Mucormycosis Strikes Beyond the Classic Host in Greek Case Series

Mucormycosis, an aggressive angioinvasive mold infection that progresses rapidly and carries high mortality, is usually associated with a recognizable group of predisposed patients. A retrospective case series from a tertiary referral center in northern Greece, spanning seven years, now documents nine histopathologically confirmed cases in which the disease appeared not only in the classic immunosuppressed host but also in trauma victims, burn patients, and critically ill individuals whose infections might easily have been mistaken for something else.

The series included nine patients with a median age of 49 years, seven of whom were male and two female. Two previously healthy adolescents developed post-traumatic cutaneous disease after injury and both recovered fully. Three patients reached craniofacial disease through the classic immunosuppressed route: one through poorly controlled type 1 diabetes, one through poorly controlled type 2 diabetes, and one through allogeneic transplantation for acute lymphoblastic leukemia.

The remaining four patients developed infection on a background of barrier disruption or critical illness. Two had major thermal burns covering 39 percent and 54 percent of total body surface area. One patient with dermatomyositis being treated with high-dose corticosteroids developed an eschar at a cannulation site. The fourth was an intubated patient with prediabetes who developed forearm necrosis with local thrombosis. Only two patients in the entire series had no documented systemic predisposition other than traumatic tissue disruption.

Microbiological findings showed a pattern across the clinical presentations. Rhizopus arrhizus predominated in the craniofacial and healthcare-associated cases, whereas the trauma and burn cases yielded a wider range of Mucorales species. This distribution underscores that the same genus can drive disease in profoundly different clinical settings, from the sinuses of a diabetic or transplanted patient to contaminated burn wounds.

Treatment followed current practice for this infection. Liposomal amphotericin B was the first-line agent in eight of the nine patients. One case with limited disease received isavuconazole monotherapy. Eight patients underwent surgery, with procedures ranging from bedside debridement to orbital exenteration, maxillectomy, and, in one case, forequarter amputation. The extent of these operations reflects how far the infection had advanced by the time it was recognized and how aggressively the fungus invades blood vessels and destroys tissue.

The burden of critical illness in the series was substantial. Eight of the nine patients, or 89 percent, required admission to the Intensive Care Unit. Among those patients, the median ICU stay was 37 days, with an interquartile range of 7 to 57 days and a full range spanning 2 to 123 days. Overall mortality was 67 percent, with six of the nine patients dying, a figure consistent with the high lethality that characterizes this infection.

The authors emphasize a diagnostic problem that may have shaped these outcomes. Mucormycosis in non-classical hosts is readily mistaken for bacterial superinfection or for the expected course of the underlying condition. That confusion delays tissue biopsy and the start of antifungal therapy, and the resulting delay may adversely affect outcome.

The practical message the authors draw from their experience is directed at clinicians facing rapidly deteriorating wounds or necrotic tissue. Rapidly progressive necrosis or thrombosis should prompt consideration of mucormycosis and tissue sampling for histopathology and culture, regardless of whether the patient belongs to the classic risk groups. The two healthy adolescents in this series, who developed cutaneous disease after trauma and survived, illustrate that neither youth nor prior good health excludes the diagnosis when tissue death advances faster than expected.

The authors are careful about the limits of what a report like this can show. This small, heterogeneous patient sample cannot determine incidence, prognostic factors, or treatment effects. What it can illustrate, they argue, is that the disease has the potential to affect patients beyond the classic host. The series therefore adds its nine cases to the narrative literature on mucormycosis in atypical settings, alongside the established metabolic and transplant-associated presentations, and argues for a lower threshold to biopsy and culture necrotic tissue in any critically ill or injured patient.

Subject of Research: A retrospective case series of nine histopathologically confirmed mucormycosis patients at a tertiary hospital in northern Greece, including trauma, burn, and healthcare-associated presentations beyond the classic immunosuppressed host.

Article Title: Mucormycosis beyond the classic host: a case series and narrative literature review from a tertiary Greek hospital

Article References: Akritidou, O., Peristeri, A. M., Vyzantiadis, T.-A., Theocharidou, C.-C., Kyrgidis, A., Sileli, M., Lavrentieva, A., & Nikopoulou, A. (2026). Mucormycosis beyond the classic host: a case series and narrative literature review from a tertiary Greek hospital. Frontiers in Fungal Biology, 7, Article 1987890. https://doi.org/10.3389/ffunb.2026.1987890

Image Credits: AI Generated

DOI: 10.3389/ffunb.2026.1987890

Keywords: mucormycosis, Mucorales, Rhizopus arrhizus, case series, liposomal amphotericin B, isavuconazole, burns, trauma, critical care, fungal infection, Greece, necrosis