Resumen
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.
Idioma original | English (US) |
---|---|
Páginas (desde-hasta) | e405-e421 |
Publicación | The Lancet Infectious Diseases |
Volumen | 19 |
N.º | 12 |
DOI | |
Estado | Published - dic 2019 |
ASJC Scopus subject areas
- Infectious Diseases
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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.
En: The Lancet Infectious Diseases, Vol. 19, N.º 12, 12.2019, p. e405-e421.Resultado de la investigación: Review article › revisión exhaustiva
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TY - JOUR
T1 - Global guideline for the diagnosis and management of mucormycosis
T2 - an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium
AU - Mucormycosis ECMM MSG Global Guideline Writing Group
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
AU - Morrissey, C. Orla
AU - Nucci, Marcio
AU - Oladele, Rita
AU - Wiederhold, Nathan P.
N1 - Funding Information: OAC reports research grants from Actelion, Amplyx, Arsanis, Astellas, AstraZeneca, Basilea, Bayer, Cidara, F2G, Gilead, GSK, Leeds University, Matinas, Medicines Company, MedPace, Melinta, Merck/MSD, Miltenyi, Pfizer, Rempex, Roche, Sanofi Pasteur, Scynexis, Seres; is a consultant to Allecra Therapeutics, Amplyx, Actelion, Astellas, Basilea, Cidara, Da Volterra, Entasis Therapeutics, F2G, Gilead, IQVIA, Janssen, Matinas, Menarini, Merck/MSD, Paratek, PSI, Scynexis, Seres, Summit, Tetraphase, Vical, and received lecture honoraria from Astellas, Basilea, Gilead, Merck/MSD and Pfizer ED reports grants from Gilead, MSD; personal fees from Pfizer, Astellas; non-financial support from MSD and Pfizer. AM reports grants from Sanofi and ROCHE. AAI reports grants and personal fees from GILEAD, personal fees from Pfizer, grants from F2G, grants from Scynexis, personal fees from Astellas, personal fees from MSD. SAA reports grants from Pfizer. SCAC reports grants from MSD Australia. MH reports reports personal fees from Basilea, Merck, Practitioner Network; and grants and personal fees from Gilead. KL reports grants, personal fees, and non-financial support from MSD, Gilead, and Pfizer; and personal fees from Abbott. REL reports personal fees from Gilead and grants from Merck. DCS reports grants from Merck and personal fees from Merck, Astellas, and AVIR. AA reports non-financial support from MSD, Gilead, and Pfizer; and personal fees from Gilead sciences and Pathoquest. RB reports grants and personal fees from Merck and Pfizer. SB reports grants from MSD; personal fees from Gilead and other from Pfizer. EC reports personal fees from Astellas and Basilea. MC reports personal fees from Astellas, Pfizer, LF Asia, Meiji, and MSD, and non-financial support from Astellas, Pfizer, and LF Asia. ALC reports grants from Astellas; grants, personal fees, and non-financial support from Pfizer; personal fees and non-financial support from Biotoscana; personal fees and non-financial support from MSD; and personal fees and non-financial support from Gilead. LD reports personal fees and non-financial support from MSD and Pfizer; and non-financial support from Teva. AHG reports grants and personal fees from Gilead, Merck, Sharp & Dohme, and Pfizer; and personal fees from Astellas and Basilea. JG reports grants from Scynexis, CIDARA; and personal fees from Gilead, Pfizer, Astellas, MSD, and United Medical. CPH reports personal fees from Schering-Plough; grants and personal fees from Pfizer, Boehringer Ingelheim, Siemens; personal fees from Basilea, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius, Essex, AstraZeneca, Bracco, MEDA Pharma, Chiesi, Covidien, Pierre Fabre, Grifols, Bayer; and grants from MeVis, German Center for Lung Research. ASI reports grants from Amplyx Pharmaceuticals, grants from Astellas Pharma USA and is founder and shareholder from Vitalex Biosciences. NK reports personal fees from Astellas, Gilead, Merck, and Pfizer. FLan reports personal fees from Gilead, MSD, and Basilea. CLF reports reports grants from Gilead and Astellas; and personal fees from Gilead, Merck Sharp & Dohme, Basilea. DGL reports consultant fees from Astellas, GILEAD, MSD, Pfizer, and Yuhan; has served