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Copyright (c) 2026 Bashaer Nasser Alharbi, Raneem Sultan Al-Ghamdi, Wafa Mater Musbel Alanazi, Norah Hamad Ibn Ahmed Eisi, Fatimah Hamad Essa, Nada Ayil Ali AlAmer, Najwa Hussain Jubran Hantol, Atheer Baalqasim Mohammed Hakami, Mohmmed Yahya Hantoul, Maram Abdulrahman Alghamdi, MOHMMED YAHYA HANTOUL, MURUJ ALI RAJEH KARIRI
This work is licensed under a Creative Commons Attribution 4.0 International License.
Early Recognition of Mucormycosis in High-Risk Patients: The Role of Nursing Assessment and Clinical Monitoring-An Updated Review
Corresponding Author(s) : Bashaer Nasser Alharbi
Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)
Abstract
Background: Mucormycosis is a rapidly progressive invasive fungal infection caused by Mucorales and is associated with substantial morbidity and mortality, particularly among patients with diabetes mellitus, hematological malignancies, transplantation, neutropenia, severe COVID-19, and other states of impaired host defense. Its angioinvasive nature promotes vascular thrombosis, tissue ischemia, infarction, and necrosis, making early recognition and treatment essential.
Aim: This review aims to provide a comprehensive clinical overview of mucormycosis, emphasizing its etiology, epidemiology, pathophysiology, histopathological characteristics, clinical manifestations, diagnostic evaluation, and current principles of treatment and nursing management.
Methods: A narrative review was developed using established medical literature addressing the microbiology, epidemiology, mechanisms of disease, clinical presentations, diagnostic approaches, and therapeutic management of mucormycosis. Particular attention was given to histopathological findings, imaging characteristics, antifungal therapy, surgical intervention, correction of predisposing conditions, and supportive multidisciplinary care.
Results: Mucormycosis primarily affects individuals with impaired immune or metabolic defenses. Rhizopus represents the most frequently implicated genus. Disease commonly involves the rhino-orbital-cerebral region, lungs, skin, gastrointestinal tract, and disseminated sites. Histopathology demonstrates broad, pauciseptate or nonseptate hyphae with irregular right-angle branching and tissue or vascular invasion. Diagnosis requires integration of clinical findings, imaging, histopathology, culture, and emerging molecular methods. Management depends on prompt antifungal therapy, extensive surgical debridement when feasible, correction of underlying risk factors, and selected use of combination or adjunctive therapies.
Conclusion: Early recognition, rapid diagnostic evaluation, aggressive source control, appropriate antifungal therapy, and correction of predisposing conditions are central to mucormycosis management. Nurses contribute substantially through risk assessment, clinical monitoring, medication management, wound care, and multidisciplinary coordination.
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- 1. Kontoyiannis DP, Walsh TJ. Mucormycosis. N Engl J Med. 2026 Feb 12;394(7):684-698.
- 2. Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SC. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel). 2023 Jun 12;9(6)
- 3. Richardson MD, Rautemaa-Richardson R. Biotic Environments Supporting the Persistence of Clinically Relevant Mucormycetes. J Fungi (Basel). 2019 Dec 20;6(1)
- 4. Alqarihi A, Kontoyiannis DP, Ibrahim AS. Mucormycosis in 2023: an update on pathogenesis and management. Front Cell Infect Microbiol. 2023;13:1254919.
- 5. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis. 2012 Feb;54 Suppl 1(Suppl 1):S16-22.
- 6. Binder U, Maurer E, Lass-Flörl C. Mucormycosis--from the pathogens to the disease. Clin Microbiol Infect. 2014 Jun;20 Suppl 6:60-6.
- 7. Denning DW. Global incidence and mortality of severe fungal disease. Lancet Infect Dis. 2024 Jul;24(7):e428-e438.
- 8. Pasquier G. COVID-19-associated mucormycosis in India: Why such an outbreak? J Mycol Med. 2023 Aug;33(3):101393.
- 9. Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms. 2021 Mar 04;9(3)
- 10. Prakash H, Chakrabarti A. Global Epidemiology of Mucormycosis. J Fungi (Basel). 2019 Mar 21;5(1)
- 11. Özbek L, Topçu U, Manay M, Esen BH, Bektas SN, Aydın S, Özdemir B, Khostelidi SN, Klimko N, Cornely O, Zakhour J, Kanj SS, Seidel D, Hoenigl M, Ergönül Ö. COVID-19-associated mucormycosis: a systematic review and meta-analysis of 958 cases. Clin Microbiol Infect. 2023 Jun;29(6):722-731.
- 12. Ibrahim AS, Spellberg B, Edwards J. Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis. 2008 Dec;21(6):620-5.
- 13. Cheok KPL, Farrow A, Springell D, O'Reilly M, Morley S, Stone N, Roddie C. Mucormycosis after CD19 chimeric antigen receptor T-cell therapy: results of a US Food and Drug Administration adverse events reporting system analysis and a review of the literature. Lancet Infect Dis. 2024 Apr;24(4):e256-e265.
