This review highlights the significance of a multidisciplinary approach, increased awareness among high-risk groups, and continued epidemiological monitoring for future outbreaks of mucormycosis.
Abstract
Mucormycosis is a rare but very aggressive invasive fungal infection that has emerged as
a major opportunistic infection during the COVID-19 pandemic, particularly in immunocompromised
patients. The term “black fungus” is used for a group of fungi known as Mucorales such as
Rhizopus, Mucor, Lichtheimia, and Apophysomyces species. Uncontrolled diabetes mellitus, extensive
use of corticosteroids, lengthy intensive care unit (ICU) stay, and exposure to contaminated
medicine, including oxygen delivery systems, were largely blamed for the sudden surge in cases,
especially in India. There is rapid angioinvasion in mucormycosis, causing vascular thrombosis and
necrosis, which can result in high mortality when diagnosis and treatment is delayed. The clinical
manifestations are rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated
mucormycosis. A high degree of clinical suspicion with imaging studies, histopathological examination,
and advanced molecular studies like polymerase chain reaction and internal transcribed spacer
sequencing are necessary for accurate diagnosis. Management strategies emphasize early initiation
of antifungal therapy, most commonly liposomal amphotericin B, posaconazole, or isavuconazole,
alongside aggressive surgical debridement when indicated. In recent clinical trials, isavuconazole is
highly effective and less toxic compared to other azoles. This review highlights the significance of a
multidisciplinary approach, increased awareness among high-risk groups, and continued epidemiological
monitoring for future outbreaks. Continuous efforts are required to improve the diagnostic
capacity and preparedness for public health in order to lower the burden of mucormycosis in the
world.
Abstract Background Purpureocillium lilacinum is a ubiquitous environmental fungus widely utilized as an agricultural biocontrol agent, but it is increasingly recognized as an opportunistic human pathogen. While invasive fungal infections caused by this microorganism have been documented globally, disseminated systemic presentations in pediatric oncology remain exceptionally rare and carry high mortality rates. Case Description We report the case of an 11-year-old female patient with a high-grade osteosarcoma who developed high-risk febrile leukopenia during chemotherapy. Blood cultures from both a subcutaneous port and peripheral blood turned positive for both yeast-like and hyphal structures, which were further identified by DNA barcoding (ITS and EF1a regions) as P. lilacinum. The patient exhibited concurrent multiorgan dissemination, including hyperchromic scaling skin lesions in the perianal region and limbs, as well as diffuse bilateral pulmonary micronodules confirmed via video-thoracoscopy biopsy. Despite initial treatment with amphotericin B and fluconazole, clinical resolution was successfully achieved only after optimizing the antifungal regimen with oral voriconazole. The patient fully recovered and remains stable. Conclusions To our knowledge, this represents the first clinical isolation and reported case of disseminated systemic P. lilacinum infection in a pediatric oncological patient in Ecuador. This case highlights the aggressive nature of this pathogen in immunosuppressed children, the challenge of its diagnosis due to the lack of specialized infrastructure for antifungal susceptibility testing, and the critical importance of a multidisciplinary approach and prompt, targeted first-line therapy with voriconazole to ensure survival.
Johana Salgado, Estefanía Mariño-Brito, Francisco Mosquera-Yuqui et al.· Oxford Medical Case Reports· 0 citations
Tintelnotia destructans is a recently described fungus within the family Phaeosphaeriaceae, previously reported only in superficial human infections such as keratitis, onychomycosis, and non-invasive sinus fungus ball. We describe the first case of invasive rhinosinusal infection due to this pathogen in a child with severe aplastic anemia. Diagnosis was established by histopathology showing submucosal fungal invasion and broad-range fungal PCR targeting 18S rRNA identifying T. destructans. Combined endoscopic surgical debridement, antifungal therapy (liposomal amphotericin B and isavuconazole) and immune reconstitution after emergency haplo-identical hematopoietic stem cell transplant ultimately led to complete recovery without recurrence 18 months after treatment, despite continued therapeutic immunosuppression for GvHD. This case expands the known pathogenic spectrum of T. destructans, demonstrating its potential to cause invasive disease in severely immunocompromised hosts. Advances in molecular diagnostic tools may expand the spectrum of fungi causing invasive fungal infections by identification of novel pathogenic species.