as a board member for Gilead and Yuhan; and has received research support, travel support and payment for lectures, including service on Speaker's bureaus, from Astellas, GILEAD, MSD, Pfizer, and Yuhan. TL reports grants from Gilead; personal fees and non-financial support from Gilead, Astellas, and MSD; and personal fees from Basilea. GM reports personal fees from Gilead and Pfizer. JFM reports personal fees from Scynexis, Gilead, Merck, United Medical, and Teva; grants from F2G, Pulmocide, and Amplyx. JM reports grants from Astellas, Gilead, MSD, and Pfizer. COM reporsts grants from Gilead and Merck. MN reports grants from Pfizer; and personal fees from Gilead, Scynexis, Cidara, Teva, United Medical, MSD, and Jansen. LP reports grants from Gilead, MSD, and Pfizer. APas reports grants from Gilead; and personal fees from Gilead, United Medical. ZR reports grants from Astellas and Teva. MRi reports personal fees from Gilead, MSD, and Basilea. ER reports grants from Gilead, Pfizer, Merck, and Sanofi; personal fees and non-financial support from Pfizer, Merck, and Astellas. MRu reports personal fees from Scynexis, Daiichi Sankyo, and Kedplasma GmbH. JS reports personal fees from Pfizer and MSD. MS reports grants and personal fees from Gilead and Merck. BS reports personal fees from Cempra, Bayer, Forge, Shionogi, Alexion, Synthetic Biologics, Paratek, Ovagene, Accuryx, and Bioversys; and is shareholder for Motif, BioAIM, Synthetic Biologics, Mycomed, and ExBaq. WS reports fees from Astellas and Merck. BHT reports grants from Pfizer. AJU reports personal fees from MSD, Basilea, and Aicuris. JJV reports personal fees from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, Deutsches Zentrum für Infektionsforschung, Uniklinik Freiburg/Kongress und Kommunikation, Akademie für Infektionsmedizin, Universität Manchester, Deutsche Gesellschaft für Infektiologie, Ärztekammer Nordrhein, Uniklinik Aachen, Back Bay Strategies, and Deutsche Gesellschaft für Innere Medizin; and grants from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, Deutsches Zentrum für Infektionsforschung, Bundesministerium für Bildung und Forschung. MJGTV reports having been on speakers' bureau for Pfizer, MSD/Merck, Gilead Sciences, Organobalance and Astellas Pharma; received research funding from 3M, Astellas Pharma, DaVolterra and Gilead Sciences; and is a consultant to Berlin Chemie, MSD/Merck and Astellas Pharma. TJW reports grants from Amplyx, Astellas, Merck, Scynexis, Allergan, Medicines Company, Lediant, and Tetraphase; and having served on Advisory Boards of Astellas, Merck, Scynexis, Allergan, Medicines. PLW reports personal fees from Gilead, MSD; and grants from Bruker. NPW reports grants from Astellas, bioMerieux, F2G, and Viamet; and personal fees from Mayne Pharma. All other authors declare no competing interests. Funding Information: The following authors are fellows of the European Confederation of Medical Mycology (ECMM): OAC, AAI, SCAC, ED, BH, MH, HEJ, KL, DCS, AC, MA, AA, AMSA, SAA, HB, SB, MC, ALC, LD, AHG, ASI, SSK, NK, ML, FL, FL, CLF, MM, GM, JFM, JM, COM, MN, RO, LP, AP, MR, ER, SS, JS, JJV, MJGTV, TJW, PLW, and NPW. The following authors are members of the Mycoses Study Group and Research Consortium (MSG ERC): OAC, SCAC, DCS, ASI, BS, WS, TJW, NPW, TZ. The following authors are members of the Excellence Center (EC) for Medical Mycology of the European Confederation of Medical Mycology (ECMM): OAC, DA, SCM, DS, JJV, MJGTV, KL, ML, CL-F, JFM, and MR. We thank Valentina Arsic Arsenijevic, Neoh Chin Fen, and Adilia Warris for review and valuable contributions to the manuscript. The authors are indebted to Kerstin Albus, Susann Blossfeld, and Jon Salmanton-Garcia for technical support with this manuscript. Publisher Copyright: © 2019 Elsevier Ltd
PY - 2019/12
Y1 - 2019/12
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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85075522537&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(19)30312-3
DO - 10.1016/S1473-3099(19)30312-3
M3 - Review article
C2 - 31699664
AN - SCOPUS:85075522537
SN - 1473-3099
VL - 19
SP - e405-e421
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 12
ER -