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Huang SF, Ying-Jung Wu A, Shin-Jung Lee S, Huang YS, Lee CY, Yang TL, Wang HW, Chen HJ, Chen YC, Ho TS, Kuo CF, Lin YT. COVID-19 associated mold infections: Review of COVID-19 associated pulmonary aspergillosis and mucormycosis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022:S1684-1182(22)00285-7. [PMID: 36586744 PMCID: PMC9751001 DOI: 10.1016/j.jmii.2022.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
COVID-19-associated mold infection (CAMI) is defined as development of mold infections in COVID-19 patients. Co-pathogenesis of viral and fungal infections include the disruption of tissue barrier following SARS CoV-2 infection with the damage in the alveolar space, respiratory epithelium and endothelium injury and overwhelming inflammation and immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to fungal infections during COVID-19 include the administration of immune modulators such as corticosteroids and IL-6 antagonist. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) is increasingly reported during the COVID-19 pandemic. CAPA usually developed within the first month of COVID infection, and CAM frequently arose 10-15 days post diagnosis of COVID-19. Diagnosis is challenging and often indistinguishable during the cytokine storm in COVID-19, and several diagnostic criteria have been proposed. Development of CAPA and CAM is associated with a high mortality despiteappropriate anti-mold therapy. Both isavuconazole and amphotericin B can be used for treatment of CAPA and CAM; voriconazole is the primary agent for CAPA and posaconazole is an alternative for CAM. Aggressive surgery is recommended for CAM to improve patient survival. A high index of suspicion and timely and appropriate treatment is crucial to improve patient outcome.
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Affiliation(s)
- Shiang-Fen Huang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Internal Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan
| | - Alice Ying-Jung Wu
- Division of Infectious Diseases, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei City, Taiwan
| | - Susan Shin-Jung Lee
- School of Internal Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan,Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Liang Yang
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan,Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Hsiao-Wei Wang
- Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho- Su Memorial Hospital, Taipei, Taiwan
| | - Hung Jui Chen
- Department of Infectious Diseases, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yi Ching Chen
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzong-Shiann Ho
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan,Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Chien-Feng Kuo
- Division of Infectious Diseases, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan,Corresponding author
| | - Yi-Tsung Lin
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Corresponding author
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Almyroudi MP, Akinosoglou K, Rello J, Blot S, Dimopoulos G. Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review. Diagnostics (Basel) 2022; 12:3092. [PMID: 36553099 PMCID: PMC9777018 DOI: 10.3390/diagnostics12123092] [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: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.
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Affiliation(s)
- Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, School of Medicine University of Patras, 26504 Rio, Greece
| | - Jordi Rello
- Vall d’Hebron Institute of Research, Barcelona, Spain & Clinical Research, CHU Nîmes, 30900 Nîmes, France
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane 4029, Australia
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Madan S, Yadav R, Rohatgi J, Sharma R, Nasir I, Saini A, Tadu N, Das GK, Sahu PK, Gupta N, Beri N. Demographic and Clinical Profile of Patients Presenting with COVID-19-Associated Rhino-orbito-cerebral Mucormycosis at a Tertiary Care Center. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1757894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives Individuals affected with rhino-orbito-cerebral mucormycosis (ROCM) associated with coronavirus disease 2019 (COVID-19) increased enormously in northern India during the second wave of the novel coronavirus disease. This study determined the demographic and clinical profile including the risk factors in patients presenting to a tertiary care hospital in northern India.
Materials and Methods This is a descriptive study involving patients admitted with COVID-19-associated ROCM and were managed from May 2021 to 20th July 2021.
Statistical Analysis The data was analyzed using SPSS (IBM SPSS Statistics 20, SPSS Inc., Chicago, Illinois, United States) software and Microsoft Excel (Version 16.49). The chi-squared and Fisher's exact tests were used to compare various outcomes. A p-value of less than or equal to 0.05 was considered to be statistically significant.
