Mucormycosis Risk Factors and Diagnostic Considerations

Major Risk Factors to Investigate

Hematologic malignancies, such as acute myelogenous leukemia, lymphoma, and myelodysplastic syndromes, are common risk factors in developed countries, particularly with intensive chemotherapy, according to the European Hematology Association 3, 4
Neutropenia, defined as an absolute neutrophil count <500 cells/μL, is a critical predisposing factor that must be reversed for successful treatment, as recommended by the European Society for Medical Oncology 1, 5
Solid organ transplantation recipients on immunosuppressive therapy are at substantial risk, as stated by the American Society of Transplantation 3, 4
Hematopoietic stem cell transplantation recipients, especially those with graft-versus-host disease, represent a high-risk population, according to the European Society for Blood and Marrow Transplantation 1, 5

Glucocorticoid therapy, particularly high-dose or prolonged courses, is a major independent risk factor that requires discontinuation or tapering, as recommended by the American College of Rheumatology 1, 5, 6
Immunosuppressant medications, such as calcineurin inhibitors, mTOR inhibitors, and biologics, must be reduced when feasible, according to the National Kidney Foundation 1, 5
Deferroxamine therapy for iron chelation paradoxically increases mucormycosis risk and must be discontinued immediately, as stated by the European Hematology Association 1, 5, 6

Poorly controlled diabetes with ketoacidosis remains the predominant risk factor in developing countries and settings with limited healthcare access, according to the International Diabetes Federation 3

Major trauma, such as motor vehicle accidents, natural disasters, or improvised explosive devices, with skin disruption can lead to cutaneous mucormycosis even in immunocompetent hosts, as reported by the Centers for Disease Control and Prevention 7, 3
Burns represent a significant risk factor for cutaneous and disseminated disease, according to the American Burn Association 7
Surgical procedures or iatrogenic skin disruption can serve as portals of entry, as stated by the World Health Organization 7

MRI of the brain and sinuses is superior to CT for detecting orbital and cerebral involvement, particularly when evaluating for cavernous sinus thrombosis or intracranial extension, as recommended by the European Society of Radiology 8, 9
Thoracic CT should be reviewed for the "reversed halo sign" (ground glass opacity surrounded by consolidation), which is highly suggestive of pulmonary mucormycosis in hematologic patients, according to the Fleischner Society 8
Abdominal imaging is necessary to exclude gastrointestinal or renal involvement in disseminated disease, as stated by the European Society of Radiology 8, 9