• A. Serda Kantarcioglu


The Mucorales is the largest order of zygomycete fungi comprising ubiquitous, mostly saprophytic organisms. However, once invade, the fungus shows angiotropic and neurotropic predilection. These fungi infect humans through spore inhalation. Within tissue, they grow as nonseptate moulds and have right-angle branching and irregular, non-parallel cell walls. The most prevalent agent of mucormycosis is Rhizopus species.

The rhinocerebral form of mucormycosis may occur in immunocompetent hosts, but there is a distinct predilection for diabetics. Other risk factors for mucormycosis include ketoacidosis, steroid use, neutropenia, renal failure and intravenous drug use. Direct intracranial extension from the sinuses occurs with Mucorales infection, producing characteristic lesions at the inferior frontal lobes adjacent to the posterior sinuses, usually with enhancement and reduced diffusion. Perineural invasion is a common finding in rhino-orbito-cerebral mucormycosis (ROCM), as are angioinvasion and infarcts. ROCM develops when inhaled spores infect the paranasal sinuses and extend into the orbits, optic nerves, oral cavity and cranium and invades the intracranial vasculature. Central nervous system infection almost always involves the frontal lobes. Morphological features on histopathologic examination suggest the etiology. Specific identification of the etiologic agent requires isolation of the organism by culture.

Surgical debridement of devitalized tissue, antifungal chemotherapy, correction of impaired immunity and controlling blood glucose levels are the treatment strategies for mucormycosis. Mucorales appear to be susceptible to amphotericin B and are generally not susceptible to the triazoles and echinocandins. Among the extended-spectrum triazoles, posaconazole appears to be active against most of the species.