Results One hundred and seventeen (117) patients (males: 70 [59.8%], females:47 [40.2%]) with the average age of 51.85 ± 12.80 years presented with orbital involvement. Diabetes mellitus was noted in 100 (86.2%) patients. Of the available data from the records, oxygen supplementation for the management of COVID-19 was received by 37/108 (34.3%) patients for a median average duration of 11 days. Forty-eight patients of one-hundred-seventeen (60%) patients were treated with corticosteroids with a median duration of steroid administration being 10 days. The duration between onset of symptoms related to mucormycosis and diagnosis of COVID-19 was 0 to 75 days for 48 patients. Intravenous amphotericin B was administered in all cases. External sinonasal debridement was performed in 90 of 114 (78.9%) patients, retrobulbar amphotericin B injection was administered in 56 of 117 (47.9%), and orbital exenteration was performed in 17 of 117 (14.5%) of cases.
Conclusion Administration of corticosteroids and diabetes mellitus seem to be the major underlying causes for the development of COVID-19-associated ROCM. Prompt diagnosis and multidisciplinary management approach are essential for a reduction in mortality.
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Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Rekha Yadav
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Rahul Sharma
- Department of Community Medicine, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Iffat Nasir
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Aarushi Saini
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Nampi Tadu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Gopal Krushna Das
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Pramod Kumar Sahu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Neelima Gupta
- Department of ENT, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Nitika Beri
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, 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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105
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Invasive Fungal Sinusitis in Patients With Coronavirus. J Neuroophthalmol 2022; 42:e607-e608. [PMID: 36166712 DOI: 10.1097/wno.0000000000001648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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106
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Ray A, Aayilliath K A, Banerjee S, Chakrabarti A, Denning DW. Burden of Serious Fungal Infections in India. Open Forum Infect Dis 2022; 9:ofac603. [PMID: 36589484 PMCID: PMC9792086 DOI: 10.1093/ofid/ofac603] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022] Open
Abstract
Background Fungal disease is frequent in India, but its incidence and prevalence are unclear. This review aims at defining the frequency or burden of various fungal infections in India. Methods A systematic review of the literature on the PubMed, Embase, and Web of Science (WOS) databases was conducted using appropriate search strings. Deterministic modeling determined annual incidence and prevalence estimates for multiple life- and sight-threatening infections with significant morbidity. Results Literature searches yielded >2900 papers; 434 papers with incidence/prevalence/proportion data were analyzed. An estimated 57 251 328 of the 1 393 400 000 people in India (4.1%) suffer from a serious fungal disease. The prevalence (in millions) of recurrent vulvovaginal candidiasis is 24.3, allergic bronchopulmonary aspergillosis is 2.0, tinea capitis in school-age children is 25, severe asthma with fungal sensitization is 1.36, chronic pulmonary aspergillosis is 1.74, and chronic fungal rhinosinusitis is 1.52. The annual incidence rates of Pneumocystis pneumonia (58 400), invasive aspergillosis (250 900), mucormycosis (195 000), esophageal candidiasis in HIV (266 600), candidemia (188 000), fungal keratitis (1 017 100), and cryptococcal meningitis (11 500) were also determined. Histoplasmosis, talaromycosis, mycetoma, and chromoblastomycosis were less frequent. Conclusions India's fungal burden is high and underappreciated in clinical practice.
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Affiliation(s)
- Animesh Ray
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David W Denning
- Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Global Action For Fungal Infections, Geneva, Switzerland
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107
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Factors Associated with Mortality in Coronavirus-Associated Mucormycosis: Results from Mycotic Infections in COVID-19 (MUNCO) Online Registry. J Clin Med 2022; 11:jcm11237015. [PMID: 36498589 PMCID: PMC9738048 DOI: 10.3390/jcm11237015] [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: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND COVID-19-associated mucormycosis (CAM) is associated with high morbidity and mortality. MUNCO is an international database used to collect clinical data on cases of CAM in real time. Preliminary data from the Mycotic Infections in COVID-19 (MUNCO) online registry yielded 728 cases from May to September 2021 in four South Asian countries and the United States. A majority of the cases (694; 97.6%) consisted of a mucormycosis infection. The dataset allowed for the analysis of the risk factors for adverse outcomes from CAM and this analysis is presented in this paper. METHODS The submission of cases was aided by a direct solicitation and social media online. The primary endpoints were full recovery or death measured on day 42 of the diagnosis. All patients had histopathologically confirmed CAM. The groups were compared to determine the contribution of each patient characteristic to the outcome. Multivariable logistic regression models were used to model the probability of death after a CAM diagnosis. RESULTS The registry captured 694 cases of CAM. Within this, 341 could be analyzed as the study excluded patients with an unknown CAM recovery status due to either an interruption or a lack of follow up. The 341 viable cases consisted of 258 patients who survived after the completion of treatment and 83 patients who died during the period of observation. In a multivariable logistic regression model, the factors associated with an increased risk of mortality include old age (OR = 1.04, 95% CI 1.02-1.07, p = 0.001), history of diabetes mellitus (OR 3.5, 95% CI 1.01-11.9, p = 0.02) and a lower BMI (OR 0.9, 95% CI 0.82-0.98, p = 0.03). Mucor localized to sinus disease was associated with 77% reduced odds of death (OR = 0.23, 95% CI 0.09-0.57, p = 0.001), while cerebral mucor was associated with an increased odds of death (OR = 10.96, 95% CI 4.93-24.36, p = ≤0.0001). CONCLUSION In patients with CAM, older age, a history of diabetes and a lower body mass index is associated with increased mortality. Disease limited to the sinuses without a cerebral extension is associated with a lower risk of mortality. Interestingly, the use of zinc and azithromycin were not associated with increased mortality in our study.
