Mucormycosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Apr 2025

Last updated: 11 Apr 2025

Mucormycosis is predominantly a disease of immunocompromised patients.

Five types are commonly described: rhino-orbito-cerebral (most common), pulmonary, cutaneous, disseminated, and gastrointestinal (rare).

Definitive diagnosis requires positive fungal culture or detection of fungal DNA through molecular testing (where available).

Rhinocerebral mucormycosis commonly occurs in patients with diabetes mellitus and presents with headache, visual changes, sinusitis, and, later, proptosis.

Pulmonary mucormycosis commonly presents as a cough in patients with underlying malignancy or transplant (bone marrow or solid organ). Late diagnosis may result in dissemination, leading to high mortality.

High level of suspicion and early institution of combined medical therapy with amphotericin-B, surgical treatment, and immune restoration is essential for good outcomes.

Definition

Mucormycosis is a group of mold infections caused by fungi in the order Murocales.[1][2] The most common manifestations are rhino-orbito-cerebral and pulmonary infections, followed by cutaneous, disseminated, and gastrointestinal infections.[3][4]

History and exam

Key diagnostic factors

sinus and facial pain
eye pain, blurred vision
proptosis
cranial nerve palsies
dry cough, with or without dyspnea
skin nodules

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Other diagnostic factors

fever
periorbital cellulitis
viscid, dark brown-black nasal discharge
focal sensory/motor neurologic deficits and altered mental status
necrotic eschar
hemoptysis
abdominal pain and distension
gastrointestinal bleeding
peritonitis

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Risk factors

diabetes mellitus ± diabetic ketoacidosis
hematologic malignancy
neutropenia
iron overload or use of deferoxamine
use of corticosteroids
hematopoietic and solid organ transplantation, graft-versus-host disease
breakdown of skin and soft tissue
malnutrition
prematurity
liver cirrhosis

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Diagnostic tests

1st tests to order

CBC
basic metabolic profile
ABG
urinalysis
serum ketone level
CT sinuses and brain
MRI sinuses and brain
CT chest with contrast
nasal endoscopy
gastrointestinal endoscopy

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Tests to consider

bronchoscopy with bronchoalveolar lavage and/or transbronchial biopsy fungal culture
histopathology of biopsy
microbiology of biopsy

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Emerging tests

polymerase chain reaction (PCR)

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Treatment algorithm

ACUTE

suitable for surgery

unsuitable for surgery

ONGOING

treatment failure

Contributors

Authors

Rachana M. Palnitkar, MD

Infectious Diseases

Private Practice

Los Gatos

Disclosures

RMP declares that she has no competing interests.

Michael Sands, MD, MPH & TM, FIDSA

Professor of Medicine

College of Medicine

University of Florida

Jacksonville

Disclosures

MS declares that he has no competing interests.

Peer reviewers

Michail Lionakis, MD, ScD

Infectious Diseases Fellow

Laboratory of Molecular Immunology

National Institute of Allergy and Infectious Diseases

NIH

Bethesda

Disclosures

ML declares that he has no competing interests.

Rachael Morris-Jones, PhD, FRCP, PCME

Dermatology Consultant and Honorary Senior Lecturer

Kings College Hospital

London

Disclosures

RMJ declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Pham D, Howard-Jones AR, Sparks R, et al. Epidemiology, modern diagnostics, and the management of mucorales infections. J Fungi (Basel). 2023 Jun 12;9(6):659.Full text Abstract

Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005 Jul;18(3):556-69.Full text Abstract

Centers for Disease Control and Prevention. Mucormycosis: clinical overview of mucormycosis. Apr 2024 [internet publication].Full text

Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. 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. Lancet Infect Dis. 2019 Dec;19(12):e405-21.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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