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Background: The body of evidence on cutaneous mucormycosis is largely derived from case reports or single‐centre databases. Objectives: Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States. Methods: We conducted a population‐based retrospective study using the National Inpatient Sample 2016‐17 data. Fifty‐six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis. Results: An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median age was 49.5 (19–59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post‐procedural infections, were the most common predisposing conditions. Median LOS was 15 (6–31) days, median total charges were 187,030 (65,962–446,265) USD, and in‐hospital mortality rate was 16.1%. Conclusions: In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post‐procedural infections. A high index of suspicion and prompt tissue sampling in at‐risk groups is important to improve the outcomes. [ABSTRACT FROM AUTHOR]

A population of adult reproductive female brown widow spiders, Latrodectus geometricus Koch (Araneae: Theridiidae) was collected in North Central Florida. Within weeks, the spiders displayed reduced foraging behavior and began to die. A white fungal growth was observed on deceased individuals and others who showed signs of decline. Fungal samples were collected from living spiders as well as from recently deceased specimens. Samples were excised from the spiders and isolated on acidified potato dextrose agar. Morphological characterization was cross referenced with the most recent phenotypic variability studies to confirm probable matches. Molecular identification was rendered using ITS1/5.8S/ITS2 and Mucor fragilis Bainier (Mucorales: Mucoraceae) was indicated with 99% match. Little is documented regarding M. fragilis, and no prior records of pathogenic occurrence are known by the authors. Subsequent bioassay trials supported with 83% mortality that this novel strain of M. fragilis does infect and kill L. geometricus. [ABSTRACT FROM AUTHOR]

Posaconazole (Noxafil® Schering-Plough Corporation) is a triazole antifungal approved in the United States for the treatment of oropharyngeal candidiasis and for the prophylaxis of Candida and Aspergillus infections in the immunocompromised host. Posaconazole is available only as an oral suspension. When used for the prevention of Candida and Aspergillus infections, posaconazole should be taken three times daily with a high fat meal to maximize oral absorption. Failure to take posaconazole with food will lead to subtherapeutic serum levels and decreased clinical effectiveness of the drug. We report the case of a 49-year-old woman with acute myeloid leukemia who received 4 months of posaconazole as an outpatient for the labeled indication of prophylaxis of Candida and Aspergillus infections. During her last admission, the patient presented with an invasive sinus infection diagnosed as a mixed Aspergillus and Mucor etiology. The patient succumbed to this infection five weeks after presentation. Upon investigation it was found that the patient did not self-administer posaconazole as required in the product labeling, which may have led to drug failure in this patient. We submit this case to illustrate the importance of patient education regarding proper administration of posaconazole. The important role of the outpatient physician, nurse, and pharmacist in this setting is underscored. [ABSTRACT FROM AUTHOR]

The global incidence of mucormycosis has increased in recent years owing to higher numbers of individuals at risk for these infections. The diagnosis and treatment of this aggressive fungal infection are of clinical concern due to differences in species distribution in different geographic areas and susceptibility profiles between different species that are capable of causing highly aggressive infections. The purpose of this study was to evaluate the epidemiology and susceptibility profiles of Mucorales isolates in the United States over a 52-month period. Species identification was performed by combined phenotypic characteristics and DNA sequence analysis, and antifungal susceptibility testing was performed by CLSI M38 broth microdilution for amphotericin B, isavuconazole, itraconazole, and posaconazole. During this time frame, 854 isolates were included, representing 11 different genera and over 26 species, of which Rhizopus (58.6%) was the predominant genus, followed by Mucor (19.6%). The majority of isolates were cultured from the upper and lower respiratory tracts (55%). Amphotericin B demonstrated the most potent in vitro activity, with geometric mean (GM) MICs of ≤0.25 μg/ml against all genera with the exception of Cunninghamella species (GM MIC of 1.30 μg/ml). In head-to-head comparisons, the most active azole was posaconazole, followed by isavuconazole. Differences in azole and amphotericin B susceptibility patterns were observed between the genera with the greatest variability observed with isavuconazole. Awareness of the epidemiology of Mucorales isolates and differences in antifungal susceptibility patterns in the United States may aide clinicians in choosing antifungal treatment regimens. Further studies are warranted to correlate these findings with clinical outcomes.

Zygomycosis is an angioinvasive fungal infection with a high mortality rate. Cutaneous zygomycosis is the second most common form of the disease, typically characterized by necrotic eschars in an immunocompromised host. We report an unusual case of superficial intertrigo resistant to conventional therapies caused by Mucor circinelloides in a patient with HIV and diabetes. [ABSTRACT FROM AUTHOR]