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Xie S, Lai Z, Xia H, Tang M, Lai J, Liu Q, Lu Z, He D, Qi J, Liu X. A case report of brainstem hemorrhage due to Rhizopus delemar-induced encephalitis diagnosed by metagenomic next-generation sequencing (mNGS). BMC Infect Dis 2023; 23:235. [PMID: 37069515 PMCID: PMC10107577 DOI: 10.1186/s12879-023-08192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Rhizopus delemar is an invasive fungal pathogen that can cause fatal mucormycosis in immunodeficient individuals. Encephalitis caused by R. delemar is rare and difficult to diagnose early. Clinical detection methods for R. delemar include blood fungal culture, direct microscopic examination, and histopathological examination, but the detection is often inadequate for clinical diagnosis and can easily lead to missed diagnosis with delayed treatment. CASE PRESENTATION We report a case of a 47-year-old male with brainstem hemorrhage caused by encephalitis due to R. delemar. The patient had a history of hypertension, type 2 diabetes, and irregular medication. No pathogens were detected in cerebrospinal fluid (CSF) and nasopharyngeal secretion cultures. R. delemar was identified by metagenomic next-generation sequencing (mNGS) in CSF, and in combination with the patient's clinical characteristics, encephalitis caused by R. delemar was diagnosed. Antibiotic treatment using amphotericin B liposome in combination with posaconazole was given immediately. However, due to progressive aggravation of the patient's symptoms, he later died due to brainstem hemorrhage after giving up treatment. CONCLUSIONS mNGS technique is a potential approach for the early diagnosis of infections, which can help clinicians provide appropriate antibiotic treatments, thus reducing the mortality and disability rate of patients.
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Affiliation(s)
- Shuhua Xie
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Zhaohui Lai
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, 100176, China
| | - Mingze Tang
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, 100176, China
| | - Jinxing Lai
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Qing Liu
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Zhijuan Lu
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Dehai He
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Jiangli Qi
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China
| | - Xianghong Liu
- Department of Neurology, Ganzhou People's Hospital, Jiangxi, 341000, China.
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Chakravarty S, Nagarkar NM, Mehta R, Arora R, Ghosh A, Sharma AK, Satpute S, Aggarwal A. Skull Base Involvement in Covid Associated Rhino-Orbital-Cerebral Mucormycosis: A Comprehensive Analysis. Indian J Otolaryngol Head Neck Surg 2023:1-13. [PMID: 37362115 PMCID: PMC10082962 DOI: 10.1007/s12070-023-03717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/17/2023] [Indexed: 06/28/2023] Open
Abstract
The base of skull forms the first line of barrier to be breached in the transition of rhino-orbito-palatal forms of mucormycosis to intracranial forms with various neurological deficit. The pattern of base of skull erosion has prognostic implications in overall recovery and survival of the patient. The aim of the study was to assess the pattern of skull base involvement in cases of rhino-orbital-cerebral mucormycosis (ROCM) in terms of clinical presentations, radiological findings, intraoperative illustrations and post operative recovery. This is a retrospective single centre study of Covid associated Mucormycosis (CAM) patients with skull base involvement at a tertiary referral centre of central India from May 2021 to October 2021. Amongst a total of 248 patients of CAM, 54 patients with skull base involvement were included in our study. The cases were stratified into basifrontal-BF (15%), basisphenoid-BS (20%), orbital apex-OA (15%), basiocciput-BO (26%), frontal bone osteomyelitis-FBO (22%) and sphenoid bone osteomyelitis-SBO (2%), based on their pattern of involvement of skull base and intracranial spread. Early ethmoid and cribriform plate involvement progressed to frontal lobe abscess while early maxillary disease progressed to developed temporal lobe abscess. The orbital apex lesions had early onset cavernous sinus thrombosis. Analysis of clinical manifestations and postoperative follow up revealed an emerging pattern where Posterosuperior lesions of paranasal sinuses (Ethmoid, roof of maxilla and orbit) progressing to BF, BS, OA, FBO and SBO had poorer treatment outcome than Anteroinferior (Floor of maxillary sinus, palate) based lesions which involved BO of skull base. The inferiorly located diseases had better prognosis, less duration of hospital stay, lesser mortality and decreased need for second surgery. There exists a temporal relation of the initial site of fungal load in sinonasal region to their subsequent intracranial spread. Classification into subtypes helped in disease stratification which helped in prognostication and surgical planning. Early intervention by multidisciplinary team improved survival outcome.
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Affiliation(s)
- Sharmistha Chakravarty
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
| | - Nitin M. Nagarkar
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
| | - Rupa Mehta
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
| | - Ripudaman Arora
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
| | - Amritava Ghosh
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Anil Kumar Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh India
| | - Satish Satpute
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
| | - Aakash Aggarwal
- Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India
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Banerjee A, Das M, Verma P, Chatterjee A, Ramalingam K, Srivastava KC. COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review. Cureus 2023; 15:e37984. [PMID: 37223184 PMCID: PMC10202344 DOI: 10.7759/cureus.37984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
During the second wave of coronavirus disease, or COVID-19, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the year 2021 around the globe, there is a surge in the number of cases of mucormycosis or "Black Fungus" that is directly/indirectly associated with COVID-19. In this review article, mucormycosis of the orofacial region has gained importance from the maximum published literature (45 articles) from various databases like PubMed, Google Scholar, Scopus, Web of Science, and Embase. Rhino-orbital cerebral mucormycosis (ROCM) is a fatal condition associated with COVID-19 among categories of mucormycosis such as pulmonary, oral, gastrointestinal, cutaneous, and disseminated. ROCM targets the maxillary sinus, also involving teeth of the maxilla, orbits, and ethmoidal sinus. These are of particular interest to dentists and oral pathologists for proper diagnosis and identification. Co-morbid conditions, especially diabetes mellitus type II, have to be monitored carefully in COVID-19 patients as they have a higher risk of developing mucormycosis. In this review article, various presentations of COVID-19-linked mucormycosis are mentioned having particular emphasis on pathogenesis, signs and symptoms, clinical presentation, various diagnostic modalities including histopathology, radiology like CT and MRI, serology, tissue culture, various laboratory investigations, treatment protocols, management with prognosis, and so on. Any suspected case of mucormycosis needs quick detection and treatment since it progresses quickly due to the destructive course of infection. Long-term follow-up along with proper care is a must to detect any kind of recurrence.
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Affiliation(s)
- Abhisek Banerjee
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Moumalini Das
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Pooja Verma
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Abhishek Chatterjee
- Dentistry, Rampurhat Government Medical College and Hospital, Rampurhat, IND
| | - Karthikeyan Ramalingam
- Oral pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Drogari-Apiranthitou M, Skiada A, Panayiotides I, Vyzantiadis TA, Poulopoulou A, Christofidou M, Antoniadou A, Roilides E, Iosifidis E, Mamali V, Argyropoulou A, Sympardi S, Charalampaki N, Antonakos N, Mantzana P, Mastora Z, Nicolatou-Galitis O, Orfanidou M, Pana ZD, Pavleas I, Pefanis A, Sakka V, Spiliopoulou A, Stamouli M, Tofas P, Vagiakou E, Petrikkos G. Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports. J Fungi (Basel) 2023; 9:jof9040425. [PMID: 37108880 PMCID: PMC10142618 DOI: 10.3390/jof9040425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. Rhizopus (mostly R. arrhizus) predominated (67.1%), followed by Lichtheimia (8.5%) and Mucor (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (p = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population.
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Chen L, Peng W, Lan G, Long G, Yang H, Xu Y, Fu A, Yi H, Wan Q. The application of metagenomic next-generation sequencing in patients with infection or colonization caused by Lichtheimia species. Front Cell Infect Microbiol 2023; 13:1103626. [PMID: 37056706 PMCID: PMC10087083 DOI: 10.3389/fcimb.2023.1103626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundMucormycosis is considered the fourth most common invasive fungal disease after candidiasis, aspergillosis and cryptococcosis. Lichtheimia species accounted for 5%-29% of all mucormycosis. However, available data on species-specific analysis of Lichtheimia infections are limited.MethodsThis study included nine patients hospitalized in five hospitals in two cities in south China with mucormycosis or colonization caused by Lichtheimia species, diagnosed mainly by metagenomic next-generation sequencing (mNGS). The corresponding medical records were reviewed, and the clinical data analyzed included demographic characteristics, site of infection, host factors and type of underlying disease, diagnosis, clinical course, management, and prognosis.ResultsIn this study, nine patients with Lichtheimia infections or colonization had a recent history of haematological malignancy (33.3%), solid organ transplants (33.3%), pulmonary disease (22.2%), and trauma (11.1%) and were categorized as 11.1% (one case) proven, 66.7% (six cases) probable mucormycosis and 22.2% (two cases) colonization. Pulmonary mucormycosis or colonization was the predominant presentation in 77.8% of cases and mucormycosis caused by Lichtheimia resulted in death in four out of seven patients (57.1%).ConclusionThese cases highlight the importance of early diagnosis and combined therapy for these sporadic yet life-threatening infections. Further studies on the diagnosis and control of Lichtheimia infection in China are required.
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Affiliation(s)
- Lihua Chen
- Department of Laboratory Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weiting Peng
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Gongbin Lan
- Department of Transplant Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo Long
- Department of Respiratory and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Honghui Yang
- Department of Respiratory and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yajing Xu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
| | - Ai Fu
- Department of Tuberculosis, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Huimin Yi
- Department of Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiquan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, the Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Qiquan Wan,
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COVID-19-associated mucormycosis: A systematic review and meta-analysis of 958 cases. Clin Microbiol Infect 2023:S1198-743X(23)00122-2. [PMID: 36921716 PMCID: PMC10008766 DOI: 10.1016/j.cmi.2023.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases during the COVID-19 pandemic. OBJECTIVES To provide a comprehensive insight into the characteristics of COVID-19-associated mucormycosis (CAM), through a systematic review and meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science, Cochrane, CINAHL, Ovid MEDLINE, and FungiSCOPE. STUDY ELIGIBILITY CRITERIA Studies reporting individual-level information in adult CAM patients between January 1, 2020 and December 28, 2022. PARTICIPANTS Adults who developed mucormycosis during or after COVID-19. ASSESSMENT OF RISK OF BIAS Quality assessment was performed based on the National Institutes of Health Quality Assessment Tool for Case Series Studies. METHODS OF DATA SYNTHESIS Demographic information and clinical features were documented for each patient. Logistic regression analysis was used to predict the risk of mortality. RESULTS 958 individual cases reported from forty-five countries were eligible. 88.1% (844/958) were reported from low- or middle-income countries (LMIC). Corticosteroid use for COVID-19 (78.5%, 619/789) and diabetes (77.9%, 738/948) were common. Diabetic ketoacidosis (p<0.001), history of malignancy (p<0.001), underlying pulmonary (p=0.017) or renal disease (p<0.001), obesity (p<0.001), hypertension (p=0.040), age (>65 years) (p=0.001), Aspergillus co-infection (p=0.037), and tocilizumab use during COVID-19 (p=0.018) increased the mortality. CAM occurred on average 22 days after COVID-19 and 8 days after hospitalization. Diagnosis of mucormycosis in patients with Aspergillus co-infection and pulmonary mucormycosis was made on average 15.4 days (range 0-35) and 14.0 days (range 0-53) after hospitalization, respectively. Cutaneous mucormycosis accounted for <1% of cases. The overall mortality rate was 38.9% (303/780). CONCLUSION Mortality of CAM was high, and most reports were from LMIC countries. We detected novel risk factors for CAM such as older age, specific comorbidities, Aspergillus co-infection and tocilizumab use, in addition to previously identified factors.
