Brazilian task force for the management of mucormycosis
Patrick Leon de Godoy Macedo, Mariane Taborda, Vítor Falcão de Oliveira, Adriana Satie Gonçalves Kono Magri, Lígia Lins Frutuoso, Gideane Mendes de Oliveira, Sinaida T Martins, Daniel Wagner de Castro Lima Santos, Fabianne Carlesse, Francelise Bridi Cavassin, Kelsen Dantas Eulálio, Marcia Lazera Andréa, Andrea D’Ávila Freitas, José Ernesto Vidal, Dayvison Francis Saraiva Freitas, Márcia Garnica, Terezinha do Menino Jesus Silva Leitão, Rosely Maria Zancopé‐Oliveira, Márcia de Souza Carvalho Melhem, Flavio Queiroz Telles, Maria Aparecida Shikanai‐Yasuda, Fernanda Dockhorn Costa, Maria Adelaide Millington, Marcello Mihailenko Chaves Magri
Abstract
BACKGROUND: Mucormycosis is a rare but life‑threatening fungal infection that has shown an increased incidence in Brazil, especially during the COVID‑19 pandemic. OBJECTIVE: To provide an evidence‑based, context‑specific guideline for the diagnosis and management of mucormycosis within the Brazilian healthcare system. CLINICAL FEATURES: Rhino‑orbito‑cerebral disease predominates, followed by pulmonary, cutaneous, gastrointestinal and disseminated forms; delayed recognition dramatically increases mortality. EPIDEMIOLOGY: The global incidence of mucormycosis is increasing, particularly among patients with diabetes mellitus, hematologic malignancies, transplantation, and corticosteroid exposure. The most frequently isolated species is Rhizopus arrhizus, and regional variations in species distribution may be present. In Brazil, comprehensive epidemiological data remain scarce. TREATMENT: Early, aggressive surgical debridement plus induction with liposomal amphotericin B (5-10 mg/kg/day) followed by isavuconazole or posaconazole is recommended; strict control of hyperglycemia and immunosuppression is essential. CONCLUSION: Standardized national guidance, improved rapid diagnostics, systematic surveillance and equitable drug availability are critical to reduce Brazil's mucormycosis burden.