-INFECTIONS; MYCOSES STUDY-GROUP; REVERSED HALO SIGN; LIPID COMPLEXMultiple languages
Infectious Diseases; MicrobiologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/44207

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