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Osman NA, Anwar MM, Singh B, Gupta GK, Rabie AM. A peek behind the curtain in the diagnosis and management of COVID‑19‑Associated Mucormycosis (CAM). J Egypt Public Health Assoc 2023; 98:4. [PMID: 36859556 PMCID: PMC9977480 DOI: 10.1186/s42506-022-00125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/28/2022] [Indexed: 06/18/2023]
Abstract
Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) is responsible for a high mortality rate due to its unique and severe host-pathogen interactions. Critically ill or immunocompromised COVID-19 patients are more prone to suffer from aggressive mycoses. Probable victims include those with uncontrolled diabetes mellitus (DM), metabolic acidosis, prolonged neutropenia, increased ferritin levels, hypoxia, and prolonged hospitalization with/without mechanical ventilators and corticosteroids administration. The current review aims to outline the journey of patients with CAM as well as the advantages and disadvantages of the currently available diagnostic techniques. It also discussed the current status of treatment options and caveats in the management of mucormycosis. Multidisciplinary team, early diagnosis, controlling the predisposing condition(s), complete surgical debridement, effective antifungal therapies (e.g., amphotericin B, isavuconazole, and posaconazole), and implementing antifungal stewardship programs are imperative in CAM cases.
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Affiliation(s)
- Nermin A. Osman
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohammed Moustapha Anwar
- Department of Biotechnology, Institute of Graduate Studies and Research (IGSR), Alexandria University, Alexandria, Egypt
| | | | - Girish K. Gupta
- Department of Pharmaceutical Chemistry, Sri Sai College of Pharmacy, Badhani, Pathankot, 145001 Punjab India
| | - Amgad M. Rabie
- Drug Discovery & Clinical Research Department, Dikernis General Hospital (DGH), Magliss El-Madina Street, Dikernis City, 35744 Dikernis, Dakahlia Governorate Egypt
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Samaddar A, Shrimali T, Sharma A. Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases. Mycoses 2023; 66:181-195. [PMID: 36227645 DOI: 10.1111/myc.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Abstract
Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
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What Is New in Pulmonary Mucormycosis? J Fungi (Basel) 2023; 9:jof9030307. [PMID: 36983475 PMCID: PMC10057210 DOI: 10.3390/jof9030307] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Mucormycosis is a rare but life-threatening fungal infection due to molds of the order Mucorales. The incidence has been increasing over recent decades. Worldwide, pulmonary mucormycosis (PM) presents in the lungs, which are the third main location for the infection after the rhino-orbito-cerebral (ROC) areas and the skin. The main risk factors for PM include hematological malignancies and solid organ transplantation, whereas ROC infections are classically favored by diabetes mellitus. The differences between the ROC and pulmonary locations are possibly explained by the activation of different mammalian receptors—GRP78 in nasal epithelial cells and integrin β1 in alveolar epithelial cells—in response to Mucorales. Alveolar macrophages and neutrophils play a key role in the host defense against Mucorales. The diagnosis of PM relies on CT scans, cultures, PCR tests, and histology. The reversed halo sign is an early, but very suggestive, sign of PM in neutropenic patients. Recently, the serum PCR test showed a very encouraging performance for the diagnosis and follow-up of mucormycosis. Liposomal amphotericin B is the drug of choice for first-line therapy, together with correction of underlying disease and surgery when feasible. After a stable or partial response, the step-down treatment includes oral isavuconazole or posaconazole delayed release tablets until a complete response is achieved. Secondary prophylaxis should be discussed when there is any risk of relapse, such as the persistence of neutropenia or the prolonged use of high-dose immunosuppressive therapy. Despite these novelties, the mortality rate from PM remains higher than 50%. Therefore, future research must define the place for combination therapy and adjunctive treatments, while the development of new treatments is necessary.
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Dam P, Cardoso MH, Mandal S, Franco OL, Sağıroğlu P, Polat OA, Kokoglu K, Mondal R, Mandal AK, Ocsoy I. Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis 2023; 52:102557. [PMID: 36805033 PMCID: PMC9940844 DOI: 10.1016/j.tmaid.2023.102557] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Patients with respiratory viral infections are more likely to develop co-infections leading to increased fatality. Mucormycosis is an epidemic amidst the COVID-19 pandemic that conveys a 'double threat' to the global health fraternity. Mucormycosis is caused by the Mucorales group of fungi and exhibits acute angioinvasion generally in immunocompromised patients. The most familiar foci of infections are sinuses (39%), lungs (24%), and skin tissues (19%) where the overall dissemination occurs in 23% of cases. The mortality rate in the case of disseminated mucormycosis is found to be 96%. Symptoms are mostly nonspecific and often resemble other common bacterial or fungal infections. Currently, COVID-19-associated mucormycosis (CAM) is being reported from a number of countries such as the USA, Turkey, France, Mexico, Iran, Austria, UK, Brazil, and Italy, while India is the hotspot for this deadly co-infection, accounting for approximately 28,252 cases up to June 8, 2021. It strikes patients within 12-18 days after COVID-19 recovery, and nearly 80% require surgery. Nevertheless, the mortality rate can reach 94% if the diagnosis is delayed or remains untreated. Sometimes COVID-19 is the sole predisposing factor for CAM. Therefore, this study may provide a comprehensive resource for clinicians and researchers dealing with fungal infections, intending to link the potential translational knowledge and prospective therapeutic challenges to counter this opportunistic pathogen.
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Affiliation(s)
- Paulami Dam
- Chemical Biology Laboratory, Department of Sericulture, Raiganj University, North Dinajpur, West Bengal, 733134, India
| | - Marlon H Cardoso
- S-inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil; Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil; Instituto de Biociências (INBIO), Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Mato Grosso do Sul, Brazil
| | - Sukhendu Mandal
- Laboratory of Molecular Bacteriology, Department of Microbiology, University of Calcutta, 700019, India
| | - Octávio L Franco
- S-inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil; Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil
| | - Pınar Sağıroğlu
- Department of Medical Microbiology, School of Medicine, Erciyes University, Kayseri, Turkey
| | | | - Kerem Kokoglu
- Department of Otolaryngology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Rittick Mondal
- Chemical Biology Laboratory, Department of Sericulture, Raiganj University, North Dinajpur, West Bengal, 733134, India
| | - Amit Kumar Mandal
- Chemical Biology Laboratory, Department of Sericulture, Raiganj University, North Dinajpur, West Bengal, 733134, India; Centre for Nanotechnology Science (CeNS), Raiganj University, North Dinajpur, West Bengal, 733134, India.
| | - Ismail Ocsoy
- Department of Analytical Chemistry, Faculty of Pharmacy, Erciyes University, Kayseri, 38039, Turkey.
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Schwarz P. Mukormykosen - Epidemiologie, Diagnostik und Therapie*. INFO HÄMATOLOGIE + ONKOLOGIE 2023. [PMCID: PMC9943589 DOI: 10.1007/s15004-023-9818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Patel SN, Shah S, Panchal J, Desai C, Upadhya IB, Patel M. Spotlight on the Mucormycosis Outbreak: A Deadly Fungal Infection That Followed the COVID-19 Pandemic. Cureus 2023; 15:e35095. [PMID: 36938207 PMCID: PMC10022911 DOI: 10.7759/cureus.35095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic along with its treatment has brought myriad potential complications including the heightened risk of secondary fungal infections like mucormycosis. Mucormycosis is a rare angioinvasive fungal infection that has traditionally been highly fatal despite surgical intervention and antifungal medications. AIM To re-evaluate the risk factors, epidemiology, and possible COVID-19-associated conditions on a larger sample size than the existing data. METHODOLOGY We studied the possible risk factors, clinical presentations, treatment, and outcome of 203 patients with mucormycosis in a single-center retrospective-prospective observational study for three months at a tertiary care hospital after obtaining due permission from the institutional ethics committee. RESULTS The mean age of patients was 52 ± 11.5 years, and 92.61% had a history of COVID-19 infection. Around 86.7% of patients were suffering from diabetes mellitus with 50% being already known cases whereas the other 50% developed post-COVID-19 infection; 65.02% of patients were administered corticosteroids during their COVID-19 treatment. About 51.72% of patients required hospital admission and among them, 16.25% of patients required ICU support. The mean oxygen saturation (SpO2) levels on admission were 84.61 ± 12.96%, and 38.92% of patients required mechanical respiratory support. The mean duration between COVID-19 infection and the onset of mucormycosis was 18.80 ± 16.61 days. The most common clinical presentations were facial pain and swelling (26.6%) and ophthalmic symptoms including eye swelling, pain, and ptosis (25.12%). Antifungal treatment was given to all the patients and 89.36% of the patients underwent surgical debridement of fungal mass. At the end of three months, 60.59% of the 188 patients survived with improvement, 13.30% had no improvement and/or deterioration of health, and 18.72% succumbed to mucormycosis. Intracranial involvement and leukocytosis were positively associated with mortality whereas surgical intervention was significant for positive outcomes at the end of three months in patients with mucormycosis (p<0.05). CONCLUSION The sudden rise of mucormycosis during the second wave of COVID-19 can be attributed to uncontrolled blood sugar levels along with high corticosteroid usage as well as various nosocomial factors during the COVID-19 treatment. Early and aggressive treatment with surgical intervention and antifungal drugs can improve disease outcomes.
