Disseminated mucormycosis
ICD-10 B46.4 · ICD-11 1F2C.1

Brain (CNS) Mucormycosis: Salvage Protocol When First-Line Treatment Has Not Achieved the Expected Response

Mucormycosis with central nervous system (brain) involvement demands rapid escalation when initial combined surgical and systemic antifungal treatment fails to produce the required clinical and radiological improvement. This protocol addresses that next step.

Central nervous system (brain) involvement of mucormycosis, in a patient who has already received first-line combined therapy and has not met the defined response criteria.

Prior therapy: Early complete surgical debridement with clean margins, combined with immediate systemic antifungal treatment using liposomal amphotericin B.

Goals not reached: Stable disease or partial response — defined as resolution of signs and symptoms of infection with substantial radiographical improvement on weekly imaging — was not achieved, warranting escalation to salvage therapy.

Salvage therapy centres on switching the antifungal class; the specific agents, sequencing, and circumstances under which combination therapy is appropriate are detailed in the full protocol.

Treatment goal: Stable disease or partial response, with resolution of signs and symptoms of infection and substantial radiographical improvement on imaging.

References
  • In CNS involvement, animal models and the above observations support use of liposomal amphotericin B at 10 mg/kg per day.
  • Isavuconazole is strongly supported as salvage treatment.
  • Posaconazole delayed release tablets or infusions are strongly supported for salvage treatment, and when available should be preferred over posaconazole oral suspension, which in turn is marginally supported for salvage treatment.
  • In cases of primary treatment failure with isavuconazole or posaconazole, the guideline group supports recommendations for all three lipid-based amphotericin B formulations with strong to moderate strength.
  • In case of extensive disease, rapid progression, or poor general condition, the addition of isavuconazole or posaconazole can be considered.
  • Therapy can be continued until resolution of signs and symptoms of infection, and substantial radiographical improvement.
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