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108
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Anand T, Mukherjee A, Satija A, Velamuri PS, Singh KJ, Das M, Josten K, Yadav PD, Sahay RR, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Kataria S, Sharma P, Panda S, Shete AM, Majumdar T, Abraham P, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Deswal V, Kumar K. A case control investigation of COVID-19 associated mucormycosis in India. BMC Infect Dis 2022; 22:856. [PMID: 36384482 PMCID: PMC9667849 DOI: 10.1186/s12879-022-07844-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07844-y.
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Dandu H, Kumar M, Malhotra HS, Kumar N, Kumar N, Gupta P, Puri B, Yadav G. T-cell dysfunction as a potential contributing factor in post-COVID-19 mucormycosis. Mycoses 2022; 66:202-210. [PMID: 36305225 PMCID: PMC9874625 DOI: 10.1111/myc.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The second wave of COVID-19 in India was followed by large number of mucormycosis cases. Indiscriminate use of immunosuppressive drugs, underlying diseases such as diabetes, cancers, or autoimmune diseases was thought to be the cause. However, the mortality was not as high as that seen in non-COVID mucormycosis. OBJECTIVE To study the detailed characteristics of T-cells for evaluating the underlying differences in the T-cell immune dysfunction in post-COVID and non-COVID mucor patients. MATERIAL AND METHOD The study included histopathologically confirmed cases of mucor (13 post-COVID, 13 non-COVID) and 15 healthy individuals (HI). Expression of T-cell activation (CD44, HLADR, CD69, CD38) and exhaustion (CTLA, PD-1, LAG-3 and TIM-3) markers was evaluated by flow cytometry. RESULTS All cases showed significant depletion of T-cells compared to HI. Both post-COVID and non-COVID groups showed increased activation and exhaustion as compared to HI. Non-COVID mucor group showed significant activation of CD4+ T cells for HLADR and CD38 (p = .025, p = .054) and marked T-cell exhaustion in form of expression of LAG-3 on both CD4+ T and CD8+ T cells in comparison with post-COVID patients (p = .011, p = .036). Additionally, co-expression of PD-1 & LAG-3 and LAG-3 & TIM-3 on CD8+ T cells was statistically significant in non-COVID mucor patients (p = .016, p = .027). CONCLUSION Immunosuppression in non-COVID mucor showed pronounced exhaustion of T-cells in comparison to post-COVID mucor cases implicating T-cell immune dysfunction is much more severe in non-COVID mucor which are in a state of continuous activation followed by extreme exhaustion leading to poorer outcome.
