{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:40:46Z","timestamp":1777480846932,"version":"3.51.4"},"reference-count":55,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Henry Schueler Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>The early diagnosis and treatment of mucormycosis improves outcomes and saves lives [...]<\/jats:p>","DOI":"10.3390\/jof11070507","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T06:03:13Z","timestamp":1751868193000},"page":"507","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Recognizing the Early Risk-Based Clinical Manifestations of Mucormycosis: Cornerstones for Improved Survival and Therapeutic Outcomes"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4669-957X","authenticated-orcid":false,"given":"Panagiotis","family":"Zagaliotis","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Weill Cornell Medicine, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7078-9778","authenticated-orcid":false,"given":"Thomas J.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Center for Innovative Therapeutics and Diagnostics, Richmond, VA 23220, USA"},{"name":"Departments of Medicine and Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and outcome of zygomycosis: A review of 929 reported cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Skiada, A., Pavleas, I., and Drogari-Apiranthitou, M. (2020). Epidemiology and Diagnosis of Mucormycosis: An Update. J. Fungi, 6.","DOI":"10.3390\/jof6040265"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1093\/cid\/cir880","article-title":"A global analysis of mucormycosis in France: The RetroZygo Study (2005\u20132007)","volume":"54","author":"Lanternier","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1469-0691.2010.03456.x","article-title":"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","volume":"17","author":"Skiada","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1055\/s-0029-1220775","article-title":"Zygomycosis in neonates: An uncommon but life-threatening infection","volume":"26","author":"Roilides","year":"2009","journal-title":"Am. J. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1093\/clinids\/27.5.1138","article-title":"The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992\u20131993: Results of population-based laboratory active surveillance","volume":"27","author":"Rees","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kontoyiannis, D.P., Yang, H., Song, J., Kelkar, S.S., Yang, X., Azie, N., Harrington, R., Fan, A., Lee, E., and Spalding, J.R. (2016). Prevalence, clinical and economic burden of mucormycosis-related hospitalizations in the United States: A retrospective study. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-2023-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.3201\/eid1609.100276","article-title":"Increasing incidence of mucormycosis in University Hospital, Belgium","volume":"16","author":"Saegeman","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1086\/313803","article-title":"Zygomycosis in the 1990s in a tertiary-care cancer center","volume":"30","author":"Kontoyiannis","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/INF.0b013e318062115c","article-title":"Zygomycosis in children: A systematic review and analysis of reported cases","volume":"26","author":"Zaoutis","year":"2007","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Walsh, T.J., Hospenthal, D.R., Petraitis, V., and Kontoyiannis, D.P. (2019). Necrotizing Mucormycosis of Wounds Following Combat Injuries, Natural Disasters, Burns, and Other Trauma. J. Fungi, 5.","DOI":"10.3390\/jof5030057"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e70028","DOI":"10.1111\/myc.70028","article-title":"Invasive Mould Infections Following Combat-Related Injuries-A Retrospective Cohort Study","volume":"68","author":"Azulay","year":"2025","journal-title":"Mycoses"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.cmi.2023.12.006","article-title":"Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: A multicentre retrospective study from India","volume":"30","author":"Muthu","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.cmi.2023.03.008","article-title":"COVID-19-associated mucormycosis: A systematic review and meta-analysis of 958 cases","volume":"29","author":"Manay","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s11046-021-00528-2","article-title":"Coronavirus Disease (COVID-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature","volume":"186","author":"Garg","year":"2021","journal-title":"Mycopathologia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1093\/cid\/cir865","article-title":"Pathogenesis of mucormycosis","volume":"54","author":"Brahim","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1093\/cid\/cir869","article-title":"Host defenses against zygomycetes","volume":"54","author":"Roilides","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Alqarihi, A., Kontoyiannis, D.P., and Ibrahim, A.S. (2023). Mucormycosis in 2023: An update on pathogenesis and management. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1254919"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1172\/JCI42164","article-title":"The endothelial cell receptor GRP78 is required for mucormycosis pathogenesis in diabetic mice","volume":"120","author":"Liu","year":"2010","journal-title":"J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"eads7369","DOI":"10.1126\/scitranslmed.ads7369","article-title":"A humanized antibody against mucormycosis targets angioinvasion and augments the host immune response","volume":"17","author":"Gu","year":"2025","journal-title":"Sci. Transl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1080\/00365540410020794","article-title":"Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy","volume":"36","author":"Thajeb","year":"2004","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s11908-012-0272-6","article-title":"Rhino-orbital-cerebral mucormycosis","volume":"14","author":"Gamaletsou","year":"2012","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Serris, A., Danion, F., and Lanternier, F. (2019). Disease Entities in Mucormycosis. J. Fungi, 5.","DOI":"10.3390\/jof5010023"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4103\/0975-962X.189339","article-title":"Proximity of maxillary posterior teeth roots to maxillary sinus and adjacent structures using Denta scan\u00ae","volume":"7","author":"Fry","year":"2016","journal-title":"Indian J. Dent."