Advancements in Understanding of Mucorales Biology and the Management of Mucormycosis

Mucormycosis is a life-threatening infection caused by certain species of the fungal order Mucorales. Although respiratory tract is the primary site of infection by Mucorales, mucormycosis can affect different organ and manifesting as rhino cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated disease (Alqarihi et al., 2023). This opportunistic infection affects patients with defects in the numbers and/or function of professional phagocytes and also individuals with unique metabolic defects. In particular, poorly controlled diabetes mellitus, acidosis, malnutrition, acquired iron overload syndromes, trauma or burns, especially in the setting of natural disasters (e.g., tornados, tsunamis), are unique predisposing conditions for mucormycosis. While the exact global burden of mucormycosis remains unknown, its incidence is steadily increasing over the past three decades. The COVID-19 pandemic has dramatically increased this trend, resulting in a surge of up to 50 times the previously recorded maximum cases (Hoenigl et al., 2022). Alarmingly, the mortality rates of mucormycosis exceed 40% and approach almost 100% in disseminated type of the disease. This high mortality rate, which has shown little improvement in recent years, is attributed to the delay in diagnosis, the limited therapeutic options, and the incompletely understood immunopathogenesis of the disease. In particular, necrosis and angioinvasion are prominent pathogenic features of mucormycosis that account for rapid dissemination and poor response to antifungals. Additionally, the intrinsic antifungal resistance of Mucorales to most available antifungal drugs is poorly characterized at the molecular level (Lax et al., 2024). A better understanding of Mucorales biology, including the molecular mechanisms governing physiological immune response, pathogenesis, and antifungal resistance, may lead to improved management of the disease. Through this Research Topic, we aim to provide the most recent advances in understanding the development and treatment of the infection. (see more)