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Affiliation(s)
- Shubham N Patel
- Medicine, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
| | - Suchi Shah
- Pharmacology, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
| | - Jigar Panchal
- Pharmacology, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
| | - Chetna Desai
- Pharmacology, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
| | - Ila B Upadhya
- Otolaryngology, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
| | - Masum Patel
- Medicine, B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, IND
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Sharma A, Bedi M, Patel P, Singh Arora A. Black fungus outbreak in India - A direct consequence of COVID-19 surge: A myth or reality. GONDWANA RESEARCH : INTERNATIONAL GEOSCIENCE JOURNAL 2023; 114:117-123. [PMID: 35153531 PMCID: PMC8816797 DOI: 10.1016/j.gr.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 05/06/2023]
Abstract
The deadly second wave of COVID-19 has seen an unprecedented surge in mucormycosis associated mortality in India, overwhelming the heath authorities with challenges beyond measure. Also known as black fungus, this life-threatening fungal infection usually manifests in the nose, spreads to the eyes, and in some cases also to the brain. Immune suppression, pre-existing conditions, prolonged and indiscriminate use of steroids, and unhygienic environments are some of the widely recognized risk factors for contracting black fungus in individuals recovered from COVID-19. However, diagnosis of the infection remains insufficient due to the lack a holistic understanding of the possible risks, symptoms, and exposure pathways and therefore no definite protocol exists for managing this fatal infection. Here, we synthesize the current state of knowledge on black fungus outbreak in India and identify key gaps in its understanding with respect to potential risk factors leading to the widespread infection. We looked at 3354 black fungus cases in India, enlisting ailment history (particularly diabetes) and steroid usage in COVID-19 patients as the key factors responsible for exacerbating risks associated with the disease. However, we also press on the possibilities that other less studied non-traditional risk factors may also have a role in causing the infection. Black fungus is therefore a reality of COVID-19, with or without diabetes or steroid use needs to be investigated. We believe such a review is imperative for making informed decisions specially around timely diagnosis and channelizing efforts in controlling the spread of COVID-19 associated mucormycosis.
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Affiliation(s)
- Archana Sharma
- Department of Environmental Science and Engineering, Marwadi University, Rajkot 36004, Gujarat, India
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh 15261, PA, USA
| | - Prachi Patel
- Department of Environmental Engineering, University of Ottawa, Ontario, Canada
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Özdemir O, Seden N, Çağlıyan A, Yiğit Ö. Short-term Postoperative Outcomes of Platelet-rich Plasma after Inferior Turbinate Radiofrequency. ISTANBUL MEDICAL JOURNAL 2023. [DOI: 10.4274/imj.galenos.2022.39018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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The mucormycosis and stroke: The learning curve during the second COVID-19 pandemic. J Stroke Cerebrovasc Dis 2023; 32:106819. [PMID: 36495645 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The Angio-invasive Rhino-orbito-cerebral mucormycosis (ROCM) producing strokes is a less explored entity. Our hospital, a stroke-ready one, had an opportunity to manage mucormycosis when it was identified as the nodal center for mucormycosis management. We are sharing our experiences and mistakes in managing the cerebrovascular manifestations of ROCM. METHODS We conducted a prospective observational study during the second wave of the COVID-19 pandemic from 1st May 2021 to 30th September 2021, where consecutive patients aged more than 18 years with microbiologically confirmed cases of ROCM were included. Clinical details (timing of stroke onset after ROCM symptoms, GCS, NIHSS), imaging findings (ASPECTS, the territory of stroke, the pattern of infarct, hemorrhagic transformation, cavernous sinus thrombosis), angiogram findings, management details (IV thrombolysis), and outcomes (mRS at discharge and duration of hospital stay) were documented. We also compared the demographics, clinical features (NIHSS), radiological findings, treatment details, duration of hospital stay, and functional outcome at the discharge of the ROCM stroke patients with stroke patients without ROCM. RESULTS Stroke developed in 42% of patients with ROCM, predominantly anterior circulation border zone ischemic infarcts. Strokes occurred after a median of five days from the onset of ROCM symptoms. The most common vessel involved was the ophthalmic artery, followed by the cavernous ICA. We could not thrombolyse ROCM stroke patients. ROCM patients who developed stroke compared with patients without stroke had a more infiltrative fungal infection and higher inflammatory markers. Mucormycosis associated stroke patients had higher in-hospital mortality and poor functional outcomes. T CONCLUSION Due to delayed recognition of stroke symptoms, none received reperfusion strategies, leading to poor functional outcomes. For early stroke detection, ROCM cases need frequent monitoring and education of patients and their relatives about the ALS acronym (loss of ambulation, limb weakness, and loss of speech).
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Joseph R, Venkatnarayan K, Nanaiah A, Ramachandran P. A case of hoarseness of voice following COVID-19 infection. Monaldi Arch Chest Dis 2023; 93. [PMID: 36714915 DOI: 10.4081/monaldi.2023.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023] Open
Abstract
Mucormycosis is a fatal angio-invasive fungal infection associated with a high mortality. Apart from the traditional risk factors, COVID-19 infection and steroid therapy for the same have been recently identified to predispose to this life-threatening infection. Usual presentations of mucormycosis include rhino-orbito-cerebral, pulmonary, gastrointestinal, renal and cutaneous involvement. We report an unusual case of mediastinal involvement by mucormycosis in a patient recovering from moderate COVID-19 pneumonia. Early diagnosis, prompt initiation of antifungal therapy accompanied by timely surgical debridement were pivotal in averting morbidity and mortality in this patient.
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Affiliation(s)
- Ruby Joseph
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru.
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru.
| | - Ashitha Nanaiah
- Department of Pathology, St. John's National Academy of Health Sciences, Bengaluru.
| | - Priya Ramachandran
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru.
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Salah H, Houbraken J, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species. Med Mycol 2023; 61:6967136. [PMID: 36592959 PMCID: PMC9874029 DOI: 10.1093/mmy/myac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Due to an increasing number of patients at risk (i.e., those with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported and associated with high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of IFI caused by filamentous fungi around the world followed by Fusarium spp., however, other fungi are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium filamentous fungi in human clinical samples over an 11-year period in Qatar using molecular techniques. We recovered 53 filamentous fungal isolates from patients with various clinical conditions. Most patients were males (75.5%), 9.4% were immunocompromised, 20.7% had IFI, and 11.3% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including the nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Among the fungi isolated, 49% were dematiaceous fungi, followed by Mucorales (30%), with the latter group Mucorales being the major cause of IFI (5/11, 45.5%). The current study highlights the epidemiology and spectrum of filamentous fungal genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, excluding superficial infections, which can aid in the surveillance of uncommon and emerging mycoses.
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Affiliation(s)
- Husam Salah
- To whom correspondence should be addressed. Husam Salah, M.Sc. Division
of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical
Corporation, Doha, Qatar, PO Box 3050. Tel: +97-444-391-047. E-mail: ;
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity
Institute, Utrecht, Netherlands
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute,
Utrecht, Netherlands,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of
Amsterdam, Amsterdam, The
Netherlands
| | | | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and
Pathology, Hamad Medical Corporation, Doha,
Qatar,Department of Biology, College of Science, University of
Babylon, Hilla, Iraq
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Keshri A, Mathialagan A, Aishwarya A, Ravisankar, Bhuskute G, Kanaujia V, Singh AK, Singh RK, Dhiman RK, Agarwal R. Is mucormycosis the end? A comprehensive management of orbit in COVID associated rhino-orbital-cerebral mucormycosis: preserving the salvageable. Eur Arch Otorhinolaryngol 2023; 280:819-827. [PMID: 36053359 PMCID: PMC9438883 DOI: 10.1007/s00405-022-07620-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/16/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rhino-orbital-cerebral mucor mycosis (ROCM) is a relatively rare opportunistic infection caused by the Mucorales species. While ROCM suggests involvement of the paranasal sinuses, orbit and brain ROM (rhino-orbital-Mucormycosis) stands for the fungal invasion in sinuses and orbit sans cerebral involvement. In India with the outbreak of the second COVID wave and the delta variant of the virus, there has been a steep increase in this opportunistic fulminant fungal infection, named COVID-associated Mucor mycosis (CAM). The most critical question in orbital management is when to go ahead with an exenteration. Our study aims to design a pertinent minimal invasive surgical protocol for surgeons to manage such cases based on our surgical experience and mitigate the need for exenteration and save the eyes wherever possible. METHODS The study is a retrospective analysis of patients of ROM with and without brain involvement, who underwent minimal surgical management between March 2021 to March 2022 along with their follow-up. RESULTS There were 184 eyes of 148 patients diagnosed with CAM. The mean age was 51.7 years with a male predominance of 103 (70%). All patients developed ROM following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36 ± 23 days. 18 cases (12%) were bilateral. 76 eyes (41%) had no vision at the presentation. Imaging revealed paranasal sinus involvement (100%), orbital apex involvement (61%), cavernous sinus involvement (53%), and central nervous system (CNS) involvement (47%). All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. Endoscopic debridement of the orbital disease was performed in 45 (30.4%) cases, 15(8.1%) eyes underwent exenteration and were later rehabilitated with a customized ocular prosthesis, 103 (56%) eyes underwent transcutaneous retrobulbar amphotericin-B. At a mean follow-up of 13.1 months; the complete resolution was seen in 25 (17%) cases, the residual stable lesion was seen in 77(52%) of the cases and new lesions were developed in 13(9%) of the cases. Mortality was seen in 33 (22%) patients and all of them had CNS involvement. CONCLUSIONS Systemic and protocol-based management can save the life and salvage the eyes.