CNS mucormycosis Neurotropism Angiotropism Perineural spread 



AmB lipid complex


Acquired immunodeficiency syndrome


Agglutinin-like sequence


Amphotericin B


β-hydroxy butyrate


Brain heart infusion




Central nervous system




Cerebrospinal fluid


Computed tomography


Dendritic cell


European Confederation of Medical Mycology


European Committee on Antimicrobial Susceptibility Testing


Granulocyte colony-stimulating factor


Granulocyte-macrophage colony-stimulating factor


Grocott methenamine silver


Glucose-regulated protein


Hyperbaric oxygen


Haematoxylin and eosin


Human immunodeficiency virus






Innate lymphocyte




International Society for Human and Animal Mycology


Internal transcribed spacer




Potassium hydroxide


Liposomal AmB


Matrix-assisted laser desorption/ionization time-of-flight


Major histocompatibility complex


Minimal inhibitory concentration


Mononuclear cell


Magnetic resonance imaging


Natural killer


Nitric oxide


Periodic acid-Schiff


Polymerase chain reaction


Platelet-derived growth factor


Pectin lyase


Polymorphonuclear neutrophil


Pathogen recognition receptor/Pattern recognition receptor




Regulated on activation, normal T cell expressed and secreted


Rhinocerebral mucormycosis


Rhino-orbito-cerebral mucormycosis


Special Interest Group


Toll-like receptor


Tumour necrosis factor

Th 1

T-helper type 1




  1. Abbas AK, Lichtman AH, Pillai S. Cellular and molecular immunology E-book. Philadelphia, PA: Elsevier Health Sciences; 2014a.Google Scholar
  2. Abbas AK, Lichtman AH, Pillai S. Basic immunology: functions and disorders of the immune system. Philadelphia, PA: Elsevier Health Sciences; 2014b.Google Scholar
  3. Adelman LS, Aronson SM. The neuropathologic complications of narcotics addiction. Bull N Y Acad Med. 1969;45(2):225.PubMedPubMedCentralGoogle Scholar
  4. Air EL, et al. Isolated cerebellar mucormycosis, slowly progressive over 1 year in an immunocompetent patient. Surg Neurol Int. 2010;1:81.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Aköz T, Civelek B, Akan M. Rhinocerebral mucormycosis: report of two cases. Ann Plast Surg. 1999;43(3):309–12.PubMedCrossRefGoogle Scholar
  6. Al-Ajam M, et al. Mucormycosis in the eastern Mediterranean: a seasonal disease. Epidemiol Infect. 2006;134(2):341–6.PubMedCrossRefGoogle Scholar
  7. Alastruey-Izquierdo A, et al. In vitro activity of antifungals against Zygomycetes. Clin Microbiol Infect. 2009;15(s5):71–6.PubMedCrossRefGoogle Scholar
  8. Almyroudis NG, et al. In vitro susceptibilities of 217 clinical isolates of zygomycetes to conventional and new antifungal agents. Antimicrob Agents Chemother. 2007;51(7):2587–90.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Al-Shafai L, Mikulis D. Diffusion MR imaging in a case of acute ischemic optic neuropathy. Am J Neuroradiol. 2006;27(2):255–7.PubMedGoogle Scholar
  10. Alsuhaibani AH, Al-Thubaiti G, Al Badr FB. Optic nerve thickening and infarction as the first evidence of orbital involvement with mucormycosis. Middle East Afr J Ophthalmol. 2012;19(3):340.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Angali RK, et al. Fatal rhino-orbito-cerebral mucormycosis in a healthy individual. J Oral Maxillofac Pathol. 2014;18(3):460.PubMedPubMedCentralCrossRefGoogle Scholar
  12. Antachopoulos C, et al. Rapid susceptibility testing of medically important zygomycetes by XTT assay. J Clin Microbiol. 2006;44(2):553–60.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Arikan S, et al. Comparative in vitro activities of posaconazole, voriconazole, itraconazole, and amphotericin B against Aspergillus and Rhizopus, and synergy testing for Rhizopus. Sabouraudia. 2008;46(6):567–73.CrossRefGoogle Scholar
  14. Arizono K, et al. A case report of rhinocerebral mucormycosis in hemodialysis patient receiving deferoxamine. Nihon Jinzo Gakkai Shi. 1989;31(1):99–103.PubMedGoogle Scholar
  15. Artis WM, et al. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis transferrin and iron availability. Diabetes. 1982;31(12):1109–14.PubMedCrossRefGoogle Scholar
  16. Asan A, Okten SS, Sen B. Airborne and soilborne microfungi in the vicinity Hamitabat Thermic Power Plant in Kirklareli City (Turkey), their seasonal distributions and relations with climatological factors. Environ Monit Assess. 2010;164(1–4):221–31.PubMedCrossRefGoogle Scholar
  17. Babior BM. Phagocytes and oxidative stress. Am J Med. 2000;109(1):33–44.PubMedCrossRefGoogle Scholar
  18. Bagdade J. Phagocytic and microbicidal function in diabetes mellitus. Acta Endocrinol Suppl (Copenh). 1976;205:27.Google Scholar
  19. Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis—the bitter and the sweet. PLoS Pathog. 2017;13(8):e1006408.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Baradkar V, et al. Fatal rhino-orbito-cerebral infection caused by Saksenaea vasiformis in an immunocompetent individual: first case report from India. Indian J Med Microbiol. 2008;26(4):385.PubMedCrossRefGoogle Scholar
  21. Ben-Ami R, et al. A clinicopathological study of pulmonary mucormycosis in cancer patients: extensive angioinvasion but limited inflammatory response. J Infect. 2009;59(2):134–8.PubMedCrossRefGoogle Scholar
  22. Bhadani PP, et al. A rare presentation of invasive rhino-orbital mucormycosis in an immunocompetent young girl: a case report. Indian J Pathol Microbiol. 2007;50(4):785–6.PubMedGoogle Scholar
  23. Bhattacharyya AK, et al. Rhinocerebral mucormycosis: an unusual case presentation. J Laryngol Otol. 1992;106(1):48–9.PubMedCrossRefGoogle Scholar
  24. Bichile LS, Abhyankar SC, Hase N. Chronic mucormycosis manifesting as hydrocephalus. J Neurol Neurosurg Psychiatry. 1985;48(11):1188.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Binder U, Maurer E, Lass-Flörl C. Mucormycosis—from the pathogens to the disease. Clin Microbiol Infect. 2014;20(s6):60–6.PubMedCrossRefGoogle Scholar
  26. Bitar D, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997–2006. Emerg Infect Dis. 2009;15(9):1395.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Blanco JL, Garcia ME. Immune response to fungal infections. Vet Immunol Immunopathol. 2008;125(1–2):47–70.PubMedCrossRefGoogle Scholar
  28. Blodi FC, Hannah FT, Wadsworth JA. Lethal orbitocerebral phycomycosis in otherwise healthy children. Am J Ophthalmol. 1969;67(5):698–705.PubMedCrossRefGoogle Scholar
  29. Boelaert JR, et al. Mucormycosis during deferoxamine therapy is a siderophore-mediated infection. In vitro and in vivo animal studies. J Clin Invest. 1993;91(5):1979–86.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Bouchara J, et al. Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components. Eur J Cell Biol. 1996;70(1):76–83.PubMedGoogle Scholar
