Although considered to be a rare
infection,
mucormycosis (
zygomycosis) has emerged as the second most common invasive mould
infection. Despite the advent of newer
antifungal agents, mortality rate of
mucormycosis remains exceedingly high. Successful management of
mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical
debridement and prompt administration of active
antifungal agents. However,
mucormycosis is not always amenable to cure. There are challenging obstacles that lead to difficulties in management of
amphotericin B. These include unique host-based risk factors for
mucormycosis, the fungus' resistance to innate host defences and distinctive features of its immunopathogenesis, such as extensive angioinvasion, increased virulence and use of
chelators by the fungus as
siderophores. In addition to these obstacles, the difficulties in early diagnosis, including nonspecific clinical manifestations, lack of serological methods, as well limitations of culture and molecular methods, lead to delay in initiation of antifungal
therapy. Finally, the variability of susceptibility to
amphotericin B and resistance to most other conventional
antifungal agents leads to major limitations in successful treatment of this devastating
infection.