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Affiliation(s)
- Amit Keshri
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Arulalan Mathialagan
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Ankita Aishwarya
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Ravisankar
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Govind Bhuskute
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Vikas Kanaujia
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - A. K. Singh
- Council of Scientific and Industrial Research, New Delhi, India
| | - R. K. Singh
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - R. K. Dhiman
- Department of Hepatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Rachna Agarwal
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
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Amalanathan S, Satish Kumar C, Abinaya R, Prathiba K, Kumaran Ramesh C, Kavitha B, Malini A, Amudhasubba R. Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2023; 39:73. [PMCID: PMC10127177 DOI: 10.1186/s43163-023-00430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
Background India witnessed a massive surge of rhino orbital cerebral mucormycosis (ROCM) cases during the second wave of COVID-19, recording the highest number of cases in the world, indeed, an epidemic within the pandemic. Objectives To describe the clinical profile of patients with COVID-19-associated mucormycosis (CAM) and the clinical suspects for mucormycosis. Methods This single-center descriptive, observational study/audit was done at Indira Gandhi Medical College, Pondicherry, South India. This study is about the clinical profile of 7 CAM patients and 14 COVID-19 patients who were suspects of CAM, based on their risk factors and clinical symptoms, and were referred to the ENT department. Statistical analysis All the descriptive variables were summarized as mean, frequency, and percentages for qualitative data. Results All 7 CAM patients were COVID-19 positive and were not vaccinated against COVID-19, All 7 were known diabetic, all 7 had steroid therapy for their COVID status, and 5 out of 7 (71%) had uncontrolled diabetes mellitus at the time of diagnosis. Facial pain, nasal discharge, and eye swelling were the presenting symptoms of CAM. Maxillary and ethmoid sinuses were the most commonly involved para nasal sinuses. Four out of seven (57.1%) CAM patients survived after 16 months of follow-up, after surgical and medical treatment for CAM. Of the 14 clinical suspects who were negative for CAM, 2 were negative for COVID-19, their risk factors were brought under control, 3 expired due to COVID complications, and 9 patients are alive till date. Conclusion Uncontrolled diabetes is a risk factor for ROCM/CAM, another possible risk factor is steroid therapy, and we hypothesize that COVID infection could also be a possible risk factor that needs to be studied more extensively in a larger sample. Early clinical suspicion, withdrawal of steroids, rapid control of diabetes mellitus, appropriate investigations, and early surgical intervention combined with medical treatment offers better outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s43163-023-00430-2.
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Affiliation(s)
- Sophia Amalanathan
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - C Satish Kumar
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - R Abinaya
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - K Prathiba
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - Colbert Kumaran Ramesh
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - B Kavitha
- Department of Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - A Malini
- Department of Microbiology, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - Reddy Amudhasubba
- Department of Ophthalomology, Indira Gandhi Medical College & Research Institute, Pondicherry, India
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Eker C, Tarkan O, Surmelioglu O, Dagkiran M, Tanrisever I, Yucel Karakaya SP, Ulas B, Onan E, Uguz AH, Ozdemir S. Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients. Eur Arch Otorhinolaryngol 2023; 280:219-226. [PMID: 35768700 PMCID: PMC9244150 DOI: 10.1007/s00405-022-07526-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19. MATERIALS AND METHODS A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared. RESULTS Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741). CONCLUSIONS With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.
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Affiliation(s)
- Caglar Eker
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Tarkan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Surmelioglu
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Muhammed Dagkiran
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ilda Tanrisever
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Sevinc Puren Yucel Karakaya
- grid.98622.370000 0001 2271 3229Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Burak Ulas
- grid.98622.370000 0001 2271 3229Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Elvan Onan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Aysun Hatice Uguz
- grid.98622.370000 0001 2271 3229Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Suleyman Ozdemir
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
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Tomar K, Roy ID, Natarajan MR, Singh AK, Ramanujam V. Surgical Challenges in the Management of Post COVID-19 Midface Mucormycosis (PCoMM): An Institutional Protocol. J Craniofac Surg 2023; 34:e46-e52. [PMID: 36008879 PMCID: PMC9793999 DOI: 10.1097/scs.0000000000008963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed another serious threat, mucormycosis infection, affecting the maxilla and orbitocerebral region. This condition has not spared world population from its merciless claws. This article addresses the challenges faced by the maxillofacial surgeons in setting the protocols from preoperative diagnosis, surgical management to postoperative care, including short-term and long-term rehabilitation. To manage this relentlessly progressing condition, a multispecialty team approach is to be activated in diagnosing, managing, and rehabilitating the patients. PURPOSE The purpose of this clinical study is to document and analyze the clinical and demographic data, presentation of the lesion, the diagnostic methods followed for early clinical detection, and management of post COVID-19 midface mucormycosis. The article also discusses postoperative medical management and prosthetic rehabilitation. RESULTS Most of the mucormycosis cases reporting to our center were treated and recovered patients of Severe Acute Respiratory Syndrome Coronavirus 2 infection. Thirty-four (n=34) case were operated for post COVID-19 midface mucormycosis between October 2020 and December 2021. Male to Female ratio is 1:42. The average age of the patients was 57.5 years. Maximum patients were in fifth and sixth decade of life. Maxilla was the involved bone. Treatment was primarily surgical debridement to extended or radical maxillectomy. All patients were treated with Liposomal Amphotericin B and tab posaconazole for 3 to 4 weeks depending upon the age, weight, and physiological state of the patients to attain an optimal cumulative load. Three patients succumbed to illness postoperatively (n=3, 1.02%). Average duration of hospital stay was 47 days. The average review period was 5.1 months.
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Rais N, Ahmad R, Ved A, Parveen K, Bari DG, Prakash O. Diabetic Ketoacidosis (DKA), a Leading Risk Factor for Mucormycosis (Black Fungus), during the Era of Coronavirus Disease-2019 (COVID-19): An Overview. Curr Diabetes Rev 2023; 19:33-45. [PMID: 35293299 DOI: 10.2174/1573399818666220315162424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) and steroid medication, coincided with coronavirus disease 2019 (COVID-19), results in a weakened immune system, allowing some commonly found pathogens to become more harmful. Mucormycosis (black fungus) is a type of opportunistic infection caused by fungi belonging to the Mucorales family. DM is the most prominent risk factor for mucormycosis. Excessive blood sugar and decreased insulin levels lead to diabetic ketoacidosis (DKA), a devastating complication of DM that can be fatal if left untreated. METHODS Diabetic ketoacidosis is more common in type 1 diabetic patients, although it can also be fall in type 2 diabetic patients. DKA occurs when the body lacks enough insulin to allow blood sugar to enter the cells and is used for energy. Instead, the liver breaks down fat for fuel-producing chemicals known as ketones. RESULTS When too many ketones are created too quickly, they can reach dangerously high levels in the body. Mucormycosis is a rare but serious infectious disease that requires medication or surgical removal. CONCLUSION The confluence of diabetes and COVID-19 makes managing mucormycosis a serious and dead issue. Although the effectiveness of prophylactic antifungal therapy has yet to be demonstrated, hyperglycemia control appears to be the most important step in managing mucormycosis in DKA patients.
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Affiliation(s)
- Nadeem Rais
- Department of Pharmacy, Bhagwant University, Ajmer, Rajasthan-305004, India
- Department of Pharmacy, Vivek College of Technical Education, Bijnor, Uttar Pradesh-246701, India
| | - Rizwan Ahmad
- Department of Pharmacy, Vivek College of Technical Education, Bijnor, Uttar Pradesh-246701, India
| | - Akash Ved
- Goel Institute of Pharmaceutical Sciences, Lucknow, Uttar Pradesh-226028, India
| | - Kehkashan Parveen
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, Uttar Pradesh-202002, India
| | - Darakhshan Gazala Bari
- Department of Pharmacy, Vivek College of Technical Education, Bijnor, Uttar Pradesh-246701, India
| | - Om Prakash
- Goel Institute of Pharmacy and Sciences, Lucknow, Uttar Pradesh-226028, India
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Sharma N, Wani SN, Behl T, Singh S, Zahoor I, Sehgal A, Bhatia S, Al-Harrasi A, Aleya L, Bungau S. Focusing COVID-19-associated mucormycosis: a major threat to immunocompromised COVID-19. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:9164-9183. [PMID: 36454526 PMCID: PMC9713750 DOI: 10.1007/s11356-022-24032-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 disease has been identified to cause remarkable increase of mucormycosis infection cases in India, with the majority of cases being observed in individuals recovering from COVID-19. Mucormycosis has emanated as an outcome of the recent COVID-19 pandemic outbreak as rapidly developing fatal illness which was acquired by Mucorales fungus which is a subcategory of molds known as mucormycetes. Mucormycosis is one of the serious, sporadic mycotic illnesses which is a great threat to immunocompromised COVID-19 patients and affects people of all ages, including children with COVID-19 infections. This is associated with tissue damaging property and, therefore, causes serious clinical complications and elevated death rate. The COVID-19-associated mucormycosis or "black fungus" are the terms used interchangeably. The rapid growth of tissue necrosis presenting as "rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated disease" are various clinical forms of mucormycosis. The patient's prognosis and survival can be improved with proper surgeries using an endoscopic approach for local tissue protection in conjunction with course of appropriate conventional antifungal drug like Amphotericin-B and novel drugs like Rezafungin, encochleated Amphotericin B, Orolofim, and SCY-078 which have been explored in last few years. This review provides an overview of mucormycosis including its epidemiology, pathophysiology, risk factors, its clinical forms, and therapeutic approaches for disease management like antifungal therapy, surgical debridement, and iron chelators. The published patents and ongoing clinical trials related to mucormycosis have also been mentioned in this review.
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Affiliation(s)
- Neelam Sharma
- Department of Pharmaceutics, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, 133207, India
| | | | - Tapan Behl
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Sukhbir Singh
- Department of Pharmaceutics, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, 133207, India.
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Koppolu P, Afroz MM, Khan TA, Lingam AS, Husna S, Syeda MS. Mucormycosis as Post Coronavirus Disease Complication. Int J Mycobacteriol 2023; 12:96-99. [PMID: 36926770 DOI: 10.4103/ijmy.ijmy_207_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Mucormycosis is called as black fungus, which is caused by fungus belonged to Mucorales. If this fungus, effects healthy individuals it won't cause any serious complications, but it may cause life-threatening issues when Mucorales affects individuals who have low immunity. The mortality rate of black fungus is more than 50%, and it may also range till 100% if the individual is having any preexisting or chronic disease. This was the case of a 55-year-old male patient complaint of having generalized pain in the maxillary teeth bilaterally and suffering fullness in the maxillary sinus. To check on other possible diseases, doctors have conducted other diagnosis tests, and orthopantomogram revealed in the diagnosis that there was the presence of haziness in the left maxillary sinus, which looked like an incompletely formed soap bubble and additionally he diagnosed with coronavirus disease positive. Then, doctors suggested a chest computerized tomography (CT) along with head CT excluding the brain and further investigation of this case was given below in detail. The report reveals acute necrotizing suppurative sinusitis with dead bony tissue, soft-tissue necrosis with fungal infestation showing broad hyphae with right-angle branching suggestive of mucormycosis.
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Affiliation(s)
- Pradeep Koppolu
- Department of Preventive Dental Sciences, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Malik Afroz
- Department of Oral Surgery and Diagnostic Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Tahseen Ali Khan
- Department of Oral Surgery and Diagnostic Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Amara Swapna Lingam
- Department of Oral Surgery and Diagnostic Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Sajida Husna
- Department of Oral Pathology, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
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Arbune M, Arbune AA, Nechifor A, Chiscop I, Sapira V. Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature. Antibiotics (Basel) 2022; 12:antibiotics12010031. [PMID: 36671232 PMCID: PMC9854657 DOI: 10.3390/antibiotics12010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration.