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Affiliation(s)
- Himanshu Dandu
- Department of Internal MedicineKing George's Medical UniversityLucknowIndia
| | - Manish Kumar
- Department of PathologyKing George's Medical UniversityLucknowIndia
| | | | - Naveen Kumar
- Department of Internal MedicineKing George's Medical UniversityLucknowIndia
| | - Neeraj Kumar
- Department of NeurologyKing George's Medical UniversityLucknowIndia
| | - Prashant Gupta
- Department of MicrobiologyKing George's Medical UniversityLucknowIndia
| | - Bipin Puri
- Department of Pediatric SurgeryKing George's Medical UniversityLucknowIndia
| | - Geeta Yadav
- Department of PathologyKing George's Medical UniversityLucknowIndia
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Pruthi HS. When to Initiate Antifungal Treatment in COVID-19 Patients with Secondary Fungal Co-infection. CURRENT CLINICAL MICROBIOLOGY REPORTS 2022; 9:60-68. [PMID: 36345368 PMCID: PMC9630809 DOI: 10.1007/s40588-022-00184-0] [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] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Purpose of Review Severe-acute respiratory coronavirus 2 (SARS-CoV-2) has been driving the health care delivery system for over 2 years. With time, many issues related to co-infections in COVID-19 patients are constantly surfacing. There have been numerous reports about various fungal co-infections in patients with COVID-19. The extent of severity of fungal pathogens has been recognized as a substantial cause of morbidity and mortality in this population. Awareness, understanding, and a systematic approach to managing fungal co-infections in COVID-19 patients are important. No guidelines have enumerated the stepwise approach to managing the fungal infections co-occurring with COVID-19. This review is intended to present an overview of the fungal co-infections in COVID-19 patients and their stepwise screening and management. Recent Findings The most common fungal infections that have been reported to co-exist with COVID-19 are Candidemia, Aspergillosis, and Mucormycosis. Prevalence of co-infections in COVID-19 patients has been reported to be much higher in hospitalized COVID-19 patients, especially those in intensive care units. While clear pathogenetic mechanisms have not been delineated, COVID-19 patients are at a high risk of invasive fungal infections. Summary As secondary fungal infections have been challenging to treat in COVID-19 patients, as they tend to affect the critically ill or immunocompromised patients, a delay in diagnosis and treatment may be fatal. Antifungal drugs should be initiated with caution after carefully assessing the immune status of the patients, drug interactions, and adverse effects. The crucial factors in successfully treating fungal infections in COVID-19 patients are optimal diagnostic approach, routine screening, and timely initiation of antifungal therapy.
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Affiliation(s)
- Harnoor Singh Pruthi
- Deparment of Cardiology, Capitol Hospital, Pathankot Road (NH-44), Jalandhar, Punjab 144012 India
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111
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Shah NN, Khan Z, Ahad H, Elderdery AY, Alomary MN, Atwah B, Alhindi Z, Alsugoor MH, Elkhalifa AME, Nabi S, Bashir SM, Yaqub T, Rather GA, Ansari MA. Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review. J Infect Public Health 2022; 15:1299-1314. [PMID: 36279686 PMCID: PMC9562622 DOI: 10.1016/j.jiph.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/01/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023] Open
Abstract
As of 25th July, 2022, global Disease burden of 575,430,244 confirmed cases and over 6,403,511 deaths have been attributed to coronavirus disease 2019 (COVID-19). Co-infections/secondary infections continue to plague patients around the world as result of the co-morbidities like diabetes mellitus, biochemical changes caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) especially significant elevation in free iron levels, immune suppression caused by SARS-CoV-2, and indiscriminate use of systemic corticosteroids for the treatment of severe COVID-19 disease. In such circumstances, opportunistic fungal infections pose significant challenge for COVID-19 disease therapy in patients with other co-morbidities. Although COVID-19-associated Mucormycosis (CAM) has been widely recognized, currently extensive research is being conducted on mucormycosis. It has been widely agreed that patients undergoing corticosteroid therapy are highly susceptible for CAM, henceforth high index of screening and intensive care and management is need of an hour in order to have favorable outcomes in these patients. Diagnosis in such cases is often delayed and eventually the disease progresses quickly which poses added burden to clinician and increases patient load in critical care units of hospitals. A vast perusal of literature indicated that patients with diabetes mellitus and those with other co-morbidities might be highly vulnerable to develop mucormycosis. In the present work, the case series of three patients presented at Chest Disease Hospital Srinagar, Jammu and Kashmir infected with CAM has been described with their epidemiological data in supplementary section. All these cases were found to be affected with co-morbidity of Diabetes Mellitus (DM) and were under corticosteroid therapy. Furthermore, given the significant death rate linked with mucormycosis and the growing understanding of the diseases significance, systematic review of the literature on CAM has been discussed and we have attempted to discuss emerging CAM and related aspects of the disease.