  31. Bouza E, Munoz P, Guinea J. Mucormycosis: an emerging disease? Clin Microbiol Infect. 2006;12(s7):7–23.CrossRefGoogle Scholar
  32. Brown RB, Lau SK. Case 3-2001: a 59-year-old diabetic man with unilateral visual loss and oculomotor-nerve palsy. N Engl J Med. 2001;344(4):286–93.CrossRefGoogle Scholar
  33. Bybee JD, Rogers DE. The phagocytic activity of polymorphonuclear leukocytes obtained from patients with diabetes mellitus. Transl Res. 1964;64(1):1–13.Google Scholar
  34. Caramalho R, et al. Etest cannot be recommended for in vitro susceptibility testing of Mucorales. Antimicrob Agents Chemother. 2015;59(6):3663–5.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Chakrabarti A, Singh R. Mucormycosis in India: unique features. Mycoses. 2014;57(s3):85–90.PubMedCrossRefGoogle Scholar
  36. Chakrabarti A, et al. Apophysomyces elegans: an emerging zygomycete in India. J Clin Microbiol. 2003;41(2):783–8.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Chakrabarti A, et al. Apophysomyces elegans: epidemiology, amplified fragment length polymorphism typing, and in vitro antifungal susceptibility pattern. J Clin Microbiol. 2010;48(12):4580–5.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Chamilos G, et al. Zygomycetes hyphae trigger an early, robust proinflammatory response in human polymorphonuclear neutrophils through toll-like receptor 2 induction but display relative resistance to oxidative damage. Antimicrob Agents Chemother. 2008;52(2):722–4.PubMedCrossRefGoogle Scholar
  39. Chamilos G, et al. Generation of IL-23 producing Dendritic Cells (DCs) by airborne fungi regulates fungal pathogenicity via the induction of TH-17 responses. PLoS One. 2010;5(9):e12955.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Chibucos MC, et al. An integrated genomic and transcriptomic survey of mucormycosis-causing fungi. Nat Commun. 2016;7:12218.PubMedPubMedCentralCrossRefGoogle Scholar
  41. Chinn R, Diamond RD. Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun. 1982;38(3):1123–9.PubMedPubMedCentralGoogle Scholar
  42. Chmel H, Grieco MH. Cerebral mucormycosis and renal aspergillosis in heroin addicts without endocarditis. Am J Med Sci. 1973;266(3):225–31.PubMedCrossRefGoogle Scholar
  43. CLSI C. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard—second edition—document M38-A2. Wayne, PA: CLSI; 2008.Google Scholar
  44. Çolakoǧlu G. Airborne fungal spores at the Belgrad forest near the city of Istanbul (Turkey) in the year 2001 and their relation to allergic diseases. J Basic Microbiol. 2003;43(5):376–84.PubMedCrossRefGoogle Scholar
  45. Cornely O, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014;20:5–26.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Cuadrado LM, et al. Cerebral mucormycosis in two cases of acquired immunodeficiency syndrome. Arch Neurol. 1988;45(1):109–11.PubMedCrossRefGoogle Scholar
  47. Dannaoui E. Antifungal resistance in Mucorales. Int J Antimicrob Agents. 2017;50(5):617–21.PubMedCrossRefGoogle Scholar
  48. Dannaoui E, et al. Efficacy of antifungal therapy in a nonneutropenic murine model of zygomycosis. Antimicrob Agents Chemother. 2002;46(6):1953–9.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Dannaoui E, et al. In vitro susceptibilities of zygomycetes to conventional and new antifungals. J Antimicrob Chemother. 2003;51(1):45–52.PubMedCrossRefGoogle Scholar
  50. Davies BW, et al. Increased incidence of rhino-orbital-cerebral mucormycosis after Colorado flooding. Ophthalmic Plast Reconstr Surg. 2017;33(3S):S148–51.PubMedCrossRefGoogle Scholar
  51. De Hoog G, et al. Atlas of clinical fungi. 2nd ed. Utrecht: Centraalbureau voor Schimmelcultures; 2000.Google Scholar
  52. De Lucca AJ, Walsh TJ. Antifungal peptides: novel therapeutic compounds against emerging pathogens. Antimicrob Agents Chemother. 1999;43(1):1–11.PubMedPubMedCentralCrossRefGoogle Scholar
  53. Delves PJ, Roitt IM. The immune system. N Engl J Med. 2000;343(1):37–49.PubMedCrossRefGoogle Scholar
  54. Diamond RD, Clark RA. Damage to Aspergillus fumigatus and Rhizopus oryzae hyphae by oxidative and nonoxidative microbicidal products of human neutrophils in vitro. Infect Immun. 1982;38(2):487–95.PubMedPubMedCentralGoogle Scholar
  55. Diamond RD, Haudenschild CC, Erickson NF 3rd. Monocyte-mediated damage to Rhizopus oryzae hyphae in vitro. Infect Immun. 1982;38(1):292–7.PubMedPubMedCentralGoogle Scholar
  56. Dolatabadi S, et al. Differentiation of clinically relevant Mucorales Rhizopus microsporus and R. arrhizus by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). J Med Microbiol. 2015;64(7):694–701.PubMedCrossRefGoogle Scholar
  57. Ejdys E. Environment of school as potential place of interindividual transmissions. Wiad Parazytol. 2001;47(3):353–8.PubMedGoogle Scholar
  58. El JB, et al. Erysipelas of the face revealing a mucormycosis. J Mycol Med. 2011;21(3):202–5.CrossRefGoogle Scholar
  59. El-Herte RI, Baban TA, Kanj SS. Mucormycosis: a review on environmental fungal spores and seasonal variation of human disease. Adv Infect Dis. 2012;2(03):76.CrossRefGoogle Scholar
  60. Elinav H, et al. Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature. Clin Microbiol Infect. 2009;15(7):693–7.PubMedCrossRefGoogle Scholar
  61. Escobar A, Del Brutto OH. Multiple brain abscesses from isolated cerebral mucormycosis. J Neurol Neurosurg Psychiatry. 1990;53(5):431–3.PubMedPubMedCentralCrossRefGoogle Scholar
  62. EUCAST, T.S.o.A.S.T.A.o.t.E.E.C.f.A.S.T., EUCAST Definitive Document E.Def 9.2 in Method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia forming mould. Basel, Switzerland, 2014: EUCAST; 2017.Google Scholar
  63. Fairley C, et al. Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology. 2000;107(3):555–8.PubMedCrossRefGoogle Scholar
  64. Falci DR, Pasqualotto AC. Profile of isavuconazole and its potential in the treatment of severe invasive fungal infections. Infect Drug Resist. 2013;6:163.PubMedPubMedCentralGoogle Scholar
  65. Fisher EW, et al. Rhinocerebral mucormycosis: use of liposomal amphotericin B. J Laryngol Otol. 1991;105(7):575–7.PubMedCrossRefGoogle Scholar
  66. Fong K, Seneviratne E, McCormack J. Mucor cerebral abscess associated with intravenous drug abuse. Intern Med J. 1990;20(1):74–7.Google Scholar
  67. Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med. 2001;125(3):375–8.PubMedGoogle Scholar
  68. Fu Y, et al. Cloning and functional characterization of the Rhizopus oryzae high affinity iron permease (rFTR1) gene. FEMS Microbiol Lett. 2004;235(1):169–76.PubMedGoogle Scholar