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Affiliation(s)
- Manuela Arbune
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Anca-Adriana Arbune
- Neurology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Alexandru Nechifor
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Iulia Chiscop
- Clinical Surgical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Violeta Sapira
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
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A Practical Workflow for the Identification of Aspergillus, Fusarium, Mucorales by MALDI-TOF MS: Database, Medium, and Incubation Optimization. J Clin Microbiol 2022; 60:e0103222. [PMID: 36326257 PMCID: PMC9769873 DOI: 10.1128/jcm.01032-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is an increasing body of literature on the utility of MALDI-TOF MS in the identification of filamentous fungi. However, the process still lacks standardization. In this study, we attempted to establish a practical workflow for the identification of three clinically important molds: Aspergillus, Fusarium, and Mucorales using MALDI-TOF MS. We evaluated the performance of Bruker Filamentous Fungi database v3.0 for the identification of these fungi, highlighting when there would be a benefit of using an additional database, the MSI-2 for further identification. We also examined two other variables, namely, medium effect and incubation time on the accuracy of fungal identification. The Bruker database achieved correct species level identification in 85.7% of Aspergillus and 90% of Mucorales, and correct species-complex level in 94.4% of Fusarium. Analysis of spectra using the MSI-2 database would also offer additional value for species identification of Aspergillus species, especially when suspecting species with known identification limits within the Bruker database. This issue would only be of importance in selected cases where species-level identification would impact therapeutic options. Id-Fungi plates (IDFP) had almost equivalent performance to Sabouraud dextrose agar (SDA) for species-level identification of isolates and enabled an easier harvest of the isolates with occasional faster identification. Our study showed accurate identification at 24 h for Fusarium and Mucorales species, but not for Aspergillus species, which generally required 48 h.
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Chaganti PD, Katta R, Yerukalapudi SH, Karri MD, Firdous A. Mucormycosis in Post Novel Corona Virus Patients: An Institutional Experience. Indian J Otolaryngol Head Neck Surg 2022:1-7. [PMID: 36571098 PMCID: PMC9760537 DOI: 10.1007/s12070-022-03305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Mucormycosis is an emerging angioinvasive fungal infection caused by ubiquitous saprophytic filamentous fungus that belongs to the class Zygomycosis. Mucormycosis or black fungus infections in patients with recent COVID-19 infections has given rise to a new epidemic during the second wave of this current COVID-19 pandemic in India. Steroid misuse, poor glycemic control, use of industrial grade oxygen, improper humidification and specific variants strains have resulted in profound immunosuppression and are attributed for the high incidence of COVID associated Mucormycosis (CAM) in India. The aims of the present study were to assess the age and gender specific incidence of CAM, the utility of special stains (PAS and GMS) for diagnosing mucormycosis (false negatives and sensitivity). In the present study emphasis was laid on identifying if there exists a correlation between host response, angioinvasion and bone invasion with mortality. The Present study is a retrospective, cross sectional analytical study taken up in the Department of Pathology, Guntur Medical College for a period of 2 months between 1st of May 2021 to 30th of June 2021. Results were tabulated in Microsoft excel 2016 and SPSS software version 14 was used for calculation of odds ratio and for performing multivariate analysis. All samples were routinely fixed using 10% buffered formalin, processed and sectioned. All the sections were stained with Haematoxylin and Eosin and also special stains for fungus like periodic acid Schiff (PAS) and Gomori Methenamine silver (GMS) were used wherever required. CAM is a serious complication after recovery from COVID-19 infection due to its high morbidity and mortality (13.7% in this series). CAM epidemiology and presentation is mostly similar to non-COVID mucormycosis seen in pre-COVID era.
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Affiliation(s)
| | - Ramya Katta
- grid.468934.40000 0001 0102 3472Department of Pathology, Guntur Medical College, Guntur, India
| | - Sai Himaja Yerukalapudi
- grid.468934.40000 0001 0102 3472Department of Pulmonary Medicine, Guntur Medical College, Guntur, India
| | - Maruthi Devi Karri
- grid.468934.40000 0001 0102 3472Department of Pathology, Guntur Medical College, Guntur, India
| | - Arshiya Firdous
- grid.468934.40000 0001 0102 3472Department of Pathology, Guntur Medical College, Guntur, India
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Arslan Gulen T, Turunc T, Sahin AR, Oruc E, Kurutkan MN. Evaluation of the effect of the COVID-19 pandemic on mucormycosis studies with bibliometric analysis. Medicine (Baltimore) 2022; 101:e32118. [PMID: 36482644 PMCID: PMC9726392 DOI: 10.1097/md.0000000000032118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) is a relatively new concept in the literature that emerged during the pandemic. Bibliometric analysis is a type of analysis that uses mathematical and statistical methods to study the formal properties of knowledge areas. This study aimed to reveal the main themes, conceptual structures, and trends of bibliometric studies on mucormycosis in 2 different periods, pre-and during the pandemic. METHODS This study consisted of 2 periods: pre-COVID-19 and COVID-19. Articles were collected from the Web of Science (WOS) Core Collection database. We provided AND and OR connectors for the keyword query and selected studies based on relevant keywords. Collected data were classified based on their publication date and examined using the R programming language (Version 4.0.3) package Bibliometrix and SciMAT Software. RESULTS A total of 1261 articles were investigated, and performance and information structure analyses were conducted. Based on Bradford's law, the Journal of Fungi was the top-ranked journal in both periods. Cureus and mycoses were placed 2nd and 3rd in the second period. India is the largest contributor. In performance analysis, conceptual structures such as Rhizopus oryzae, epidemiology, diagnosis, management, treatment, and outcomes were at the forefront of mucormycosis publications during the COVID-19 period. CONCLUSIONS Research trends have shifted to the clinical treatment and management of COVID-19. Therefore, pathogenesis, diagnosis, follow-up, and treatment strategies for CAM should be developed in the future.
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Affiliation(s)
- Tugba Arslan Gulen
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
- *Correspondence: Tugba Arslan Gulen, University of Health Sciences Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Kişla Mahallesi, 01370, Yüreğir, Adana, Turkey (e-mail: )
| | - Tuba Turunc
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Riza Sahin
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Ebru Oruc
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Agrawal A, Tripathi PS, Shukla P, Nigam P, Kheti P. Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9002219 DOI: 10.1186/s43055-022-00765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rhinocerebral mucormycosis has emerged as a common coinfection in coronavirus disease 2019 (COVID-19) patients during the convalescence period. Frequent spread of disease from sinonasal mucosa to bone, neck spaces, orbit, and brain occurs along the perivascular/perineural routes or through direct invasion. Brain involvement represents severe manifestation and is often associated with poor functional outcomes and high mortality rates. Magnetic resonance imaging (MRI) is the modality of choice for the intracranial assessment of disease severity in mucormycosis. Early and accurate identification of intracranial extension is imperative to improve survival rates. With this pictorial essay, we aim to familiarize the readers with the cross-sectional imaging features of intracranial complications of mucormycosis. The radiological details in this essay should serve as a broad checklist for radiologists and clinicians while dealing with this fulminant infection.
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80
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Motamedi M, Golmohammadi Z, Yazdanpanah S, Saneian SM, Shafiekhani M. Epidemiology, clinical features, therapeutic interventions and outcomes of mucormycosis in Shiraz: an 8-year retrospective case study with comparison between children and adults. Sci Rep 2022; 12:17174. [PMID: 36229497 PMCID: PMC9561111 DOI: 10.1038/s41598-022-21611-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023] Open
Abstract
Mucormycosis is an invasive fungal infection with high morbidity and mortality rate despite the early diagnosis and proper therapeutic interventions. Given the importance of epidemiological data in reviewing the attitude toward infectious diseases in developing countries, the current retrospective case study aimed to compare the epidemiological aspects, risk factors, clinical characteristics, therapeutic interventions, and outcomes of mucormycosis between adults and children during eight years (2013-2021) in the main infectious disease referral centers in the southwest of Iran. The median age of 164 patients included in this study was 47 years (IQR 22-59). The median length of hospitalization was 33 days.The annual incidence of mucormycosis-related hospitalizations was estimated 1.76 per 10,000 admissions during the study period. Moreover, the incidence of infection was 2.4 times higher in males than females in children. Diabetes mellitus was the most frequent predisposing factor in adults (46.0%). The main risk factor in children was hematologic malignancy (52.6%), but a considerable proportion of them (28.9%) were immunocompetent.The most frequent antifungal agent used was liposomal amphotericin B (82.3%) as monotherapy. The combination therapy was used more in adults (15.8%) than children (7.9%). In addition, surgical intervention with antifungal therapy was considered the most effective therapeutic approach. The in-hospital mortality rate was 14.6% for adults, whereas it was zero for children. Our findings provide a recent epidemiologic analysis of mucormycosis among hospitalized patients in both children and adults. Mucormycosis mainly affects individuals with diabetes mellitus or hematological malignancies and presents as rhino-orbito-cerebral form. Proven diagnosis of mucormycosis according to clinical manifestations and histopathology observations accompanied by proper antifungal treatments may improve survival rates.
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Affiliation(s)
- Marjan Motamedi
- grid.412571.40000 0000 8819 4698Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Golmohammadi
- grid.412571.40000 0000 8819 4698Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Yazdanpanah
- grid.412571.40000 0000 8819 4698Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Mojtaba Saneian
- grid.412571.40000 0000 8819 4698Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- grid.412571.40000 0000 8819 4698Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Shiraz Organ Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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81
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G Hamed M, Hegazy AA, Embaby A, Abdelmoneem S, Al Badea AA, Ali Awad AA, Walaa M, Gobran MA, Awwad O, AbdElmonem D, A Zaitoun N, Abdelmaksoud MA, AbdelAal AA. Identifying Independent Predictors of Mortality in COVID-19 Patients with Mucormycosis. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2022. [DOI: 10.13005/bpj/2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Coronavirus disease 2019 (COVID-19) may lead to immunosuppression, leaving patients vulnerable to secondary invasive fungal infection like mucormycosis. The present study aimed to determine whether there are any risk factors associated with mortality in mucormycosis among COVID-19 patients. Patients and Methods: Patients with COVID-19 diagnosed with mucormycosis who received treatment at University Hospitals were included in the study. Complete blood count (CBC), glycated hemoglobin (HBA1c), C-reactive protein (CRP), serum albumin level, creatinine, ferritin levels, lactate dehydrogenase (LDH), D-dimer and histopathological observations were performed for all participants’ specimens. Results: The number (N) of patients included in the study was 46. About 85 % (39/46) of patients had post-COVID-19 syndrome and the other 7 cases were in the active phase of the disease. CRP, serum ferritin, D-dimer, CRP/albumin ratio and CRP/absolute lymphocyte counts were statistically significant (P<0.05) within non-survivors as compared to survivors. After analysis of multivariate analysis that patients had oxygen support, while elevated CRP/albumin ratios were independent predictors of mortality in COVID-19 patients associated with mucormycosis. Conclusions: Mucormycosis can be caused by immunosuppression conditions associated with COVID-19 infection. Oxygen levels and C-reactive protein/albumin are independent predictors of mortality and morbidity in post COVID-19 patients.