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Affiliation(s)
- Naveed Nazir Shah
- Department of Chest Medicine, Govt. Medical College Srinagar, Jammu & Kashmir, India
| | - Zaid Khan
- Department of Chest Medicine, Govt. Medical College Srinagar, Jammu & Kashmir, India
| | - Hashim Ahad
- Government Dental College, Srinagar, Jammu & Kashmir, India
| | - Abozer Y Elderdery
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Saudi Arabia
| | - Mohammad N Alomary
- National Centre for Biotechnology, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Banan Atwah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Zain Alhindi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mahdi H Alsugoor
- Department of Emergency Medical Services, faculty of Health Sciences, AlQunfudah, Umm Al-Qura University, Makkah 21912, Saudi Arabia
| | - Ahmed M E Elkhalifa
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia & Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti 1158, Sudan
| | - Showket Nabi
- Large Animal Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Ethics & Jurisprudence, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama Alusteng, Srinagar, Jammu & Kashmir 190006, India
| | - Showkeen Muzamil Bashir
- Molecular biology Laboratory, Division of Veterinary Biochemistry, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama Alusteng, Srinagar, Jammu & Kashmir 190006, India.
| | - Tahir Yaqub
- Institute of Microbiology University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Gulzar Ahmed Rather
- Department of Biomedical Engineering, Sathyabama Institute of Science & Technology, Deemed to be University, Chennai, Tamil Nadu, India
| | - Mohammad Azam Ansari
- Department of Epidemic Disease Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
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Pandey S, Malhotra HS, Garg RK, Sharma K, Rizvi I, Kumar S, Kumar N, Uniyal R, Sharma PK, Gupta P, Jain A, Reddy DH. Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study. J Infect Public Health 2022; 15:1265-1269. [PMID: 36272391 PMCID: PMC9557112 DOI: 10.1016/j.jiph.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Rhino cerebral mucormycosis is an uncommon opportunistic infection of the nasal sinuses and brain, and a group of saprophytic fungi causes it. During the second wave of COVID-19, India witnessed an unprecedented number of patients with rhino cerebral mucormycosis. Invasion of the cavernous sinus and occlusion of the internal carotid artery in many cases resulted in a stroke. The study aimed to assess the clinical and neuroimaging predictors of stroke in patients with rhino cerebral mucormycosis. We also evaluated the predictors of death in these patients at 90 days. METHODS A prospective study was performed at a tertiary care centre in India between July 2021 and September 2021. We enrolled consecutive microbiologically confirmed patients of rhino cerebral mucormycosis. All patients underwent neuroimaging of the brain. Treatment comprised of anti-fungal drugs and endoscopic nasal/sinus debridement. We followed the patients for 90 days and assessed the predictors of stroke and mortality RESULTS: Forty-four patients with rhino cerebral mucormycosis were enrolled. At inclusion, in 24 patients, the RT-PCR test for SARS-COV-2 was negative. Diabetes mellitus was the most frequent (72.7 %) underlying risk factor; in most, diabetes mellitus was recently discovered. At inclusion or subsequent follow-up, stroke was seen in 11 (25 %) patients. Only seven patients had hemiparesis. Imaging revealed internal carotid artery occlusion in 17 (38.6 %) patients. Hypertension, corticosteroid use, and cavernous sinus thrombosis were independent predictors of stroke. Nine (20.5 %) died during follow-up, and stroke was an independent predictor of death. CONCLUSION Stroke indicated poor prognosis among rhino cerebral mucormycosis patients encountered during the second wave of the COVID-19 epidemic.