  69. Gaing A, Corbalan F, Weinberger J. Phycomycosis (mucormycosis) in differential diagnosis of cerebral mass lesions in intravenous drug users. Mt Sinai J Med. 1992;59(1):69.PubMedGoogle Scholar
  70. Gamaletsou MN, et al. Rhino-orbital-cerebral mucormycosis. Curr Infect Dis Rep. 2012;14(4):423–34.PubMedCrossRefGoogle Scholar
  71. Garcia-Covarrubias L, et al. Rhino-orbitocerebral mucormycosis attributable to Apophysomyces elegans in an immunocompetent individual: case report and review of the literature. J Trauma. 2001;50(2):353–7.PubMedCrossRefGoogle Scholar
  72. Gebremariam T, et al. CotH3 mediates fungal invasion of host cells during mucormycosis. J Clin Invest. 2014;124(1):237–50.PubMedCrossRefGoogle Scholar
  73. Gebremariam T, et al. Bicarbonate correction of ketoacidosis alters host-pathogen interactions and alleviates mucormycosis. J Clin Invest. 2016;126(6):2280–94.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Ghuman H, Voelz K. Innate and adaptive immunity to Mucorales. J Fungi. 2017;3(3):48.CrossRefGoogle Scholar
  75. Ghuman MS, et al. Bilateral optic nerve infarction in rhino-cerebral mucormycosis: a rare magnetic resonance imaging finding. J Neurosci Rural Pract. 2015;6(3):403.PubMedPubMedCentralCrossRefGoogle Scholar
  76. Gil-Lamaignere C, et al. Interferon-γ and granulocyte-macrophage colony-stimulating factor augment the activity of polymorphonuclear leukocytes against medically important zygomycetes. J Infect Dis. 2005;191(7):1180–7.PubMedCrossRefGoogle Scholar
  77. Ginsberg F, et al. Isolated cerebral mucormycosis: case report with CT and pathologic correlation. Am J Neuroradiol. 1987;8(3):558–60.PubMedGoogle Scholar
  78. Gniadek A, Macura A. Intensive care unit environment contamination with fungi. Adv Med Sci. 2007;52:283–7.PubMedGoogle Scholar
  79. Gollard R, et al. Isolated cerebral mucormycosis: case report and therapeutic considerations. Neurosurgery. 1994;34(1):174–7.PubMedGoogle Scholar
  80. Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev. 2011;24(2):411–45.PubMedPubMedCentralCrossRefGoogle Scholar
  81. Gomez-Lopez A, et al. In vitro susceptibility of clinical isolates of Zygomycota to amphotericin B, flucytosine, itraconazole and voriconazole. J Antimicrob Chemother. 2001;48(6):919–21.PubMedCrossRefGoogle Scholar
  82. Gordon S, Plűddemann A. Tissue macrophage heterogeneity: issues and prospects. In: Seminars in immunopathology. New York: Springer; 2013.Google Scholar
  83. Gordon S, Taylor PR. Monocyte and macrophage heterogeneity. Nat Rev Immunol. 2005;5(12):953.PubMedCrossRefGoogle Scholar
  84. Gordon S, Plüddemann A, Martinez Estrada F. Macrophage heterogeneity in tissues: phenotypic diversity and functions. Immunol Rev. 2014;262(1):36–55.PubMedPubMedCentralCrossRefGoogle Scholar
  85. Gottfredsson M, Perfect JR. Fungal meningitis. In: Seminars in neurology. New York: Thieme Medical Publishers, Inc.; 2000.Google Scholar
  86. Gregory J, Golden A, Haymaker W. Muconnycosis of the central nervous system. A report of three cases. Bull Johns Hopkins Hosp. 1943;6:405–15.Google Scholar
  87. Groll AH, et al. Comparative efficacy and distribution of lipid formulations of amphotericin B in experimental Candida albicans infection of the central nervous system. J Infect Dis. 2000;182(1):274–82.PubMedCrossRefGoogle Scholar
  88. Hameroff SB, Eckholdt JW, Lindenberg R. Cerebral phycomycosis in a heroin addict. Neurology. 1970;20(3):261–5.PubMedCrossRefGoogle Scholar
  89. Hampton MB, Kettle AJ, Winterbourn CC. Inside the neutrophil phagosome: oxidants, myeloperoxidase, and bacterial killing. Blood. 1998;92(9):3007–17.PubMedGoogle Scholar
  90. Hariri BM, Cohen NA. New insights into upper airway innate immunity. Am J Rhinol Allergy. 2016;30(5):319.PubMedPubMedCentralCrossRefGoogle Scholar
  91. Harris JS. Mucormycosis: report of a case. Pediatrics. 1955;16(6):857–67.PubMedGoogle Scholar
  92. Hibbett DS, et al. A higher-level phylogenetic classification of the fungi. Mycol Res. 2007;111(5):509–47.PubMedCrossRefGoogle Scholar
  93. Hofman V, et al. Usefulness of frozen section in rhinocerebral mucormycosis diagnosis and management. Pathology. 2003;35(3):212–6.PubMedCrossRefGoogle Scholar
  94. Honda A. A murine model of zygomycosis by Cunninghamella bertholletiae. Mycopathologia. 1998;144(3):141–6.PubMedCrossRefGoogle Scholar
  95. Hontelez S, et al. Molecular view on PRR cross-talk in antifungal immunity. Cell Microbiol. 2012;14(4):467–74.PubMedCrossRefGoogle Scholar
  96. Hopkins RJ, et al. Cerebral mucormycosis associated with intravenous drug use: three case reports and review. Clin Infect Dis. 1994;19(6):1133–7.PubMedCrossRefGoogle Scholar
  97. Hosseini SMS, Borghei P. Rhinocerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngol. 2005;262(11):932–8.PubMedCrossRefGoogle Scholar
  98. Howard DH. Acquisition, transport, and storage of iron by pathogenic fungi. Clin Microbiol Rev. 1999;12(3):394–404.PubMedPubMedCentralCrossRefGoogle Scholar
  99. Hussain S, et al. Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals. Eur J Radiol. 1995;20(2):151–5.PubMedCrossRefGoogle Scholar
  100. Ibrahim AS, Kontoyiannis DP. Update on mucormycosis pathogenesis. Curr Opin Infect Dis. 2013;26(6):508.PubMedPubMedCentralCrossRefGoogle Scholar
  101. Ibrahim AS, et al. Rhizopus oryzae adheres to, is phagocytosed by, and damages endothelial cells in vitro. Infect Immun. 2005;73(2):778–83.PubMedPubMedCentralCrossRefGoogle Scholar
  102. Ibrahim AS, et al. Posaconazole mono-or combination therapy for treatment of murine zygomycosis. Antimicrob Agents Chemother. 2009;53(2):772–5.PubMedCrossRefGoogle Scholar
  103. Ibrahim AS, et al. Pathogenesis of mucormycosis. Clin Infect Dis. 2012;54(Suppl 1):S16–22.PubMedPubMedCentralCrossRefGoogle Scholar
  104. Jacobs S, Gonzalez CE, Walsh TJ. Mucormycosis and entomophthoramycosis. 2002.
  105. Jones PG, et al. Focal intracranial mucormycosis presenting as chronic meningitis. JAMA. 1981;246(18):2063–4.PubMedCrossRefGoogle Scholar
  106. José R-H. Dimorphism on Mucor species with emphasis on M. rouxii and M. bacilliformis. In: Szaniszlo PJ, editor. Fungal dimorphism with emphasis on fungi pathogenic for humans. New York: Springer US, Plenum Press; 1985. p. 361–86.Google Scholar
  107. Kantarcioğlu AS, et al. A Rhizopus oryzae strain isolated from resected bone and soft tissue specimens from a sinonasal and palatal mucormycosis case. Report of a case and in vitro experiments of yeastlike cell development. Med Mycol. 2006;44(6):515–21.PubMedCrossRefGoogle Scholar
  108. Kasantikul V, Shuangshoti S, Taecholarn C. Primary phycomycosis of the brain in heroin addicts. Surg Neurol. 1987;28(6):468–72.PubMedCrossRefGoogle Scholar
  109. Kasliwal MK, et al. Bilateral anterior cerebral artery aneurysm due to mucormycosis. J Clin Neurosci. 2009;16(1):156–9.PubMedCrossRefGoogle Scholar
