Specifically patients with deferoxamine-therapy, hyperglycaemic with or without ketoacidosis, or other forms of acidosis are uniquely

predisposed to mucormycosis. In this review, we discuss the molecular mechanisms of infection in these patient categories in an attempt to identify novel therapies for a disease with poor prognosis. Emphasis on the effect of glucose and free iron on host–pathogen interactions are also covered. Mucormycoses are Bortezomib purchase rare life-threatening fungal infections caused by fungi of the order Mucorales.[1-3] Rhizopus species remain the most common cause of infection, although more mucormycosis cases caused by Mucor, Lichtheimia and Apophysomyces are being reported.[4-7] These infections usually afflict patients with classical immunosuppression due to neutropenia, haematologic malignancies or corticosteroid treatment.[8, 9] Additionally, hyperglycaemia, diabetic ketoacidosis (DKA) and other forms of acidosis predispose patients to mucormycosis.[3, 10] Although burn and trauma patients have long been known to be susceptible to this infection,[9, 11] recent data showed that outbreaks of mucormycosis are also associated with natural

disasters[12, 13] and even in military personnel who are injured in combat operations.[14, 15] Therefore, mucormycosis are becoming more prevalent in the last two decades. Indeed, there has been a considerable rise in the incidence of mucormycosis at BMS-354825 supplier major transplant centres.[16, 17] In fact, in high-risk patients the prevalence of mucormycosis can be up to 8% in autopsied patients with leukaemia.[18] A population-based study carried out in France demonstrated a 70% increase in mucormycosis cases between 1997 and 2006.[19] In addition, data from a tertiary care centre in India demonstrated ≥400% increase in mucormycosis incidence, mainly among DKA patients in a 16-year period.[20, 21] The standard therapy for invasive

mucormycosis includes reversal of the underlying predisposing factors (if possible), emergent, wide-spread surgical debridement of the infected area, and antifungal therapy.[2, 22, 23] Although amphotericin B (AmB) remains the only Rebamipide antifungal agent approved for the treatment of invasive mucormycosis,[2, 23, 24] it is widely accepted that lipid formulation of AmB are the first line therapy for this disease. This is because Mucorales are relatively resistant to AmB, and higher doses (1–1.5 mg/kg/day) are required for effective treatment. Due to the less toxicity of lipid formulations of AmB, it is now possible to administer more effective higher doses of these lipid formulation drugs. However, in the absence of surgical removal of the infected focus (such as excision of the eye in patients with rhinocerebral mucormycosis), antifungal therapy alone is rarely curative.[2, 23] Moreover, even when surgical debridement is combined with high-dose lipid formulation AmB, the overall mortality associated with mucormycosis reaches 50%.