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Affiliation(s)
- Mohamed G Hamed
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | | | - Ahmed Embaby
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Shimaa Abdelmoneem
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amany Abd Al Badea
- 3Otorhinolaryngology Department, Faculty of medicine, Zagazig University, Egypt
| | - Ali Awad Ali Awad
- 3Otorhinolaryngology Department, Faculty of medicine, Zagazig University, Egypt
| | - Mohammad Walaa
- 4Chest Medicine Department. Faculty of Medicine Zagazig University, Egypt
| | - Mai Ahmed Gobran
- 5Pathology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Omnia Awwad
- 6Family Medicine Fellowship in the Egyptian MOHP, Egypt
| | - Doaa AbdElmonem
- 7Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Nahla A Zaitoun
- 8Family Medicine Department, Faculty of Medicine, Zagazig University, Egypt
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Al-Ani RM. Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019. World J Virol 2022; 11:293-299. [PMID: 36188746 PMCID: PMC9523325 DOI: 10.5501/wjv.v11.i5.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus 2. This disease as well as its various treatments like steroids, antivirals, and antibacterials can alter the immune state of the affected individuals and result in secondary infections such as mucormycosis. Mucormycosis is a well-known opportunistic fungal infection that affects immunocompromised subjects, particularly those with diabetes mellitus, prolonged antibiotic or steroid use, and patients with organ trans-plantation, neutropenia, and hematological malignancies. Rhino-orbital-cerebral mucormycosis is an aggressive disease owing to its ability to invade the blood vessels by fungal hyphae, leading to necrosis of the involved structures. Large cases were reported from India, indicating that this clinical entity shows a geographical variation. The affected patients are suffering on a clinical spectrum depending on the stage of the disease. Radiological assessment, including computerized tomography and magnetic resonance imaging, is necessary to evaluate the stage of the disease and choose the appropriate surgical treatment. A multidisciplinary approach is required to treat rhino-orbital-cerebral mucor-mycosis and includes local or intravenous antifungal drugs, debridement of the dead tissues, and appropriate management of any predisposing conditions. The disease has a very poor prognosis with a death rate of 50%. This review aimed to sum-marize the demographic and clinical risk factors, investigations, treatments, and outcomes of coronavirus disease 2019 patients with rhino-orbital-cerebral mucormycosis.
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Affiliation(s)
- Raid M Al-Ani
- Department of Surgery/Otolaryngology, University of Anbar, College of Medicine, Ramadi 31001, Anbar, Iraq
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83
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Singla N, Sharma N, Sharma N, Behera A, Bhatia M. Clinical Profile of Patients Admitted With Mucormycosis During the COVID-19 Pandemic in Medicine Emergency of a Tertiary Care Hospital in North India. Cureus 2022; 14:e29219. [PMID: 36159346 PMCID: PMC9495285 DOI: 10.7759/cureus.29219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 12/15/2022] Open
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Alkhamiss AS, Ahmed AA, Rasheed Z, Alghsham R, Shariq A, Alsaeed T, Althwab SA, Alsagaby S, Aljohani ASM, Alhumaydhi FA, Alduraibi SK, Alduraibi AK, Alhomaidan HT, Allemailem KS, Alharbi RA, Alamro SA, Alqusayer AM, Alharbi SA, Alharby TA, Almujaydil MS, Mousa AM, Alghaniam SA, Alghunaim AA, Alghamdi R, Fernández N, Al Abdulmonem W. Mucormycosis co-infection in COVID-19 patients: An update. Open Life Sci 2022; 17:917-937. [PMID: 36045713 PMCID: PMC9372758 DOI: 10.1515/biol-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.
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Affiliation(s)
- Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmed A Ahmed
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ruqaih Alghsham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Departments of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thamir Alsaeed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sami A Althwab
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Suliman Alsagaby
- Department of Medical Laboratories Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Raya A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Samar A Alamro
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Arwa M Alqusayer
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sahim A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thekra A Alharby
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Mona S Almujaydil
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ayman M Mousa
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sultan A Alghaniam
- Department of Clinical Nutrition, Qassim Health Affairs, Ministry of Health, Buraidah, Saudi Arabia
| | | | - Rana Alghamdi
- Department of Chemistry, Science and Arts College, Rabigh Campus, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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85
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Diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis: a systematic review and meta-analysis. J Laryngol Otol 2022; 136:788-798. [PMID: 35514092 PMCID: PMC9203420 DOI: 10.1017/s0022215122001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to compute the pooled prevalence of diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. METHOD A systematic literature review was performed in PubMed, Scopus, Web of Science, Embase and Google Scholar. The cross-sectional studies that reported the frequency of diabetes mellitus in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis were included. RESULTS Eighteen eligible studies with a total number of 3718 patients were included in the current study. The pooled prevalence of diabetes in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis was 89 per cent and with new-onset diabetes was 32 per cent. The pooled prevalence of steroid use was high (79 per cent) too. The all-cause mortality rate was 24 per cent. CONCLUSION Diabetes mellitus was the most frequent underlying condition in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. The second most frequent underlying condition was steroid use during coronavirus disease 2019 infection. The appropriate control of hyperglycaemia and rational prescription of steroids during the treatment of coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis is recommended.
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Sharifi A, Akbari Z, Shafie’ei M, Nasiri N, Sharifi M, Shafiei M, Zand A. Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:425-432. [PMID: 35943425 PMCID: PMC9451608 DOI: 10.1097/iop.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). METHODS The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. RESULTS A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. CONCLUSIONS Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.
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Affiliation(s)
- Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Akbari
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shafie’ei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Meraj Sharifi
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohadeseh Shafiei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Zand
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Clinical characteristics and outcome of mucormycosis: A multi-center retrospective analysis in Saudi Arabia over 11 years. IJID REGIONS 2022; 4:152-156. [PMID: 35941863 PMCID: PMC9356215 DOI: 10.1016/j.ijregi.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
First multi-center study in Saudi Arabia on clinical mucormycosis epidemiology
Background Mucormycosis is a life-threatening fungal infection with variable epidemiology between countries. Limited data are available locally; we aim to describe the clinical spectrum and outcome of mucormycosis in Saudi Arabia. Methods A retrospective multi-center study including all patients with clinical and pathological evidence of mucormycosis in 3 tertiary care centers in Saudi Arabia from January 2009 to December 2019. Results Thirty-three patients were identified during the study period. The mean age was 42 years. People with diabetes accounted for 48% of the patient population. The most common site of infection was cutaneous (27%), followed by isolated sinusitis (21%) and pulmonary and rhino-orbital-cerebral mucormycosis (each 18%). The most common isolated species were Rhizopus (50%) and Mucor (15%). Most patients received medical therapy with amphotericin B (79%), and more than half were treated surgically. The 1-year mortality rate reached 48%, with higher mortality observed in disseminated and rhino-orbital-cerebral infections than in other sites. Conclusion Our study addressed the epidemiology of mucormycosis in Saudi Arabia and showed comparable patterns of clinical and mycological aspects to worldwide reports. Further studies are needed to evaluate mucormycosis risk factors and prognosis based on the species, site of infection and therapy type.
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Ralaizanaka BM, Razafindrazoto CI, Bolot E, Bors G, Housson-Wetzel S, Razafimahefa SH, Ramanampamonjy RM, Claude P. Gastrointestinal Mucormycosis-Induced Massive Lower Gastrointestinal Bleeding, Rectal Perforation, and Pulmonary Embolism: A Long Diagnostic Pathway in a Case Report. Clin Exp Gastroenterol 2022; 15:145-151. [PMID: 35983373 PMCID: PMC9381012 DOI: 10.2147/ceg.s373728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. It is responsible for surface and deep tissue destruction leading to perforations and hemorrhage. Its pathogenesis represented by an angio-invasion is at the origin of a local infarction and a vascular thrombosis. We report a case of gastrointestinal (GI) mucormycosis-induced multiple gastric ulcers, GI bleeding and rectal perforation. Case Presentation A 75-year-old man, with type II diabetes mellitus, was admitted to the intensive care unit for an acute abdominal pain associated with massive hematochezia. Clinical examination was that of an acute peritonitis and a hemorrhagic shock state. Abdominal and pelvic CT scan with intravenous contrast concluded to a perforation of the anterior wall of the rectum. He underwent immediate laparotomy with temporary colostomy. Several upper GI endoscopies had shown multiple gastric ulcer lesions. Lower GI endoscopy showed a fistulous orifice of the rectum on its anterior surface. Histopathology of the gastric biopsy showed acute and subacute inflammatory changes with filamentous elements suggesting mucormycosis. Histopathology of the rectal biopsy showed a subacute non-specific inflammation. Culture of the secretions from the rectal fistula orifice showed the strain Rhizopus sp. Antifungal susceptibility testing reported sensitivity to liposomal amphotericin B. The diagnosis of GI mucormycosis-induced multiple gastric ulcers, rectal perforation and pulmonary embolism in the patient with type II diabetes mellitus was retained. The outcomes were favorable after 6 weeks of treatment with liposomal amphotericin B associated with temporary colostomy and appropriate diabetes management. Conclusion GI mucormycosis remains a multidisciplinary diagnostic challenge, less frequent in clinical practice, with a long diagnostic pathway. This opportunistic systemic mycosis can lead to numerous GI complications including perforation, massive GI bleeding and even multiple extra-GI complications. GI mucormycosis has a good prognosis if it is treated early with medical and surgical treatment.