  110. Kaufman L, Padhye A, Parker S. Rhinocerebral zygomycosis caused by Saksenaea vasiformis. J Med Vet Mycol. 1988;26(4):237–41.PubMedCrossRefGoogle Scholar
  111. Kennedy K, et al. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clin Microbiol Infect. 2016;22(9):775–81.PubMedCrossRefPubMedCentralGoogle Scholar
  112. Khan ZU, et al. Mucor circinelloides as a cause of invasive maxillofacial zygomycosis: an emerging dimorphic pathogen with reduced susceptibility to posaconazole. J Clin Microbiol. 2009;47(4):1244–8.PubMedPubMedCentralCrossRefGoogle Scholar
  113. Khor B, et al. Rhinocerebral mucormycosis in Taiwan. J Microbiol Immunol Infect. 2003;36(4):266–9.PubMedPubMedCentralGoogle Scholar
  114. KÖMÜR S, et al. Mucormycosis: a 10-year experience at a tertiary care center in Turkey. Turk J Med Sci. 2016;46(1):58–62.PubMedCrossRefPubMedCentralGoogle Scholar
  115. Kontoyiannis DP, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005;191(8):1350–60.PubMedCrossRefPubMedCentralGoogle Scholar
  116. Kontoyiannis DP, et al. Prevalence, clinical and economic burden of mucormycosis-related hospitalizations in the United States: a retrospective study. BMC Infect Dis. 2016;16(1):730.PubMedPubMedCentralCrossRefGoogle Scholar
  117. Kwon-Chung KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis. 2012;54(Suppl 1):S8–S15.PubMedPubMedCentralCrossRefGoogle Scholar
  118. Lackner M, Caramalho R, Lass-Flörl C. Laboratory diagnosis of mucormycosis: current status and future perspectives. Future Microbiol. 2014;9(5):683–95.PubMedCrossRefGoogle Scholar
  119. Langford JD, McCartney DL, Wang RC. Frozen section-guided surgical debridement for management of rhino-orbital mucormycosis. Am J Ophthalmol. 1997;124(2):265–7.PubMedCrossRefGoogle Scholar
  120. Lanternier F, et al. A global analysis of mucormycosis in France: the RetroZygo Study (2005–2007). Clin Infect Dis. 2012;54(Suppl 1):S35–43.PubMedCrossRefGoogle Scholar
  121. Lass-Flörl C. Zygomycosis: conventional laboratory diagnosis. Clin Microbiol Infect. 2009;15(s5):60–5.PubMedCrossRefGoogle Scholar
  122. Levitz SM, et al. In vitro killing of spores and hyphae of Aspergillus fumigatus and Rhizopus oryzae by rabbit neutrophil cationic peptides and bronchoalveolar macrophages. J Infect Dis. 1986;154(3):483–9.PubMedCrossRefGoogle Scholar
  123. Lewis RE, et al. How does antifungal pharmacology differ for mucormycosis versus aspergillosis? Clin Infect Dis. 2012;54(Suppl 1):S67–72.PubMedCrossRefGoogle Scholar
  124. Li CH, et al. Sporangiospore size dimorphism is linked to virulence of Mucor circinelloides. PLoS Pathog. 2011;7(6):e1002086.PubMedPubMedCentralCrossRefGoogle Scholar
  125. Liang KP, et al. Rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans. J Clin Microbiol. 2006;44(3):892–8.PubMedPubMedCentralCrossRefGoogle Scholar
  126. Liles WC, et al. Granulocyte colony-stimulating factor administered in vivo augments neutrophil-mediated activity against opportunistic fungal pathogens. J Infect Dis. 1997;175(4):1012–5.PubMedCrossRefGoogle Scholar
  127. Liu M, et al. The endothelial cell receptor GRP78 is required for mucormycosis pathogenesis in diabetic mice. J Clin Invest. 2010;120(6):1914–24.PubMedPubMedCentralCrossRefGoogle Scholar
  128. Liu H, et al. Aspergillus fumigatus CalA binds to integrin alpha5beta1 and mediates host cell invasion. Nat Microbiol. 2016;2:16211.PubMedPubMedCentralCrossRefGoogle Scholar
  129. Lohmeyer J. Role of hemopoietic growth factors and cytokines in host defense against fungal infections. Mycoses. 1997;40(s2):37–9.PubMedCrossRefGoogle Scholar
  130. Lübbehüsen TL, Nielsen J, McIntyre M. Morphology and physiology of the dimorphic fungus Mucor circinelloides (syn. M. racemosus) during anaerobic growth. Mycol Res. 2003;107(2):223–30.PubMedCrossRefGoogle Scholar
  131. Luna JD, et al. Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis. Ophthalmic Surg Lasers. 1996;27(8):706–8.PubMedGoogle Scholar
  132. Ma L-J, et al. Genomic analysis of the basal lineage fungus Rhizopus oryzae reveals a whole-genome duplication. PLoS Genet. 2009;5(7):e1000549.PubMedPubMedCentralCrossRefGoogle Scholar
  133. Mackenzie D, Soothill J, Millar J. Meningitis caused by Absidia corymbifera. J Infect. 1988;17(3):245–8.CrossRefGoogle Scholar
  134. Margo CE, et al. Rhinocerebral mucormycosis with perineural spread. Ophthalmic Plast Reconstr Surg. 2007;23(4):326–7.PubMedCrossRefGoogle Scholar
  135. Marty FM, Cosimi LA, Baden LR. Breakthrough zygomycosis after voriconazole treatment in recipients of hematopoietic stem-cell transplants. N Engl J Med. 2004;350(9):950–2.PubMedCrossRefPubMedCentralGoogle Scholar
  136. Masucci EF, et al. Cerebral mucormycosis (phycomycosis) in a heroin addict. Arch Neurol. 1982;39(5):304–6.PubMedCrossRefGoogle Scholar
  137. Mathur S, Karimi A, Mafee M. Acute optic nerve infarction demonstrated by diffusion-weighted imaging in a case of rhinocerebral mucormycosis. Am J Neuroradiol. 2007;28(3):489–90.PubMedPubMedCentralGoogle Scholar
  138. McDermott NE, et al. Successful treatment of periodontal mucormycosis: report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e64–9.PubMedCrossRefPubMedCentralGoogle Scholar
  139. McLean FM, Ginsberg LE, Stanton CA. Perineural spread of rhinocerebral mucormycosis. Am J Neuroradiol. 1996;17(1):114–6.PubMedPubMedCentralGoogle Scholar
  140. Melsom S, Khangure M. Craniofacial mucormycosis following assault: an unusual presentation of an unusual disease. J Med Imaging Radiat Oncol. 2000;44(1):104–6.Google Scholar
  141. Mendoza L, et al. Human fungal pathogens of Mucorales and Entomophthorales. Cold Spring Harb Perspect Med. 2015;5(4):a019562.PubMedCentralCrossRefGoogle Scholar
  142. Meyers BR, et al. Rhinocerebral mucormycosis: premortem diagnosis and therapy. Arch Intern Med. 1979;139(5):557–60.PubMedCrossRefPubMedCentralGoogle Scholar
  143. Miller NS, et al. Fungal infection associated with intravenous drug abuse: a case of localized cerebral phycomycosis. J Clin Psychiatry. 1988;49:320–2.PubMedPubMedCentralGoogle Scholar
  144. Mohindra S, et al. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses. 2007;50(4):290–6.PubMedCrossRefGoogle Scholar
  145. Morace G, Borghi E. Invasive mold infections: virulence and pathogenesis of Mucorales. Int J Microbiol. 2012;2011 Scholar
  146. Mosquera J, et al. Treatment of Absidia corymbifera infection in mice with amphotericin B and itraconazole. J Antimicrob Chemother. 2001;48(4):583–6.PubMedCrossRefGoogle Scholar
  147. Mowat AG, Baum J. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med. 1971;284(12):621–7.PubMedCrossRefGoogle Scholar