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Affiliation(s)
- Shweta Pandey
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Hardeep Singh Malhotra
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Ravindra Kumar Garg
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Kamini Sharma
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Imran Rizvi
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Sukriti Kumar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Neeraj Kumar
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Ravi Uniyal
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Praveen Kumar Sharma
- Department of neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Prashant Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - D Himanshu Reddy
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
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Monroig V, Tarquinio KM. Diabetic ketoacidosis and coronavirus disease 2019-associated mucormycosis: a case report. J Med Case Rep 2022; 16:400. [PMID: 36316719 PMCID: PMC9624001 DOI: 10.1186/s13256-022-03594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background Mucormycosis is a rare, life-threatening fungal infection that affects immunocompromised hosts. Diabetes mellitus is a common predisposing condition and most often presents with rhino-orbital-cerebral infection. Association with coronavirus disease 2019 infection was revealed following a resurgence in cases of mucormycosis during the second wave of the pandemic wherein poorly controlled diabetes mellitus was the most significant risk factor in the affected population. Rhino-orbital-cerebral mucormycosis has a high mortality rate, and cerebral involvement is a poor prognostic factor. Herein, we report a case of newly diagnosed diabetes mellitus with concurrent coronavirus disease 2019 infection complicated by diabetic ketoacidosis and rhinocerebral mucormycosis at presentation, describe the diagnostic and therapeutic challenges, and discuss the interventions that ultimately resulted in a favorable clinical response. Case presentation We describe the case of a previously healthy 13-year-old African American female patient with newly diagnosed diabetes mellitus and concurrent severe acute respiratory syndrome coronavirus 2 infection whose disease course was complicated by rhinocerebral mucormycosis. She presented with fever, altered mental status, and Kussmaul respirations and was diagnosed with diabetic ketoacidosis with concern for cerebral edema. Concern for infectious cerebritis arose due to recurring fevers and persistently altered mental status despite correction of her metabolic derangements. This raised concern for infectious cerebritis and prompted evaluation with serial head imaging, lumbar puncture, and initiation of broad empiric antimicrobial regimen. Head imaging revealed an evolving cerebral abscess, and fungal deoxyribonucleic acid was identified on blood metagenomics testing, which ultimately confirmed the diagnosis of rhinocerebral mucormycosis. Treatment was challenging as she required surgical debridement of the frontal lobe and aggressive antifungal therapy complicated by electrolyte derangements and electrocardiogram changes that necessitated modification of the antimicrobial regimen. Despite these challenges and high mortality rate, the patient was discharged from the hospital in stable condition to inpatient rehabilitation service for reconditioning after prolonged hospitalization. Conclusion Rhinocerebral mucormycosis mortality is associated with delays in therapeutic interventions, thus a high index of suspicion and early recognition were essential for timely initiation of antifungal therapy and surgical debridement.
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Affiliation(s)
- Vanessa Monroig
- grid.189967.80000 0001 0941 6502Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Keiko M. Tarquinio
- grid.189967.80000 0001 0941 6502Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA ,grid.428158.20000 0004 0371 6071Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta, Atlanta, GA USA
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Singh P, Mohanti BK, Mohapatra SK, Deep A, Harsha B, Pathak M, Patro S. Post-COVID-19 Assessment of Physical, Psychological, and Socio-Economic Impact on a General Population of Patients From Odisha, India. Cureus 2022; 14:e30636. [DOI: 10.7759/cureus.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
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115
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Gandhi A, Narula A, Chandra S, Agarwal D, Mehta A, Nayak S, Arora S, Capoor MR. Battling the emerging epidemic of rhino-orbital-cerebral mucormycosis (ROCM) in COVID-19 pandemic: an interventional study. Int Ophthalmol 2022; 43:1571-1580. [PMID: 36273362 PMCID: PMC9589720 DOI: 10.1007/s10792-022-02556-3] [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] [Received: 10/04/2021] [Accepted: 10/06/2022] [Indexed: 11/26/2022]
Abstract
Purpose The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. Methods This is an interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. Results The mean age of patients was 40.45 ± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous Amphotericin and oral Posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar Amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients (P < 0.01). Overall, 68.5% responded to therapy, 8.5% showed progression and mortality rate was 22.85%, at a mean follow up period of 59.5 days. Conclusion A multidisciplinary and aggressive approach is essential in the management of CAM patients.
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Affiliation(s)
- Aastha Gandhi
- Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
| | - Anurag Narula
- Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Shreya Chandra
- Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Dhwanee Agarwal
- Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Anuj Mehta
- Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Shaktiprada Nayak
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sheetal Arora
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Malini R Capoor
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Management of Mucormycosis in Post COVID-19 Patients and Its Outcome in a Tertiary Care Center: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:3344-3351. [PMID: 36267489 PMCID: PMC9569005 DOI: 10.1007/s12070-022-03197-9] [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: 03/01/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
To assess the common presentation and extent of disease involvement clinically and radiologically and treatment modalities, sequalae of the disease, complications and treatment response. Mucormycosis is a life-threatening infection that most commonly affects immunocompromised individuals and an exponential increase in the incidence of Rhino-orbital-cerebral mucormycosis was witnessed in the second wave of the COVID-19 pandemic, despite aggressive multimodal treatment carries a significant risk of mortality. A high index of suspicion is required in order to begin the appropriate diagnostic workup and treatment. This study is conducted to access the outcome and management of mucormycosis in post covid 19 patients. The prospective study includes 180 Patients, who are attending to E.N.T. outpatient department, Triage and patients referred from other departments who had suspected/confirmed Rhino-orbital-cerebral mucormycosis/underwent surgery and/or medical treatment or both. In our study mucormycosis predominantly affected age group between 40 and 60 years, more common in males (77.8%) than females (22.2%), 77.8% patients had post covid status. Most common risk factor was diabetes mellitus.76% patients had undergone endoscopic/open surgery and 24% patients underwent only medical treatment. Among 138 patients operated, 40% had recurrence and mortality was 16.1% (significantly reduced). Early diagnosis and prompt intervention is paramount to reduce morbidity and mortality. Liposomal Amphotericin B is most effective antifungal with manageable side effects. Patients who underwent Radical debridement either endoscopically or open approach, had better outcome with minimal recurrence rates. Combined medical and surgical treatment has better outcome, lesser recurrence and mortality.