- 14. Baranwal HV, Katiyar VK, Sharma S, Mishra SP, Bhartiya SK. Cutaneous Mucormycosis Following Polytrauma: A Multidisciplinary Approach. Cureus. 2025 Aug;17(8):e89767.
- 15. Tribble DR, Rodriguez CJ. Combat-Related Invasive Fungal Wound Infections. Curr Fungal Infect Rep. 2014 Dec 01;8(4):277-286.
- 16. Dang J, Goel P, Choi KJ, Massenzio E, Landau MJ, Pham CH, Huang S, Yenikomshian HA, Spellberg B, Gillenwater TJ. Mucormycosis following burn injuries: A systematic review. Burns. 2023 Feb;49(1):15-25.
- 17. Hietbrink F, Koenderman L, Rijkers G, Leenen L. Trauma: the role of the innate immune system. World J Emerg Surg. 2006 May 20;1:15.
- 18. Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251170.
- 19. Tahiri G, Lax C, Cánovas-Márquez JT, Carrillo-Marín P, Sanchis M, Navarro E, Garre V, Nicolás FE. Mucorales and Mucormycosis: Recent Insights and Future Prospects. J Fungi (Basel). 2023 Mar 09;9(3)
- 20. Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014 Jun;20 Suppl 6:74-81.
- 21. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016 Mar;30(1):143-63.
- 22. Vallabhaneni S, Walker TA, Lockhart SR, Ng D, Chiller T, Melchreit R, Brandt ME, Smith RM., Centers for Disease Control and Prevention (CDC). Notes from the field: Fatal gastrointestinal mucormycosis in a premature infant associated with a contaminated dietary supplement--Connecticut, 2014. MMWR Morb Mortal Wkly Rep. 2015 Feb 20;64(6):155-6.
- 23. Snyder AB, Worobo RW. Risk Mitigation for Immunocompromised Consumers of Mucormycete Spoiled and Fermented Foods: Germain Guidance and Remaining Needs. Microorganisms. 2018 May 18;6(2)
- 24. Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog. 2022 Feb;163:105388.
- 25. Gupta MK, Kumar N, Dhameja N, Sharma A, Tilak R. Laboratory diagnosis of mucormycosis: Present perspective. J Family Med Prim Care. 2022 May;11(5):1664-1671.
- 26. Prattes J, Dichtl K, Sedik S, Glatz U, Egger M, Wölfler A, Zajic P, Kessler HH, Hoenigl M. Diagnostic accuracy of Mucorales PCR testing in bronchoalveolar lavage fluid samples: a retrospective analysis of a prospectively collected cohort. Clin Microbiol Infect. 2026 Jun;32(6):991-997.
- 27. Safiia J, Díaz MA, Alshaker H, Atallah CJ, Sakr P, Moshovitis DG, Nawlo A, Franceschi AE, Liakos A, Koo S. Recent Advances in Diagnostic Approaches for Mucormycosis. J Fungi (Basel). 2024 Oct 19;10(10)
- 28. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A., Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec;19(12):e405-e421.
- 29. Meena DS, Kumar D, Bohra GK. Combination therapy in Mucormycosis: Current evidence from the world literature, a mini review. J Mycol Med. 2023 Mar;33(1):101332.
- 30. Chegini Z, Didehdar M, Khoshbayan A, Rajaeih S, Salehi M, Shariati A. Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series. Mycoses. 2020 Dec;63(12):1264-1282.
- 31. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Freiberger T, Guinea J, Guarro J, de Hoog S, Hope W, Johnson E, Kathuria S, Lackner M, Lass-Flörl C, Lortholary O, Meis JF, Meletiadis J, Muñoz P, Richardson M, Roilides E, Tortorano AM, Ullmann AJ, van Diepeningen A, Verweij P, Petrikkos G., European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group. European Confederation of Medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014 Apr;20 Suppl 3:5-26.
References
1. Kontoyiannis DP, Walsh TJ. Mucormycosis. N Engl J Med. 2026 Feb 12;394(7):684-698.
2. Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SC. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel). 2023 Jun 12;9(6)
3. Richardson MD, Rautemaa-Richardson R. Biotic Environments Supporting the Persistence of Clinically Relevant Mucormycetes. J Fungi (Basel). 2019 Dec 20;6(1)
4. Alqarihi A, Kontoyiannis DP, Ibrahim AS. Mucormycosis in 2023: an update on pathogenesis and management. Front Cell Infect Microbiol. 2023;13:1254919.
5. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis. 2012 Feb;54 Suppl 1(Suppl 1):S16-22.
6. Binder U, Maurer E, Lass-Flörl C. Mucormycosis--from the pathogens to the disease. Clin Microbiol Infect. 2014 Jun;20 Suppl 6:60-6.
