Invasive Mucormycosis
COVID-19 patients with trauma, diabetes mellitus, GC use, HM, prolonged neutropenia, allo-HSCT, SOT are more likely to develop mucormycosis [35]. Mucormycosis is usually suspected based on results of direct microscopy or plus fluorescent brighteners from clinical specimens such as sputum, BALF, and skin lesions that Mucorales hyphae are non-septate or pauci-septatethe with a variable width of 6–16 μm. To confirm the diagnosis, non-pigmented hyphae showing tissue invasion should be shown in tissue sections stained with hematoxylin–eosin (HE), PAS, or GMS [36]. Culture of specimens is strongly recommended for identification of genus and species, also AST. What’s more, it is suggested to be cultured at 30 °C and 37 °C separately that typically cottony white or grayish black colony usually will be found, afterward morphological identification of fungi or DNA sequencing based on bar code genes, such as 18S, ITS, 28 s, or rDNA. MALDI-TOF identification is just moderately supported because it depends mainly on in-house databases, and many laboratories do not have this capacity [37]. Further, it is promising to detect fungi DNA, in serum as well as in other body fluids, even in paraffin-embedded tissue, however, because of lack of standardization supported it is only with moderate strength.
The treatment recommendations can be supported by the global guideline for the diagnosis and management of mucormycosis in 2019 by European Confederation of Medical Mycology (ECMM) and Mycoses Study Group Education and Research Consortium that the therapeutic and alternative medication of mucormycosis have been given more detailed guidance opinions [35]. Generally, it strongly supports an early complete surgical treatment for mucormycosis whenever possible, in addition to systemic antifungal treatment. In neutropenic patients, those with graft-versus-host disease or high risk factor, primary prophylaxis with posaconazole may be recommended. Amphotericin B lipid complex, liposomal Amphotericin B and posaconazole oral suspension are treated as the first-line antifungal monotherapy, while isavuconazole is strongly supported as salvage treatment. There are no convincing data to guide the use of antifungal combination therapy of polyenes and azoles or polyenes plus echinocandins.