  148. Mullane K, et al. Posaconazole salvage therapy allows successful allogeneic hematopoietic stem cell transplantation in patients with refractory invasive mold infections. Transpl Infect Dis. 2007;9(2):89–96.PubMedCrossRefGoogle Scholar
  149. Murthy JMK, Sundaram C. Chapter 95—Fungal infections of the central nervous system. In: Biller J, Ferro JM, editors. Handbook of clinical neurology. Amsterdam: Elsevier; 2014. p. 1383–401.Google Scholar
  150. Muszewska A, Pawłowska J, Krzyściak P. Biology, systematics, and clinical manifestations of Zygomycota infections. Eur J Clin Microbiol Infect Dis. 2014;33(8):1273–87.PubMedPubMedCentralCrossRefGoogle Scholar
  151. Nithyanandam S, et al. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. 2003;51(3):231–6.PubMedGoogle Scholar
  152. Oliveri S, et al. Rhizopus arrhizus in Italy as the causative agent of primary cerebral zygomycosis in a drug addict. Eur J Epidemiol. 1988;4(3):284–8.PubMedCrossRefPubMedCentralGoogle Scholar
  153. Onerci M, et al. Rhinocerebral mucormycosis with extension to the cavernous sinus. A case report. Rhinology. 1991;29(4):321–4.PubMedPubMedCentralGoogle Scholar
  154. Ooi EH, Wormald P-J, Tan LW. Innate immunity in the paranasal sinuses: a review of nasal host defenses. Am J Rhinol. 2008;22(1):13–9.PubMedCrossRefPubMedCentralGoogle Scholar
  155. Orguc S, et al. Rhinocerebral mucormycosis: perineural spread via the trigeminal nerve. J Clin Neurosci. 2005;12(4):484–6.PubMedPubMedCentralCrossRefGoogle Scholar
  156. Orlowski M. Mucor dimorphism. Microbiol Rev. 1991;55(2):234–58.PubMedPubMedCentralGoogle Scholar
  157. Ortín X, et al. Cunninghamella bertholletiae infection (mucormycosis) in a patient with acute T-cell lymphoblastic leukemia. Leuk Lymphoma. 2004;45(3):617–20.PubMedCrossRefPubMedCentralGoogle Scholar
  158. Paltauf A. Mycosis mucorina. Arch Pathol Anat Physiol. 1885;102(3):543–64.CrossRefGoogle Scholar
  159. Parsi K, et al. Perineural spread of rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans. Ann Indian Acad Neurol. 2013;16(3):414.PubMedPubMedCentralCrossRefGoogle Scholar
  160. Pastor FJ, et al. In vitro and in vivo antifungal susceptibilities of the Mucoralean fungus Cunninghamella. Antimicrob Agents Chemother. 2010;54(11):4550–5.PubMedPubMedCentralCrossRefGoogle Scholar
  161. Pavan R, Manjunath K. Qualitative analysis of indoor and outdoor airborne fungi in cowshed. J Mycol. 2014;2014 Scholar
  162. Peixoto D, et al. Isavuconazole treatment of a patient with disseminated mucormycosis. J Clin Microbiol. 2014;52(3):1016–9.PubMedPubMedCentralCrossRefGoogle Scholar
  163. Perkhofer S, et al. Posaconazole enhances the activity of amphotericin B against hyphae of zygomycetes in vitro. Antimicrob Agents Chemother. 2008;52(7):2636–8.PubMedPubMedCentralCrossRefGoogle Scholar
  164. Petrikkos G, et al. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis. 2003;22(12):753–6.PubMedCrossRefPubMedCentralGoogle Scholar
  165. Petrikkos G, Skiada A, Drogari-Apiranthitou M. Epidemiology of mucormycosis in Europe. Clin Microbiol Infect. 2014;20:67–73.PubMedCrossRefPubMedCentralGoogle Scholar
  166. Phan QT, et al. Als3 is a Candida albicans invasin that binds to cadherins and induces endocytosis by host cells. PLoS Biol. 2007;5(3):e64.PubMedPubMedCentralCrossRefGoogle Scholar
  167. Pierce PF, et al. Zygomycetes brain abscesses in narcotic addicts with serological diagnosis. JAMA. 1982;248(21):2881–2.PubMedCrossRefPubMedCentralGoogle Scholar
  168. Pillai P, Cyriac R, Rajeevan PS. Cerebral mucormycosis and endophthalmitis following dengue in a immunocompetent female. J Assoc Physicians India. 2016;64(1):54.Google Scholar
  169. Pitisuttithum P, et al. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother. 2005;56(4):745–55.PubMedPubMedCentralCrossRefGoogle Scholar
  170. Potenza L, et al. Mucorales-specific T cells emerge in the course of invasive mucormycosis and may be used as a surrogate diagnostic marker in high-risk patients. Blood. 2011;118(20):5416–9.PubMedCrossRefPubMedCentralGoogle Scholar
  171. Prakash H, et al. The environmental source of emerging apophysomyces variabilis infection in India. Sabouraudia. 2016;54(6):567–75.CrossRefGoogle Scholar
  172. Pursell K, et al. Impaired phagocyte respiratory burst responses to opportunistic fungal pathogens in transplant recipients: in vitro effect of r-metHuG-CSF (Filgrastim). Transpl Infect Dis. 2003;5(1):29–37.PubMedCrossRefPubMedCentralGoogle Scholar
  173. Radner AB, Witt MD, Edwards JE Jr. Acute invasive rhinocerebral zygomycosis in an otherwise healthy patient: case report and review. Clin Infect Dis. 1995;20(1):163–6.PubMedCrossRefPubMedCentralGoogle Scholar
  174. Raj P, Vella E, Bickerton R. Successful treatment of rhinocerebral mucormycosis by a combination of aggressive surgical debridement and the use of systemic liposomal amphotericin B and local therapy with nebulized amphotericin—a case report. J Laryngol Otol. 1998;112(4):367–70.PubMedCrossRefPubMedCentralGoogle Scholar
  175. Ramanathan B, et al. Cathelicidins: microbicidal activity, mechanisms of action, and roles in innate immunity. Microbes Infect. 2002;4(3):361–72.PubMedCrossRefGoogle Scholar
  176. Rangel-Guerra RA, et al. Rhinocerebral and systemic mucormycosis. Clinical experience with 36 cases. J Neurol Sci. 1996;143(1):19–30.PubMedCrossRefGoogle Scholar
  177. Rao SS, et al. Sinoorbital mucormycosis due to Apophysomyces elegans in immunocompetent individuals—an increasing trend. Am J Otolaryngol. 2006;27(5):366–9.CrossRefGoogle Scholar
  178. Reddy RHK, Raju S. Isolated cerebral mucormycosis in an immunocompetent patient—a case report. Indian J Neurosurg. 2015;4(01):038–41.CrossRefGoogle Scholar
  179. Reed C, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. 2008;47(3):364–71.PubMedPubMedCentralCrossRefGoogle Scholar
  180. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236–301.PubMedPubMedCentralCrossRefGoogle Scholar
  181. Richardson M. The ecology of the Zygomycetes and its impact on environmental exposure. Clin Microbiol Infect. 2009;15(Suppl 5):2–9.PubMedCrossRefGoogle Scholar
  182. Riefler J III, Batbouta J, Uphoff DF. Rhizopus brain abscess: report of a case and review of the literature. Mil Med. 1991;156(9):497–9.PubMedCrossRefGoogle Scholar
  183. Roden MM, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634–53.CrossRefGoogle Scholar
  184. Rodríguez MM, et al. Posaconazole combined with amphotericin B, an effective therapy for a murine disseminated infection caused by Rhizopus oryzae. Antimicrob Agents Chemother. 2008;52(10):3786–8.PubMedPubMedCentralCrossRefGoogle Scholar