7. Denning DW. Global incidence and mortality of severe fungal disease. Lancet Infect Dis. 2024 Jul;24(7):e428-e438.
8. Pasquier G. COVID-19-associated mucormycosis in India: Why such an outbreak? J Mycol Med. 2023 Aug;33(3):101393.
9. Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms. 2021 Mar 04;9(3)
10. Prakash H, Chakrabarti A. Global Epidemiology of Mucormycosis. J Fungi (Basel). 2019 Mar 21;5(1)
11. Özbek L, Topçu U, Manay M, Esen BH, Bektas SN, Aydın S, Özdemir B, Khostelidi SN, Klimko N, Cornely O, Zakhour J, Kanj SS, Seidel D, Hoenigl M, Ergönül Ö. COVID-19-associated mucormycosis: a systematic review and meta-analysis of 958 cases. Clin Microbiol Infect. 2023 Jun;29(6):722-731.
12. Ibrahim AS, Spellberg B, Edwards J. Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis. 2008 Dec;21(6):620-5.
13. Cheok KPL, Farrow A, Springell D, O'Reilly M, Morley S, Stone N, Roddie C. Mucormycosis after CD19 chimeric antigen receptor T-cell therapy: results of a US Food and Drug Administration adverse events reporting system analysis and a review of the literature. Lancet Infect Dis. 2024 Apr;24(4):e256-e265.
14. Baranwal HV, Katiyar VK, Sharma S, Mishra SP, Bhartiya SK. Cutaneous Mucormycosis Following Polytrauma: A Multidisciplinary Approach. Cureus. 2025 Aug;17(8):e89767.
15. Tribble DR, Rodriguez CJ. Combat-Related Invasive Fungal Wound Infections. Curr Fungal Infect Rep. 2014 Dec 01;8(4):277-286.
16. Dang J, Goel P, Choi KJ, Massenzio E, Landau MJ, Pham CH, Huang S, Yenikomshian HA, Spellberg B, Gillenwater TJ. Mucormycosis following burn injuries: A systematic review. Burns. 2023 Feb;49(1):15-25.
17. Hietbrink F, Koenderman L, Rijkers G, Leenen L. Trauma: the role of the innate immune system. World J Emerg Surg. 2006 May 20;1:15.
18. Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251170.
19. Tahiri G, Lax C, Cánovas-Márquez JT, Carrillo-Marín P, Sanchis M, Navarro E, Garre V, Nicolás FE. Mucorales and Mucormycosis: Recent Insights and Future Prospects. J Fungi (Basel). 2023 Mar 09;9(3)
20. Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014 Jun;20 Suppl 6:74-81.
21. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016 Mar;30(1):143-63.
22. Vallabhaneni S, Walker TA, Lockhart SR, Ng D, Chiller T, Melchreit R, Brandt ME, Smith RM., Centers for Disease Control and Prevention (CDC). Notes from the field: Fatal gastrointestinal mucormycosis in a premature infant associated with a contaminated dietary supplement--Connecticut, 2014. MMWR Morb Mortal Wkly Rep. 2015 Feb 20;64(6):155-6.
23. Snyder AB, Worobo RW. Risk Mitigation for Immunocompromised Consumers of Mucormycete Spoiled and Fermented Foods: Germain Guidance and Remaining Needs. Microorganisms. 2018 May 18;6(2)
24. Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog. 2022 Feb;163:105388.
25. Gupta MK, Kumar N, Dhameja N, Sharma A, Tilak R. Laboratory diagnosis of mucormycosis: Present perspective. J Family Med Prim Care. 2022 May;11(5):1664-1671.
26. Prattes J, Dichtl K, Sedik S, Glatz U, Egger M, Wölfler A, Zajic P, Kessler HH, Hoenigl M. Diagnostic accuracy of Mucorales PCR testing in bronchoalveolar lavage fluid samples: a retrospective analysis of a prospectively collected cohort. Clin Microbiol Infect. 2026 Jun;32(6):991-997.
27. Safiia J, Díaz MA, Alshaker H, Atallah CJ, Sakr P, Moshovitis DG, Nawlo A, Franceschi AE, Liakos A, Koo S. Recent Advances in Diagnostic Approaches for Mucormycosis. J Fungi (Basel). 2024 Oct 19;10(10)
28. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A., Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec;19(12):e405-e421.
29. Meena DS, Kumar D, Bohra GK. Combination therapy in Mucormycosis: Current evidence from the world literature, a mini review. J Mycol Med. 2023 Mar;33(1):101332.
30. Chegini Z, Didehdar M, Khoshbayan A, Rajaeih S, Salehi M, Shariati A. Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series. Mycoses. 2020 Dec;63(12):1264-1282.
31. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Freiberger T, Guinea J, Guarro J, de Hoog S, Hope W, Johnson E, Kathuria S, Lackner M, Lass-Flörl C, Lortholary O, Meis JF, Meletiadis J, Muñoz P, Richardson M, Roilides E, Tortorano AM, Ullmann AJ, van Diepeningen A, Verweij P, Petrikkos G., European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group. European Confederation of Medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014 Apr;20 Suppl 3:5-26.