Mucormycosis is a very aggressive invasive fungal disease [ 1 x 1 Christopeit, M, Lindner, A, Surov, A et al. Right flank pain and high fever in a neutropenic patient with acute lymphoblastic leukaemia. Mycoses. 2013; 56: 90–92 Crossref | PubMed | Scopus (0) | Google Scholar See all References , 2 x 2 Neblett Fanfair, R, Benedict, K, Bos, J et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med. 2012; 367: 2214–2225 Crossref | PubMed | Scopus (107) | Google Scholar See all References ]. It is a fungal emergency that affects a variety of patient groups [ 3 x 3 Roden, MM, Zaoutis, TE, Buchanan, WL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005; 41: 634–653 Crossref | PubMed | Scopus (1104) | Google Scholar See all References 3 ]. The disease, previously termed zygomycosis [ 4 x 4 Ajello, L, Dean, DF, and Irwin, RS. The zygomycete Saksenaea vasiformis as a pathogen of humans with a critical review of the etiology of zygomycosis. Mycologia. 1976; 68: 52–62 Crossref | PubMed | Google Scholar See all References 4 ], is caused by mucoralean fungi, which have collectively also been called Mucormycetes [ 5 x 5 Gomes, MZ, Lewis, RE, and Kontoyiannis, DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev. 2011; 24: 411–445 Crossref | PubMed | Scopus (138) | Google Scholar See all References , 6 x 6 Kwon-Chung, KJ. Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: molecular mycologic perspectives. Clin Infect Dis. 2012; 54: S8–S15 Crossref | PubMed | Scopus (0) | Google Scholar See all References ]. However, we prefer to use the name of the order, i.e. Mucorales.

Only five species account for 92% of cases of candidemia (Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei); however, their distribution varies in population-based studies conducted in different geographical areas. C. albicans is the most frequent species, but considerable differences are found between the number of cases caused by C. glabrata and C. parapsilosis. Studies from Northern Europe and the USA reported a high number of cases caused by C. glabrata, whereas studies from Spain and Brazil demonstrated a lower number of cases caused by C. glabrata and a higher number of cases attributed to C. parapsilosis. Globally, the frequency of C. albicans is decreasing, while that of C. glabrata and C. krusei is stable, and C. parapsilosis and C. tropicalis are increasing. Patient characteristics and prior antifungal therapy also have a considerable influence on the distribution and frequency of Candida spp., regardless of the geographical area. C. albicans is more frequent in patients aged up to 18 years, the frequency of C. parapsilosis decreases with age, and C. glabrata is more common in the elderly. Finally, the presence of horizontal transmission of Candida spp. isolates (reported mainly in patients from the adult medical and post-surgical ICU, patients from oncology-haematology units, and neonates) can affect species distribution.

The frequency and diversity of serious fungal infections is increasing [ 1 x 1 Nucci, M, Garnica, M, Gloria, AB et al. Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil. Clin Microbiol Infect. 2013; 19: 745–751 Abstract | Full Text | Full Text PDF | PubMed | Scopus (43) | Google Scholar See all References , 2 x 2 Nucci, M and Anaissie, E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007; 20: 695–704 Crossref | PubMed | Scopus (413) | Google Scholar See all References , 3 x 3 Nucci, M and Anaissie, E. Emerging fungi. Infect Dis Clin North Am. 2006; 20: 563–579 Abstract | Full Text | Full Text PDF | PubMed | Scopus (0) | Google Scholar See all References ]. Severely immunocompromised patients are particularly vulnerable to infection from unusual moulds and yeasts, which are present in the environment. Clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Localized infections may occur following penetrating trauma in healthy individuals; dissemination usually occurs among immunocompromised patients and the outcome is closely related to the degree and persistence of immunosuppression [ 4 x 4 Nucci, M, Anaissie, EJ, Queiroz-Telles, F et al. Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection. Cancer. 2003; 98: 315–319 Crossref | PubMed | Scopus (163) | Google Scholar See all References 4 ]. Diagnosis usually requires isolation and identification of the infecting pathogen; however, serology, imaging techniques and clinical manifestations are not specific, and pan-fungal and species-specific PCR are useful investigational tools. Many of the emerging opportunistic moulds demonstrate in vitro and in vivo resistance to various antifungals. As a result, successful treatment may require adjunctive surgical debridement and, when possible, reconstitution of the host immune system.