  185. Rodríguez MM, et al. Correlation of in vitro activity, serum levels, and in vivo efficacy of posaconazole against Rhizopus microsporus in a murine disseminated infection. Antimicrob Agents Chemother. 2009;53(12):5022–5.PubMedPubMedCentralCrossRefGoogle Scholar
  186. Rodriguez-Tudela J, et al. Interlaboratory evaluation of hematocytometer method of inoculum preparation for testing antifungal susceptibilities of filamentous fungi. J Clin Microbiol. 2003;41(11):5236–7.PubMedPubMedCentralCrossRefGoogle Scholar
  187. Rogers TR. Treatment of zygomycosis: current and new options. J Antimicrob Chemother. 2008;61(Suppl 1):i35–40.PubMedCrossRefGoogle Scholar
  188. Roilides E, et al. Enhancement of oxidative response and damage caused by human neutrophils to Aspergillus fumigatus hyphae by granulocyte colony-stimulating factor and gamma interferon. Infect Immun. 1993;61(4):1185–93.PubMedPubMedCentralGoogle Scholar
  189. Roilides E, et al. The role of immunoreconstitution in the management of refractory opportunistic fungal infections. Med Mycol. 1998;36:12–25.PubMedGoogle Scholar
  190. Roilides E, Kontoyiannis DP, Walsh TJ. Host defenses against zygomycetes. Clin Infect Dis. 2012;54(Suppl 1):S61–6.PubMedCrossRefGoogle Scholar
  191. Roilides E, Antachopoulos C, Simitsopoulou M. Pathogenesis and host defence against Mucorales: the role of cytokines and interaction with antifungal drugs. Mycoses. 2014;57(s3):40–7.PubMedCrossRefGoogle Scholar
  192. Romani L. Immunity to fungal infections. Nat Rev Immunol. 2004;4(1):11.CrossRefGoogle Scholar
  193. Rueping MJ, et al. Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother. 2009;65(2):296–302.CrossRefGoogle Scholar
  194. Saoulidis S, et al. Antifungal activity of posaconazole and granulocyte colony-stimulating factor in the treatment of disseminated zygomycosis (mucormycosis) in a neutropaenic murine model. Mycoses. 2011;54(5):e486–92.PubMedCrossRefGoogle Scholar
  195. Sarrami AH, et al. Fatal disseminated mucormycosis in an immunocompetent patient: a case report and literature review. Int J Prev Med. 2013;4(12):1468.PubMedPubMedCentralGoogle Scholar
  196. Scheckenbach K, et al. Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis. Auris Nasus Larynx. 2010;37(3):322–8.PubMedCrossRefGoogle Scholar
  197. Schmidt S, et al. Natural killer cell-mediated damage of clinical isolates of mucormycetes. Mycoses. 2016;59(1):34–8.PubMedCrossRefGoogle Scholar
  198. Schütz P, et al. Fatal rhino-orbito-cerebral zygomycosis caused by Apophysomyces elegans in a healthy patient. J Oral Maxillofac Surg. 2006;64(12):1795–802.PubMedCrossRefGoogle Scholar
  199. Schwartze VU, Jacobsen ID. Mucormycoses caused by Lichtheimia species. Mycoses. 2014;57(s3):73–8.PubMedCrossRefGoogle Scholar
  200. Schwartze VU, et al. Lichtheimia species exhibit differences in virulence potential. PLoS One. 2012;7(7):e40908.PubMedPubMedCentralCrossRefGoogle Scholar
  201. Schwarz P, et al. Carbon assimilation profiles as a tool for identification of zygomycetes. J Clin Microbiol. 2007;45(5):1433–9.PubMedPubMedCentralCrossRefGoogle Scholar
  202. Scully MA, et al. SWAN MRI revealing multiple microhemorrhages secondary to septic emboli from mucormycosis. Neurology. 2012;79(18):1932–3.PubMedCrossRefGoogle Scholar
  203. Sen B, Asan A. Fungal flora in indoor and outdoor air of different residential houses in Tekirdag City (Turkey): seasonal distribution and relationship with climatic factors. Environ Monit Assess. 2009;151(1–4):209–19.PubMedCrossRefGoogle Scholar
  204. Sepkowitz K, Armstrong D. Space-occupying fungal lesions. In: Scheld WM, Whitley RJ, Durack DT, editors. Infections of the central nervous system, vol. 2. Philadelphia, PA: Lippincott-Raven Press; 1997. p. 741–62.Google Scholar
  205. Sharma RR, et al. Fatal rhino-orbito-cerebral mucormycosis in an apparently normal host: case report and literature review. J Clin Neurosci. 2001;8(6):583–6.PubMedCrossRefGoogle Scholar
  206. Shatriah I, et al. Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: case report and review of literature. Middle East Afr J Ophthalmol. 2012;19(2):258.PubMedPubMedCentralCrossRefGoogle Scholar
  207. deShazo RD, et al. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1997;123(11):1181–8.PubMedCrossRefGoogle Scholar
  208. Sheikh SS, Amr SS. Fungal infections of the central nervous system. In: Rai M, editor. Progress in mycology. New York: Springer Science & Business Media; 2011.Google Scholar
  209. Shpitzer T, et al. Seasonal variations in rhino-cerebral Mucor infection. Ann Otol Rhinol Laryngol. 2005;114(9):695–8.PubMedCrossRefGoogle Scholar
  210. Siddiqi SU, Freedman JD. Isolated central nervous system mucormycosis. South Med J. 1994;87(10):997–1000.PubMedCrossRefGoogle Scholar
  211. Simitsopoulou M, et al. Cunninghamella bertholletiae exhibits increased resistance to human neutrophils with or without antifungal agents as compared to Rhizopus spp. Med Mycol. 2010;48(5):720–4.PubMedCrossRefGoogle Scholar
  212. Singh R, Shivaprakash M, Chakrabarti A. Biofilm formation by zygomycetes: quantification, structure and matrix composition. Microbiology. 2011;157(9):2611–8.PubMedCrossRefGoogle Scholar
  213. Singh P, et al. Stress response in medically important Mucorales. Mycoses. 2016;59(10):628–35.PubMedCrossRefGoogle Scholar
  214. Singh ND, et al. Apophysomyces elegans caused rhino-orbito mucormycosis: an emerging infection in immunocompetent individuals: case series with review of the literature. J Microbiol Infect Dis. 2017;7(04):207–12.CrossRefGoogle Scholar
  215. Skiada A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17(12):1859–67.PubMedCrossRefGoogle Scholar
  216. Sohail M, et al. Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment. Acta Trop. 2001;80(2):177–85.PubMedCrossRefGoogle Scholar
  217. Soler ZM, Schlosser RJ. The role of fungi in diseases of the nose and sinuses. Am J Rhinol Allergy. 2012;26(5):351.PubMedPubMedCentralCrossRefGoogle Scholar
  218. Song Y, et al. Mucormycosis in renal transplant recipients: review of 174 reported cases. BMC Infect Dis. 2017;17(1):283.PubMedPubMedCentralCrossRefGoogle Scholar
  219. Soto-Aguilar M, et al. Classification of and criteria for the diagnosis of invasive fungal sinusitis. J Investig Med. 1997;45:3A.Google Scholar
  220. Spellberg B, Edwards J, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18(3):556–69.PubMedPubMedCentralCrossRefGoogle Scholar
  221. Sponsler TA, et al. Ocular invasion in mucormycosis. Surv Ophthalmol. 1992;36(5):345–50.PubMedCrossRefGoogle Scholar
  222. Spreghini E, et al. In vitro and in vivo activities of posaconazole against zygomycetes with various degrees of susceptibility. J Antimicrob Chemother. 2010;65(10):2158–63.PubMedCrossRefGoogle Scholar