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-2008-1063850","article-title":"Pulmonary zygomycosis","volume":"29","author":"Pyrgos","year":"2008","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1086\/428780","article-title":"Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: A case-control observational study of 27 recent cases","volume":"191","author":"Kontoyiannis","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1086\/430710","article-title":"Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer","volume":"41","author":"Chamilos","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/cid\/cir122","article-title":"The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts","volume":"52","author":"Georgiadou","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/cid\/cit929","article-title":"The reversed halo sign: Pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia?","volume":"58","author":"Legouge","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/myc.12922","article-title":"Mediastinal Mucormycosis: Case report, review of literature and treatment with continuous liposomal amphotericin B irrigation","volume":"62","author":"Cooper","year":"2019","journal-title":"Mycoses"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1164\/rccm.202207-1290IM","article-title":"Pulmonary Mucormycosis with Rib Involvement in an Immunocompromised Patient","volume":"207","author":"Liu","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1378\/chest.101.6.1733","article-title":"The clinical manifestations of cardiac mucormycosis","volume":"101","author":"Jackman","year":"1992","journal-title":"Chest"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Skiada, A., Drogari-Apiranthitou, M., Pavleas, I., Daikou, E., and Petrikkos, G. (2022). Global Cutaneous Mucormycosis: A Systematic Review. J. Fungi, 8.","DOI":"10.3390\/jof8020194"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/S0140-6736(05)71020-5","article-title":"Mucormycosis: An infectious complication of traumatic injury","volume":"365","author":"Hay","year":"2005","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/00000637-200210000-00009","article-title":"Primary cutaneous mucormycosis: Guide to surgical management","volume":"49","author":"Losee","year":"2002","journal-title":"Ann. Plast. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s12281-020-00385-4","article-title":"Combat trauma-related invasive fungal wound infections","volume":"14","author":"Tribble","year":"2020","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1097\/01.inf.0000136870.17071.fd","article-title":"Successful treatment of a child with posttraumatic necrotizing fasciitis caused by Apophysomyces elegans: Case report and review of literature","volume":"23","author":"Kordy","year":"2004","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_39","first-page":"691","article-title":"Bone and joint infections caused by Mucormycetes: A challenging osteoarticular mycosis of the 21st century","volume":"55","author":"Gamaletsou","year":"2017","journal-title":"Med. Mycol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0022-3468(05)80104-6","article-title":"Mucormycosis of the neonatal gut: A \"new\" disease or a variant of necrotizing enterocolitis?","volume":"27","author":"Woodward","year":"1992","journal-title":"J. Pediatr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"249","DOI":"10.14740\/gr1662","article-title":"Gastrointestinal Mucormycosis: A Clinical Review","volume":"16","author":"Addasi","year":"2023","journal-title":"Gastroenterol. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1086\/514562","article-title":"Successful medical management of isolated renal zygomycosis: A case report and literature review","volume":"26","author":"Weng","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s100960050207","article-title":"Two cases of disseminated mucormycosis in patients with hematological malignancies and literature review","volume":"17","author":"Cuvelier","year":"1998","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"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","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/14737159.2019.1574572","article-title":"The expanding use of matrix assisted laser desorption\/ionization-time of flight mass spectroscopy (MALDI-TOF MS) in diagnosis of patients with mycotic disease","volume":"19","author":"Walsh","year":"2019","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Fissel, J.A., Holdren-Serrell, C.K., Memon, W., and Zhang, S.X. (2022). Performance of a Matrix-Assisted Laser Desorption\/Ionization Time-of-Flight Mass Spectrometry Testing Algorithm for the Rapid Identification of Clinical Filamentous Molds. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.915049"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jinf.2020.05.051","article-title":"Evaluation of MucorGenius. Mucorales PCR Assay for the Diagnosis of Pulmonary Mucormycosis","volume":"81","author":"Guegan","year":"2020","journal-title":"J. Infect."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/cid\/ciaa035","article-title":"Clinical Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-Free DNA for the Diagnosis of Infectious Diseases: A Multicenter Retrospective Cohort Study","volume":"72","author":"Hogan","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1093\/cid\/ciad599","article-title":"Plasma Microbial Cell-Free DNA Sequencing in Immunocompromised Patients With Pneumonia: A Prospective Observational Study","volume":"78","author":"Bergin","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"103115","DOI":"10.1016\/j.eclinm.2025.103115","article-title":"The diagnosis of mucormycosis by PCR in patients at risk: A systematic review and meta-analysis","volume":"81","author":"Brown","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Hoenigl, M., Arastehfar, A., Arendrup, M.C., Br\u00fcggemann, R., Carvalho, A., Chiller, T., Chen, S., Egger, M., Feys, S., and Gangneux, J.-P. (2024). Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin. Microbiol. Rev., 37.","DOI":"10.1128\/cmr.00074-23"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5282","DOI":"10.1038\/s41467-024-49637-8","article-title":"Multiple roles for hypoxia inducible factor-1\u03b1 in airway epithelial cells during mucormycosis","volume":"15","author":"Kavaliauskas","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Wurster, S., Albert, N.D., Bharadwaj, U., Kasembeli, M.M., Tarrand, J.J., Daver, N., and Kontoyiannis, D.P. (2022). Blockade of the PD-1\/PD-L1 Immune Checkpoint Pathway Improves Infection Outcomes and Enhances Fungicidal Host Defense in a Murine Model of Invasive Pulmonary Mucormycosis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.838344"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.cmi.2018.07.011","article-title":"The epidemiology and clinical manifestations of mucormycosis: A systematic review and meta-analysis of case reports","volume":"25","author":"Jeong","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"ofae257","DOI":"10.1093\/ofid\/ofae257","article-title":"Meeting the Therapeutic Challenges of Emergent and Rare Invasive Fungal Diseases Through Novel Clinical Trial Designs","volume":"11","author":"Walsh","year":"2024","journal-title":"Open Forum Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/7\/507\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:36Z","timestamp":1760033076000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/7\/507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":55,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jof11070507"],"URL":"https:\/\/doi.org\/10.3390\/jof11070507","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]}}}