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Affiliation(s)
| | | | - Eloïse Bolot
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | - Georges Bors
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | - Stéphanie Housson-Wetzel
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | | | | | - Pierre Claude
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
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Mohapatra S, Barik MR, Rath S, Sharma S, Mohapatra A, Behera S, Acharya S, Pattjoshi DR, Padhi RK, Behera HS. Diagnostic Performance and Clinical Utility of Conventional PCR Assay in Early Diagnosis of COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis. J Fungi (Basel) 2022; 8:jof8080844. [PMID: 36012832 PMCID: PMC9409716 DOI: 10.3390/jof8080844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Early diagnosis and treatment of rhino-orbital-cerebral mucormycosis (ROCM) are crucial. Potassium hydroxide with Calcofluorwhite (KOH + CFW) smears can demonstrate the fungal hyphae, but mixed infections caused by both mucorales and non-mucorales pose a diagnostic challenge. Polymerase chain reaction (PCR) can detect mixed infections and differentiate mucorales from non-mucorales. This study aimed to evaluate the utility of a single reaction PCR in the diagnosis of ROCM and the efficacy of nasal biopsy and endonasal swab in the detection of fungus. Sixty-six clinical samples were collected from 33 patients and were subjected to KOH + CFW smear, culture and PCR. PCR was performed using pan-fungal primers targeting the 28S large subunit rRNA gene, and the amplified products were further sequenced to identify the fungi. KOH + CFW smear, culture and PCR detected mucorales in 54.6%, 27.3% and 63.6% patients, respectively. PCR detected mixed infection in 51.5% patients compared to 9.1% by KOH + CFW smear. PCR detected fungus in 90% of nasal biopsies and 77.8% of endonasal swabs. Rhizopus spp. was the most common fungi identified in 43.2% of PCR-positive samples. PCR is effective in detecting mixed infection and in the diagnosis of ROCM. Nasal biopsies had better fungal detection rates than endonasal swabs.
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Affiliation(s)
- Samir Mohapatra
- Department of Ophthalmic Plastic and Reconstructive Surgery Service, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar 751024, Odisha, India
| | - Manas Ranjan Barik
- Ocular Microbiology Service, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar 751024, Odisha, India
| | - Suryasnata Rath
- Department of Ophthalmic Plastic and Reconstructive Surgery Service, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar 751024, Odisha, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India
| | - Archisman Mohapatra
- Department of Biostatistics, Generating Research Insights for Development (GRID) Council, Noida 201307, Delhi NCR, India
| | | | - Souvagini Acharya
- Department of Ear, Nose and Throat, VSSIMSAR, Burla 768017, Odisha, India
| | - Dipti Ranjan Pattjoshi
- Department of Ear, Nose and Throat, SCB Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Rajesh Kumar Padhi
- Department of Ear, Nose and Throat, Sparsh Hospitals Pvt Ltd., Bhubaneswar 751007, Odisha, India
| | - Himansu Sekhar Behera
- Ocular Microbiology Service, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar 751024, Odisha, India
- Correspondence:
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Spectrum of Mucormycosis Before and During COVID-19: Epidemiology, Diagnosis, and Current Therapeutic Interventions. CURRENT FUNGAL INFECTION REPORTS 2022; 16:131-142. [PMID: 35967987 PMCID: PMC9364274 DOI: 10.1007/s12281-022-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review More than half a billion people have been infected and 6.2 million killed by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) since the start of the pandemic in 2019. Systemic glucocorticoids are a double-edged sword, on the one hand, life-saving in treating COVID-19 complications while on the other hand, potentially leading to life-and-limb-threatening opportunistic fungal infections. Mucormycosis (MM) is caused by the mucormycetes family. Although rare, it is characterized by high mortality and significant morbidity. The gross similarities observed with other fungal infections which respond to different treatment regimens have made it all the more imperative to quickly and sensitively diagnose and treat MM. This review discusses the epidemiology of MM before and during the COVID-19 pandemic, associated risk factors, COVID-19-associated MM, diagnosis, and current therapeutic interventions. Recent Findings There has been a widespread and worrisome trend of rising in cases of MM, worldwide, but more so in the Indian subcontinent, where it is nicknamed the “black fungus.” This upsurge has picked up the pace ever since the start of the COVID-19 pandemic. Necrosis is secondary to the angio-invasive and pro-thrombotic nature of the mold resulting in extensive lesions presenting mostly as rhino-orbital MM (ROM) and rhino-orbito-cerebral MM (ROCM). Infection is mostly observed in subjects with underlying risk factors such as uncontrolled diabetes, those receiving hematopoietic stem cell transplant, and/or on corticosteroid or immunosuppressive therapy, although it is widely suspected that other factors such as iron and zinc may play a role in the pathogenesis of MM. The “One world one guideline” strategy advocates both prophylactic anti-fungal therapy along with aggressive, prompt, and individualized treatment with anti-fungal drugs such as amphotericin B in addition to vigorous surgical intervention. High-risk groups need particularly rapid diagnosis although empirical anti-fungal therapy may not be delayed. Speeding diagnostic turnaround times are essential to institute early therapy, and there is much scope for newer modalities such as PCR, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and whole-genome sequencing in such endeavors. The results of strict monitoring of blood glucose levels along with rational and limited use of steroids and immunomodulatory drugs have proven to be a significant preventive measure. Summary The significant rise in cases of MM worldwide has necessitated viewing each case with a strong index of suspicion. Adoption of rapid diagnostics, early antifungal therapy, and prompt surgical interventions are essential, while high-risk groups need particular focused care which may include prophylactic anti-fungal therapy, limited steroid use, and meticulous control of the underlying disease. Developing quicker and more sensitive diagnostic modalities has great potential to improve the detection and management of MM.
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91
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Sinha S, Kumar VB, Kumar A, Singh V, Anand A, Kusumesh R, Mishra S, Raj P, Sinha BP. Outcomes of Transcutaneous Retrobulbar Amphotericin B in Rhino-Orbital-Cerebral Mucormycosis Among Patients Recovering From COVID-19: A Preliminary Experience. Cureus 2022; 14:e27817. [PMID: 36106303 PMCID: PMC9455078 DOI: 10.7759/cureus.27817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background In this study, we aimed to assess the outcomes of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in rhino-orbital-cerebral mucormycosis (ROCM) among patients recovering from coronavirus disease 2019 (COVID-19). Methodology This retrospective study was conducted at a tertiary care center in eastern India from May 29th to July 31st, 2021, and included post-COVID-19 patients admitted with stage 3 and 4a ROCM who underwent TRAMB. The details of the ophthalmic examination, laboratory investigations, and radiological examination were retrieved from patients records. Patients were given TRAMB (3.5 mg/mL) on alternate days till they underwent debulking surgery and resumed from the second postoperative day alternatively till the patients showed clinical stabilization or improvement. Results In total, 45 eyes of 41 patients were included in the study. The median number of injections given was six (minimum = 3; maximum = 10). Following was the distribution of number of injection needed in each eye: eight eyes (three injections), six eyes (four injections), seven eyes (five injections), three eyes (six injections), eight eyes (seven injections), 11 eyes (eight injections), and one eye had received nine and ten injections each. Overall, 21/32 (65.62%) eyes had improvement in proptosis whereas 9/32 (28.12%) had improvement in ptosis. Six patients had improvement in extraocular movement. In total, 25 eyes had no improvement whereas seven eyes had improvement in vision. Four eyes underwent exenteration. All nine patients with limited orbital disease had good improvement with fewer injections (median = 4). None of the patients undergoing TRAMB had an intracranial extension of disease. Moreover, 8.88% (4/45) of the eyes had post-TRAMB transient inflammation which resolved without any intervention. Finally, 3/41 of the patients died. Conclusions TRAMB can be considered as an useful therapeutic adjunct in managing ROCM. Further, it can halt the progression of the disease while awaiting definitive surgical intervention.
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92
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COVID-19-Associated Mucormycosis: A Matter of Concern Amid the SARS-CoV-2 Pandemic. Vaccines (Basel) 2022; 10:vaccines10081266. [PMID: 36016154 PMCID: PMC9415927 DOI: 10.3390/vaccines10081266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/16/2022] Open
Abstract
Mucormycosis is an invasive fungal infection caused by fungi belonging to order Mucorales. Recently, with the increase in COVID-19 infections, mucormycosis infections have become a matter of concern globally, because of the high morbidity and mortality rates associated with them. Due to the association of mucormycosis with COVID-19 disease, it has been termed COVID-19-associated mucormycosis (CAM). In the present review, we focus on mucormycosis incidence, pathophysiology, risk factors, immune dysfunction, interactions of Mucorales with endothelial cells, and the possible role of iron in Mucorales growth. We review the limitations associated with current diagnostic procedures and the requirement for more specific, cost-effective, convenient, and sensitive assays, such as PCR-based assays and monoclonal antibody-based assays for the effective diagnosis of mucormycosis. We discuss the current treatment options involving antifungal drug therapies, adjunctive therapy, surgical treatment, and their limitations. We also review the importance of nutraceuticals-based therapy for the prevention as well as treatment of mucormycosis. Our review also highlights the need to explore the potential of novel immunotherapeutics, which include antibody-based therapy, cytokine-based therapy, and combination/synergistic antifungal therapy, as treatment options for mucormycosis. In summary, this review provides a complete overview of COVID-19-associated mucormycosis, addressing the current research gaps and future developments required in the field.
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93
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Davies GE, Thornton CR. Development of a Monoclonal Antibody and a Serodiagnostic Lateral-Flow Device Specific to Rhizopus arrhizus (Syn. R. oryzae), the Principal Global Agent of Mucormycosis in Humans. J Fungi (Basel) 2022; 8:jof8070756. [PMID: 35887511 PMCID: PMC9325280 DOI: 10.3390/jof8070756] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. Though a number of different species can cause mucormycosis, the principal agent of the disease worldwide is Rhizopus arrhizus, which accounts for the majority of rhino-orbital-cerebral, pulmonary, and disseminated infections in immunocompromised individuals. It is also the main cause of life-threatening infections in patients with poorly controlled diabetes mellitus, and in corticosteroid-treated patients with SARS-CoV-2 infection, where it causes the newly described disease, COVID-19-associated mucormycosis (CAM). Diagnosis currently relies on non-specific CT, a lengthy and insensitive culture from invasive biopsy, and a time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests for the disease that detect biomarkers of infection, and which allow point-of-care diagnosis. Here, we report the development of an IgG1 monoclonal antibody (mAb), KC9, which is specific to Rhizopus arrhizus var. arrhizus (syn. Rhizopus oryzae) and Rhizopus arrhizus var. delemar (Rhizopus delemar), and which binds to a 15 kDa extracellular polysaccharide (EPS) antigen secreted during hyphal growth of the pathogen. Using the mAb, we have developed a competitive lateral-flow device (LFD) that allows rapid (30 min) and sensitive (~50 ng/mL running buffer) detection of the EPS biomarker, and which is compatible with human serum (limit of detection of ~500 ng/mL) and bronchoalveolar lavage fluid (limit of detection of ~100 ng/mL). The LFD, therefore, provides a potential novel opportunity for the non-invasive detection of mucormycosis caused by Rhizopus arrhizus.