  223. Sravani T, et al. Rhinocerebral mucormycosis: pathology revisited with emphasis on perineural spread. Neurol India. 2014;62(4):383–6.PubMedPubMedCentralCrossRefGoogle Scholar
  224. Stave GM, Heimberger T, Kerkering TM. Zygomycosis of the basal ganglia in intravenous drug users. Am J Med. 1989;86(1):115–7.PubMedPubMedCentralCrossRefGoogle Scholar
  225. Strenger V, et al. Low penetration of caspofungin into cerebrospinal fluid following intravenous administration of standard doses. Int J Antimicrob Agents. 2017;50(2):272–5.PubMedCrossRefGoogle Scholar
  226. Sun QN, et al. In vitro activities of posaconazole, itraconazole, voriconazole, amphotericin B, and fluconazole against 37 clinical isolates of zygomycetes. Antimicrob Agents Chemother. 2002;46(5):1581–2.PubMedPubMedCentralCrossRefGoogle Scholar
  227. Sundaram C, et al. Cerebral zygomycosis. Mycoses. 2005;48(6):396–407.PubMedCrossRefGoogle Scholar
  228. Taj-Aldeen S, et al. Rare pediatric rhino-orbital infection caused by Saksenaea vasiformis. Infection. 2012;40(6):703–7.PubMedCrossRefGoogle Scholar
  229. Talmi YP, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg. 2002;127(1):22–31.PubMedCrossRefGoogle Scholar
  230. Teixeira CA, et al. Rhinocerebral mucormycosis: literature review apropos of a rare entity. BMJ Case Rep. 2013;2013:bcr2012008552.PubMedPubMedCentralCrossRefGoogle Scholar
  231. Terk MR, et al. MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation. Magn Reson Imaging. 1992;10(1):81–7.PubMedCrossRefGoogle Scholar
  232. Thirumala S, Nathu MP. Original research article study of fungal spores diversity, in Malebenur region of Karnataka, India. Int J Curr Microbiol App Sci. 2013;2(3):44–8.Google Scholar
  233. Torres-Narbona M, et al. Impact of zygomycosis on microbiology workload: a survey study in Spain. J Clin Microbiol. 2007a;45(6):2051–3.PubMedPubMedCentralCrossRefGoogle Scholar
  234. Torres-Narbona M, et al. In vitro activities of amphotericin B, caspofungin, itraconazole, posaconazole, and voriconazole against 45 clinical isolates of zygomycetes: comparison of CLSI M38-A, Sensititre YeastOne, and the Etest. Antimicrob Agents Chemother. 2007b;51(3):1126–9.PubMedCrossRefPubMedCentralGoogle Scholar
  235. Torres-Narbona M, et al. Workload and clinical significance of the isolation of zygomycetes in a tertiary general hospital. Med Mycol. 2008;46(3):225–30.PubMedCrossRefPubMedCentralGoogle Scholar
  236. Tsung L, et al. Intraventricular amphotericin for absidiomycosis in an immunocompetent child. Hong Kong Med J. 2010;16(2):137–40.PubMedPubMedCentralGoogle Scholar
  237. Verma A, Brozman B, Petito CK. Isolated cerebral mucormycosis: report of a case and review of the literature. J Neurol Sci. 2006;240(1):65–9.PubMedPubMedCentralCrossRefGoogle Scholar
  238. Vigouroux S, et al. Zygomycosis after prolonged use of voriconazole in immunocompromised patients with hematologic disease: attention required. Clin Infect Dis. 2005;40(4):e35–7.PubMedCrossRefGoogle Scholar
  239. Vitale RG, et al. Antifungal susceptibility and phylogeny of opportunistic members of Mucorales. J Clin Microbiol. 2011; Scholar
  240. Voigt K, et al. The zygomycetes in a phylogenetic perspective. Persoonia. 2013;30:i.PubMedCentralCrossRefGoogle Scholar
  241. Wächtler B, et al. Candida albicans-epithelial interactions: dissecting the roles of active penetration, induced endocytosis and host factors on the infection process. PLoS One. 2012;7(5):e36952.PubMedPubMedCentralCrossRefGoogle Scholar
  242. Waldorf AR. Pulmonary defense mechanisms against opportunistic fungal pathogens. Immunol Ser. 1989;47:243–71.PubMedGoogle Scholar
  243. Waldorf AR, Diamond RD. Neutrophil chemotactic responses induced by fresh and swollen Rhizopus oryzae spores and Aspergillus fumigatus conidia. Infect Immun. 1985;48(2):458–63.PubMedPubMedCentralGoogle Scholar
  244. Waldorf AR, Levitz SM, Diamond RD. In vivo bronchoalveolar macrophage defense against Rhizopus oryzae and Aspergillus fumigatus. J Infect Dis. 1984a;150(5):752–60.PubMedCrossRefGoogle Scholar
  245. Waldorf A, Ruderman N, Diamond R. Specific susceptibility to mucormycosis in murine diabetes and bronchoalveolar macrophage defense against Rhizopus. J Clin Invest. 1984b;74(1):150–60.PubMedPubMedCentralCrossRefGoogle Scholar
  246. Walsh TJ, et al. Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. Antimicrob Agents Chemother. 2001;45(12):3487–96.PubMedPubMedCentralCrossRefGoogle Scholar
  247. Walsh TJ, et al. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis. 2012;54(Suppl 1):S55–60.CrossRefGoogle Scholar
  248. Walther G, et al. DNA barcoding in Mucorales: an inventory of biodiversity. Persoonia. 2013;30:11.PubMedPubMedCentralCrossRefGoogle Scholar
  249. Wang M, et al. Role of the unfolded protein response regulator GRP78/BiP in development, cancer, and neurological disorders. Antioxid Redox Signal. 2009;11(9):2307–16.PubMedPubMedCentralCrossRefGoogle Scholar
  250. Warris A, et al. Cytokine responses and regulation of interferon-gamma release by human mononuclear cells to Aspergillus fumigatus and other filamentous fungi. Sabouraudia. 2005;43(7):613–21.CrossRefGoogle Scholar
  251. Watson DF, et al. Isolated cerebral phycomycosis presenting as focal encephalitis. Arch Neurol. 1985;42(9):922–3.PubMedCrossRefGoogle Scholar
  252. Weprin BE, et al. Long-term survival in rhinocerebral mucormycosis: case report. J Neurosurg. 1998;88(3):570–5.PubMedCrossRefPubMedCentralGoogle Scholar
  253. Wetli CV, et al. Fungal cerebritis from intravenous drug abuse. J Forensic Sci. 1984;29(1):260–8.PubMedCrossRefPubMedCentralGoogle Scholar
  254. Wolkow N, et al. Chronic orbital and calvarial fungal infection with Apophysomyces variabilis in an immunocompetent patient. Surv Ophthalmol. 2017;62(1):70–82.PubMedPubMedCentralCrossRefGoogle Scholar
  255. Woods KF, Hanna BJ. Brain stem mucormycosis in a narcotic addict with eventual recovery. Am J Med. 1986;80(1):126–8.PubMedCrossRefPubMedCentralGoogle Scholar
  256. Yang D, et al. Mammalian defensins in immunity: more than just microbicidal. Trends Immunol. 2002;23(6):291–6.PubMedCrossRefGoogle Scholar
  257. Yousem DM, et al. MR findings in rhinocerebral mucormycosis. J Comput Assist Tomogr. 1989;13(5):878–82.PubMedCrossRefGoogle Scholar
  258. Zeilender S, et al. Fatal Cunninghamella bertholletiae infection in an immunocompetent patient. Chest. 1990;97(6):1482–3.PubMedCrossRefPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • A. Serda Kantarcioglu
    • 1
  1. 1.Division of Mycology, Department of Medical Microbiology, Cerrahpasa Medical FacultyIstanbul University-CerrahpasaIstanbulTurkey

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