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117
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Al-Ani RM, Al Tameemi KM. COVID-19-related Rhino-orbital-cerebral Mucormycosis. Qatar Med J 2022; 2022:47. [PMID: 36258686 PMCID: PMC9574569 DOI: 10.5339/qmj.2022.47] [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: 05/31/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background: There is an increasing number of COVID-19-related Rhino-orbital-cerebral mucormycosis (ROCM), especially from India. Objectives: To evaluate the demographic, clinical, radiological, and outcome of the COVID-19-related ROCM cases in a single center. Materials and Methods: The medical records of the patients with COVID-19-related ROCM were retrospectively reviewed. The study covered 22 months duration from March 2020 to December 2021 in Imam Hussain Medical City, Karbala city, Iraq. Results: Of the 14 patients with COVID-19-related ROCM, there were 71.4% males with a male-to-female ratio of 2.5:1. The median age was 61 years (age range: 27-80 years). There were 42.9% of patients with a history of being a current smoker. All patients had a history of DM, and 57.1% of patients had a history of hypertension. All patients were without a history of the previous episode of COVID-19 or taking the vaccine. The median duration from the COVID-19 diagnosis to the diagnosis of ROCM was 19 days (duration range of 10-40 days). Most of the cases were of severe type (57.1%). All of the patients were taking corticosteroid and oxygen therapy. Nasal obstruction, nasal discharge, cheek swelling, and necrotic tissue were clinical features in all patients. The majority of the cases were on the left side (71.4%). Stage 3 was found in 42.9%. Amphotericin B was used for all patients and surgical debridement in 13 cases. Five patients have died (35.7%). Conclusion: COVID-19-related ROCM is an aggressive disease associated with a high mortality rate of 35.7%. Early diagnosis and on-time initiation of treatment are recommended to get the best outcome.
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Affiliation(s)
- Raid M. Al-Ani
- College of Medicine, University of Anbar, Anbar, Iraq ,E-mail:
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118
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Vidhyadevi R, Saudhamini S, Padmanaban S, Sundar D, Kannappan S, Suryaprabha G. Association of Risk Factors among Nasal and Orbital Mucormycosis in Coronavirus Disease 2019 Infection: A Cross-Sectional Study. J Curr Ophthalmol 2022; 34:460-464. [PMID: 37180537 PMCID: PMC10170986 DOI: 10.4103/joco.joco_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To study the risk factors of mucormycosis and analyze their association among nasal and orbital mucormycosis in Coronavirus disease 2019 (COVID-19) infection. Methods All patients diagnosed of rhino-orbito-cerebral mucormycosis (ROCM) with previous COVID-19 infection were included in the study. The details such as age, sex, presence of co-morbidities, and serum ferritin levels were collected. ROCM patients were classified into two groups, nasal mucormycosis (stage 1 and 2 of ROCM) and orbital mucormycosis (stage 3 and 4 of ROCM), and data were collected. Duration of COVID-19 symptoms, the time interval between COVID-19 infection and onset of ROCM symptoms, computed tomography severity score (CTSS) and usage of steroids were collected accordingly. The collected data were compared between nasal group and orbital group. Results Among 52 patients, 15 patients had nasal and 37 patients had orbital mucormycosis. Forty-one patients were more than 40 years, 43 patients were males. Seven out of ten risk factors were found to be significant on comparing nasal and orbital group. Patients of age more than 40 years (P = 0.034), elderly diabetics (P = 0.014), poor control of diabetes (P = 0.003), high serum ferritin levels (P = 0.043), duration between COVID-19 and mucormycosis of more than 20 days (P = 0.038), CTSS of more than 9/25 (P = 0.020), and steroid usage during COVID-19 infection (P = 0.034) are prone to develop orbital mucormycosis. On multivariate logistic regression analysis, these variables did not emerge as independent risk factors. Conclusions Patients with severe COVID-19 infection along with other associated risk factors can be prone to develop severe forms of mucormycosis. We did not find them to be statistically significant on multivariate analysis. In the future, large scale studies are needed to know their significance.