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Affiliation(s)
- Genna E. Davies
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Christopher R. Thornton
- MRC Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
- Correspondence:
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94
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COVID-19, Mucormycosis and Cancer: The Triple Threat-Hypothesis or Reality? J Pers Med 2022; 12:jpm12071119. [PMID: 35887616 PMCID: PMC9320339 DOI: 10.3390/jpm12071119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 01/09/2023] Open
Abstract
COVID-19 has been responsible for widespread morbidity and mortality worldwide. Invasive mucormycosis has death rates scaling 80%. India, one of the countries hit worst by the pandemic, is also a hotbed with the highest death rates for mucormycosis. Cancer, a ubiquitously present menace, also contributes to higher case fatality rates. All three entities studied here are individual, massive healthcare threats. The danger of one disease predisposing to the other, the poor performance status of patients with all three diseases, the impact of therapeutics for one disease on the pathology and therapy of the others all warrant physicians having a better understanding of the interplay. This is imperative so as to effectively establish control over the individual patient and population health. It is important to understand the interactions to effectively manage all three entities together to reduce overall morbidity. In this review article, we search for an inter-relationship between the COVID-19 pandemic, emerging mucormycosis, and the global giant, cancer.
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95
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Wang J, Wang Y, Han F, Chen J. Multiple diagnostic methods for mucormycosis: A retrospective case series. J Clin Lab Anal 2022; 36:e24588. [PMID: 35792018 PMCID: PMC9396201 DOI: 10.1002/jcla.24588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/25/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- JiaXin Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - YaoMin Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - JiangHua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
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Farghly Youssif S, Abdelrady MM, Thabet AA, Abdelhamed MA, Gad MOA, Abu-Elfatth AM, Saied GM, Goda I, Algammal AM, Batiha GES, Abd El-Rady NM, Hetta HF, Kasem SM. COVID-19 associated mucormycosis in Assiut University Hospitals: a multidisciplinary dilemma. Sci Rep 2022; 12:10494. [PMID: 35729170 PMCID: PMC9212202 DOI: 10.1038/s41598-022-13443-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Mucormycosis is a life-threatening opportunistic angioinvasive fungal infection. We aimed to describe the frequency, presentations, predictors, and in-hospital outcome of mucormycosis patients in the scope of CoronaVirusDisease-19 (COVID-19) during the third viral pandemic wave. This cross-sectional retrospective study included all patients who fulfilled the criteria of mucormycosis with concurrent confirmed covid19 infection admitted to Assuit University Hospital between March 2021 and July 2021. Overall, 433 patients with definite covid-19 infection, of which 33 (7.63%) participants were infected with mucormycosis. Mucormycosis was predominantly seen in males (21 vs. 12; p = 0.01). Diabetes mellitus (35% vs. 63.6%; p < 0.001), hypertension (2% vs.45.5%; p 0.04), and Smoking (26.5% vs. 54.5%; p < 0.001) were all significantly higher in mucormycosis patients. Inflammatory markers, especially E.S.R., were significantly higher in those with mucormycosis (p < 0.001). The dose of steroid intake was significantly higher among patients with mucormycosis (160 mg vs. 40 mg; p < 0.001). Except for only three patients alive by residual infection, 30 patients died. The majority (62%) of patients without mucormycosis were alive. Male sex; Steroid misuse; D.M.; Sustained inflammation; Severe infection were significant risk factors for mucormycosis by univariate analysis; however, D.M.; smoking and raised E.S.R. were predictors for attaining mucormycosis by multivariate analysis.
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Affiliation(s)
- Sahar Farghly Youssif
- Department of Chest Disease and Tuberculosis, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Marwa M Abdelrady
- Department of Anesthesia and Critical Care, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Ahmed Atef Thabet
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Mohamed A Abdelhamed
- Department of Neurology and Psychiatry, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Mohamed Omar A Gad
- Department of Otorhinolaryngology, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Ahmed Mohmmed Abu-Elfatth
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Ghada Mohamed Saied
- Department of Clinical Pathology Department, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Islam Goda
- Department of Ophthalmology Department, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
| | - Abdelazeem M Algammal
- Department of Bacteriology, Immunology and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicines, Damanhour University, Damanhour, 22511, Egypt
| | - Nessren M Abd El-Rady
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt.
| | - Soheir M Kasem
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Assuit University, Assiut, 71515, Egypt
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97
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Acosta-España JD, Voigt K. Mini Review: Risk Assessment, Clinical Manifestation, Prediction, and Prognosis of Mucormycosis: Implications for Pathogen- and Human-Derived Biomarkers. Front Microbiol 2022; 13:895989. [PMID: 35794908 PMCID: PMC9251460 DOI: 10.3389/fmicb.2022.895989] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023] Open
Abstract
Mucormycosis is a fungal disease caused by members of the fungal order Mucorales, which are abundantly found in terrestrial environments. The fungi propagate clonally via mitospores, which are transmitted to humans through the air and cause superficial or invasive infections. The disease has emerged in recent years and coincides generally with immunosuppression on the patient side. Mucormycosis is still rarely recognized in the clinical because of its unspecific symptoms which often triggers misdiagnosis with bacterial or viral infections leading to prolonged therapeutic cycles and loss of valuable time to manage mucormycosis properly. Infected patients develop various clinical forms, most notably ranging from rhinocerebral via pulmonary to gastrointestinal forms. Traditional diagnosis is based on culture and histopathologic examinations of the affected tissue. But, the achievement of a precise result is time-consuming, labor-intensive, requires mycological expertise and the finding appears often too late. A rapid and precise diagnosis is mandatory because symptoms are non-specific and the disease is rapidly progressing with often fatal outcome. Mucormycosis was increasingly associated with other infections and underlying conditions and risk factors causing comorbidities, which are difficult to successfully manage. This mini-review summarizes the current knowledge on the epidemiology and causative agents of mucormycosis, transmission, risk factors, clinical presentation, diagnosis, and highlights the lack of appropriate biomarkers on the pathogen and the host sides for rapid pathogen and host susceptibility detection, respectively. Fungal antigens and single nucleotide polymorphisms (SNPs) in human host genes are useful for the assessment of susceptibility. This mini-review addresses possibilities for early prediction of susceptibility to mucormycosis based on forecasting of the risk of infection with fungal pathogens other than Mucorales. The topic of early prediction and diagnosis of mucormycosis represents a current research gap and highlights the importance of potential future developments in the area of risk assessment, susceptibility prognosis in conjunction with early diagnosis to reduce mortality in patients suffering from mucormycosis.
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Affiliation(s)
- Jaime David Acosta-España
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Jena, Germany,Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany,Department of Medical Microbiology, Hospital Vozandes Quito, Quito, Ecuador,School of Medicine, Universidad de las Américas, Quito, Ecuador
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Jena, Germany,Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany,*Correspondence: Kerstin Voigt,
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98
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Kant R, Totaganti M, Mohan B, Bairwa M, Panda PK, Tyagi A, Prasad A, Bahurupi Y. Clinical Characteristics of 100 Patients With COVID-19-Associated Mucormycosis From a Tertiary Care Center in North India. Cureus 2022; 14:e25652. [PMID: 35800201 PMCID: PMC9252165 DOI: 10.7759/cureus.25652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Fungal infection in patients with coronavirus disease 2019 (COVID-19) has emerged as a new challenge in healthcare facilities. This study aimed to describe the demographic and clinical characteristics of COVID-19-associated mucormycosis (CAM). Methodology This retrospective, single-center case series included patients who were hospitalized and diagnosed with COVID-19 and mucormycosis at the All India Institute of Medical Sciences, Rishikesh (North India) from April 15, 2021, onwards and last followed up on June 30, 2021. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed. Results Of the 100 consecutive inpatients with CAM, 95 (95%) had diabetes mellitus. At the onset of illness, the most common manifestations were facial swelling (85%), eye swelling (83%), headache (68%), pain around the eyeball (67%), malaise (57%), and fever (50%). The most common organ involved on examination was the nose and paranasal sinus (96%), followed by the orbit (83%), palate (19%), and cranial nerves (7%). Pulmonary involvement was seldom observed (1%). Predominant pathological findings were the presence of aseptate hyphae (75%), necrosis (75%), angioinvasion (36%), and perineural invasion (2.6%). During the last follow-up, 13 patients died, with 11 (84.6%) having severe COVID-19 and two (15.3%) having moderate COVID-19. Conclusions Steroid use and diabetes mellitus are the significant risk factors of CAM. Patients with CAM usually present with face/eye swelling with radiological involvement of the nose and sinus and may die because of severe COVID-19.
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99
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Lamoth F. The unresolved issues in the management of mucormycosis. Eur J Intern Med 2022; 100:29-30. [PMID: 35351351 DOI: 10.1016/j.ejim.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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100
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Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha) 2022; 67:363-387. [PMID: 35220559 PMCID: PMC8881997 DOI: 10.1007/s12223-021-00934-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
Mucormycosis is a deadly opportunistic disease caused by a group of fungus named mucormycetes. Fungal spores are normally present in the environment and the immune system of the body prevents them from causing disease in a healthy immunocompetent individual. But when the defense mechanism of the body is compromised such as in the patients of diabetes mellites, neustropenia, organ transplantation recipients, and other immune-compromised states, these fungal spores invade our defense mechanism easily causing a severe systemic infection with approximately 45-80% of case fatality. In the present scenario, during the COVID-19 pandemic, patients are on immunosuppressive drugs, glucocorticoids, thus are at high risk of mucormycosis. Patients with diabetes mellitus are further getting a high chance of infection. Usually, the spores gain entry through our respiratory tract affecting the lungs and paranasal sinuses. Besides, they can also enter through damage into the skin or through the gastrointestinal route. This review article presents the current statistics, the causes of this infection in the human body, and its diagnosis with available recent therapies through recent databases collected from several clinics and agencies. The diagnosis and identification of the infection were made possible through various latest medical techniques such as computed tomography scans, direct microscopic observations, MALDI-TOF mass spectrometry, serology, molecular assay, and histopathology. Mucormycosis is so uncommon, no randomized controlled treatment studies have been conducted. The newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate) may be beneficial in patients who are refractory to or intolerant of Liposomal Amphotericin B. but due to lack of early diagnosis and aggressive surgical debridement or excision, the mortality rate remains high. In the course of COVID-19 treatments, there must be more vigilance and alertness are required from clinicians to evaluate these invasive fungal infections.
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Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India
| | - Anjana Goel
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India.
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