What Is New in Pulmonary Mucormycosis?

François Danion (1, 2, 3) , Anne Coste (4, 5) , Coralie Le Hyaric (1, 2) , Clea Melenotte (6) , Frederic Lamoth (7, 8) , Thierry Calandra (7, 6) , Dea Garcia-Hermoso (9) , Vishukumar Aimanianda (9) , Fanny Lanternier (6, 9) , Olivier Lortholary (6, 9)

1 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
2 UNISTRA - Université de Strasbourg
3 IRM - Immuno-Rhumatologie Moléculaire
4 UBO - Université de Brest
5 LaTIM - Laboratoire de Traitement de l'Information Medicale
6 Hôpital Necker - Enfants Malades [AP-HP]
7 UNIL - Université de Lausanne = University of Lausanne
8 IMUL - Institute of Microbiology [University of Lausanne]
9 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals

Mucormycosis is a rare but life-threatening fungal infection due to molds of the order Mucorales. The incidence has been increasing over recent decades. Worldwide, pulmonary mucormycosis (PM) presents in the lungs, which are the third main location for the infection after the rhino-orbito-cerebral (ROC) areas and the skin. The main risk factors for PM include hematological malignancies and solid organ transplantation, whereas ROC infections classically are classically favored by diabetes mellitus. The differences between the ROC and pulmonary locations are possibly explained by the activation of different mammalian receptors—GRP78 in nasal epithelial cells and integrin β1 in alveolar epithelial cells—in response to Mucorales. Alveolar macrophages and neutrophils play a key role in the host defense against Mucorales. The diagnosis of PM relies on CT scans, cultures, PCR tests, and histology. The reversed halo sign is an early, but very suggestive, sign of PM in neutropenic patients. Recently, the serum PCR test showed a very encouraging performance for the diagnosis and follow-up of mucormycosis. Liposomal amphotericin B is the drug of choice for first-line therapy, together with correction of underlying disease and surgery when feasible. After a stable or partial response, the step-down treatment includes oral isavuconazole or posaconazole delayed release tablets until a complete response is achieved. Secondary prophylaxis should be discussed when there is any risk of relapse, such as the persistence of neutropenia or the prolonged use of high-dose immunosuppressive therapy. Despite these novelties, the mortality rate from PM remains higher than 50%. Therefore, future research must define the place for combination therapy and adjunctive treatments, while the development of new treatments is necessary.

Mots clés: pulmonary mucormycosis; Mucorales; review; Epidemiology; treatment

Domaines: Sciences du Vivant [q-bio]

François Danion, Anne Coste, Coralie Le Hyaric, Clea Melenotte, Frederic Lamoth, et al.. What Is New in Pulmonary Mucormycosis?. Journal of Fungi, 2023, 9 (3), pp.307. ⟨10.3390/jof9030307⟩. ⟨pasteur-04173138⟩