Invasive pulmonary aspergillosis (IPA) affects patients with neutropenia, solid organ recipients, and those receiving corticosteroids and other immunosuppressive therapies [ 1 x 1 Patterson, TF, Kirkpatrick, WR, White, M et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore). 2000; 79: 250–260 Crossref | PubMed | Scopus (618) | Google Scholar See all References , 2 x 2 Singh, N and Paterson, DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev. 2005; 18: 44–69 Crossref | PubMed | Scopus (437) | Google Scholar See all References , 3 x 3 Marr, KA, Carter, RA, Boeckh, M, Martin, P, and Corey, L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood. 2002; 100: 4358–4366 Crossref | PubMed | Scopus (714) | Google Scholar See all References , 4 x 4 Marr, KA, Patterson, T, and Denning, D. Aspergillosis. Pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am. 2002; 16: 875–894 (vi.) Abstract | Full Text | Full Text PDF | PubMed | Scopus (251) | Google Scholar See all References , 5 x 5 Perea, S and Patterson, TF. InvasiveAspergillus infections in hematologic malignancy patients. Semin Respir Infect. 2002; 17: 99–105 Crossref | PubMed | Scopus (43) | Google Scholar See all References , 6 x 6 Cornillet, A, Camus, C, Nimubona, S et al. Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6‐year survey. Clin Infect Dis. 2006; 43: 577–584 Crossref | PubMed | Scopus (207) | Google Scholar See all References , 7 x 7 Bouza, E, Guinea, J, Peláez, T, Pérez‐Molina, J, Alcalá, L, and Muñoz, P. Workload due toAspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital. J Clin Microbiol. 2005; 43: 2075–2079 Crossref | PubMed | Scopus (53) | Google Scholar See all References , 8 x 8 Ader, F, Nseir, S, Le Berre, R et al. Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin Microbiol Infect. 2005; 11: 427–429 Crossref | PubMed | Scopus (90) | Google Scholar See all References , 9 x 9 Bulpa, P, Dive, A, and Sibille, Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J. 2007; 30: 782–800 Crossref | PubMed | Scopus (180) | Google Scholar See all References , 10 x 10 Samarakoon, P and Soubani, AO. Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature. Chron Respir Dis. 2008; 5: 19–27 Crossref | PubMed | Scopus (75) | Google Scholar See all References , 11 x 11 Meersseman, W, Lagrou, K, Maertens, J, and Van Wijngaerden, E. Invasive aspergillosis in the intensive care unit. Clin Infect Dis. 2007; 45: 205–216 Crossref | PubMed | Scopus (193) | Google Scholar See all References , 12 x 12 Bulpa, PA, Dive, AM, Garrino, MG et al. Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?. Intensive Care Med. 2001; 27: 59–67 Crossref | PubMed | Scopus (94) | Google Scholar See all References , 13 x 13 Rello, J, Esandi, ME, Mariscal, D, Gallego, M, Domingo, C, and Valles, J. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: report of eight cases and review. Clin Infect Dis. 1998; 26: 1473–1475 Crossref | PubMed | Scopus (106) | Google Scholar See all References ]. Patients with severe chronic obstructive pulmonary disease (COPD) who are receiving broad-spectrum antibiotics and corticosteroids are becoming one of the main risk groups for IPA [ 14 x 14 Agustí, C, Rano, A, Aldabo, I, and Torres, A. Fungal pneumonia, chronic respiratory diseases and glucocorticoids. Med Mycol. 2006; 44: 207–211 Crossref | Scopus (6) | Google Scholar See all References , 15 x 15 Barouky, R, Badet, M, Denis, MS, Soubirou, JL, Philit, F, and Guerin, C. Inhaled corticosteroids in chronic obstructive pulmonary disease and disseminated aspergillosis. Eur J Intern Med. 2003; 14: 380–382 Abstract | Full Text PDF | PubMed | Scopus (21) | Google Scholar See all References , 16 x 16 Garcés Jarque, JM, Terradas Robledo, R, Álvarez‐Lerma, F, Grau Cerrato, S, Salvado Costa, M, and Torres‐Rodríguez, JM. Lung aspergillosis. Role of the corticoids as associated risk factor in the patient with chronic bronchitis. Rev Clin Esp. 2003; 203: 472–474 Crossref | PubMed | Google Scholar See all References , 17 x 17 Ader, F, Nseir, S, Tillie‐Leblond, I, and Guery, B. Acute invasive pulmonary aspergillosis in chronic lung disease. a review. Rev Mal Respir. 2006; 23: 6511–6520 Google Scholar See all References ]. However, data on this disease are limited, fragmented, and usually obtained from case reports, or small collections of cases from different institutions.