Manon Jaboyedoff, F. Lamoth, C. Bertelli et al.· Open Forum Infectious Diseas...· 0 citations
ABSTRACT During the COVID-19 pandemic, an unprecedented outbreak of mucormycosis affected tens of thousands of patients, mainly in India. This study reviewed the available published cases up to 2022 and updated the epidemiological curve up to November 2025. PRISMA-guided systematic review of PubMed, Embase, and SciELO (Dec. 2019-Dec. 2022), supplemented by official reports and cohort studies published until 2025. We analyzed 1,482 cases from 39 studies (90.8% conducted in India; 69.7% male individuals; mean age 52 years). Diabetes mellitus was present in >78% of patients, and 64.3% received corticosteroids. Rhino-orbital (40.7%) and rhino-orbito-cerebral (33.9%) were the dominant forms of mucormycosis. Amphotericin B was used in 49.5% of cases, and surgical debridement in 55.5%. The mortality rate was 25%. After 2022, the incidence collapsed globally: India dropped from >47,000 cases in 2021 to <100 cases/year; Europe, the Middle East, and Latin America reported zero outbreaks in 2024-2025. COVID-19-associated mucormycosis represented a major opportunistic infection during the acute phase of the pandemic. Although its incidence declined markedly after widespread vaccination implementation, improved corticosteroid use, and better glycemic control, it remains a serious and life-threatening condition in vulnerable populations. The findings highlight important risk factors, clinical challenges, and management considerations that remain relevant to inform current clinical practice and future post-pandemic scenarios.
J. Mendes, Raphaella Vieira Lima, Rafael Moreira da Silva et al.· Revista da Sociedade Brasile...· 0 citations
Background: Bacteria of the genus Providencia are emerging pathogens associated with a wide range of infections, particularly in healthcare settings. In veterinary medicine, infections caused by these organisms are uncommon, and, to date, there have been no reports of carbapenem-resistant Providencia spp. causing infection in companion animals. Methods and Results: This study describes a comprehensive investigation of bacterial endocarditis caused by carbapenem-resistant Providencia rettgeri in a cat, including clinical, imaging, pathological, microbiological, and genomic findings. A 1.5-year-old mixed-breed female cat was admitted to a referral veterinary hospital with an extensive pelvic limb wound and a recent history of laparotomy. During hospitalization, a heart murmur was detected, and echocardiographic examination revealed vegetation-like lesion on the mitral valve. Despite intensive treatment, the patient’s clinical condition progressively deteriorated over a 15-day period, ultimately leading to euthanasia. Necropsy confirmed bacterial endocarditis with evidence of systemic septic embolization. P. rettgeri was isolated from blood collected from both heart ventricles and from an endocardial swab and its identity was confirmed by MALDI-ToF mass spectrometry. Antimicrobial susceptibility testing demonstrated resistance to meropenem. Whole-genome sequencing confirmed the species identification and revealed a Col3M plasmid carrying multiple antimicrobial resistance genes, including the carbapenemase gene blaNDM-1. Discussion: To the best of our knowledge, this is the first report of carbapenem-resistant Providencia spp. causing infection in a companion animal. This case highlights the emergence of Providencia spp. as potential veterinary pathogens capable of causing severe, invasive and fatal infections.
Maisa de Carvalho, Yasmin Gonçalves de Castro, Mayara Lucia Muniz Rezende et al.· Antibiotics· 0 citations
Pyogenic liver abscess (PLA) has traditionally been considered prevalent in Asia. However, its incidence is increasing in Europe.
Klebsiella pneumoniae
(Kp) has emerged as the leading causative pathogen, and hypervirulent strains pose a higher risk of invasive disease and metastatic complications, such as endogenous endophthalmitis (EE).
The case describes a 77-year-old woman who presented with fever and right upper quadrant abdominal pain. She was diagnosed with a second episode of PLA within 3 months, caused by Kp. Despite prompt antimicrobial therapy and percutaneous transhepatic drainage, the patient developed acute vision loss in the left eye during hospitalization. Ophthalmologic assessment confirmed EE secondary to bacteremia. Whole-genome sequencing identified the isolate as hypervirulent Kp (hvKp) sequence type 23 (ST23). While the liver abscess resolved following treatment, the patient sustained permanent loss of vision in the affected eye despite aggressive medical and surgical management.
This case illustrates the invasive nature of hvKp and its potential for recurrence and metastatic complications. Improved recognition through targeted virulence testing is essential to avoid underdiagnosis.
This case highlights the aggressive nature of hvKp. Early recognition of systemic and ocular symptoms, prompt ophthalmologic evaluation, and timely source control are essential. Optimal management requires multidisciplinary collaboration and the use of molecular diagnostics, including whole-genome sequencing, to identify hypervirulent lineages and support surveillance.
Laura Veinberga, Anna Elizabete Liepina, I. Markevica et al.· International journal of sur...· 0 citations
The importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches is emphasized and increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes.
Cinthya Karina Mejía-Escobar, José Roberto Andino, Sandra Montoya et al.· Journal of the Pediatric Inf...· 0 citations