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Affiliation(s)
- Ramasamy Vidhyadevi
- Department of Ophthalmology, PSGIMSR, Coimbatore, Tamil Nadu, India
- Address for correspondence: Ramasamy Vidhyadevi, Department of Ophthalmology, PSGIMSR, Coimbatore - 641 004, Tamil Nadu, India. E-mail:
| | - S. Saudhamini
- Department of Ophthalmology, PSGIMSR, Coimbatore, Tamil Nadu, India
| | | | | | - Suvetha Kannappan
- Department of Community Medicine, PSGIMSR, Coimbatore, Tamil Nadu, India
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Sulena S, Dhawan M, Singh N, Arora H, Singh G, Aggarwal V, Tapasvi C. Clinicoradiological profile and outcome of cavernous sinus syndrome with coronavirus disease-2019-associated rhino-orbito-cerebral mucormycosis. J Neurosci Rural Pract 2022; 13:730-739. [PMID: 36743739 PMCID: PMC9894018 DOI: 10.25259/jnrp-2022-2-29] [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: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along with comparative analysis of CSS negative COVID-19-associated ROCM. Material and Method This was a prospective and observational study conducted from May 1, 2021, to July 31, 2021. Subjects included ROCM with active or recovered COVID-19 (past 6 weeks) and were categorized and staged. CSS was defined as involvement of two or more of third, fourth, fifth, or sixth cranial nerve with one each direct and indirect qualitative neuroradiological features. Clinicoradiological features of CSS-positive and negative COVID-19-associated ROCM groups were compared. Results Incidence of CSS with COVID-19-associated ROCM was 28%. Mean age of subjects was 44 ± 15 years with 60% being males and 73% were proven ROCM. Significant differences seen across the CSS-positive and negative groups were ocular, nasal, and cerebral findings including eyelid and periocular discoloration, ptosis, proptosis, ophthalmoplegia, nasal discharge, mucosal inflammation, and fever. Oculomotor, trochlear, and abducens nerves were significantly involved more in CSS-positive group. Significant radiological findings across two groups included indirect features in orbit, nose, and paranasal sinuses along with direct features in cavernous sinus. Surgical intervention was more common in CSS-positive group. Mortality in CSS-positive group at 8-24 weeks was 13 and 27%, respectively. Conclusion Extension of ROCM to CSS was more common in young males in advanced stages of proven ROCM with concurrent COVID-19. CSS-positive group had significant difference in clinicoradiological features involving orbit, nose, paranasal sinuses, and central nervous system as compared to CSS-negative group. This study highlights the need to develop an objective scoring system considering clinical and radiological features for diagnosis of CSS with COVID-19-associated ROCM.
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Affiliation(s)
- Sulena Sulena
- Department of Neurology, Guru Gobind Singh Medical College, Faridkot, India
| | - Munish Dhawan
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Navchint Singh
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Hobinder Arora
- Department of Community Medicine, Guru Gobind Singh Medical College, Faridkot, India
| | - Gurbax Singh
- Department of ENT, Guru Gobind Singh Medical College, Faridkot, India
| | - Varun Aggarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bathinda, India
| | - Chaitanya Tapasvi
- Department of Radiodiagnosis, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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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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Shastri M, Raval DM, Patel D, Patel AB, Chopra A, Rathod VM, Dobariya R, Patel NS, Patel NH, Patel A, Gohel DM. Mucormycosis, Diabetes and COVID-19 Pneumonia: Unleashing the Facts. Cureus 2022; 14:e29555. [PMID: 36312629 PMCID: PMC9595072 DOI: 10.7759/cureus.29555] [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: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mucormycosis (MM) is an angioinvasive locally destructive fungal infection. Before the coronavirus disease 2019 (COVID-19) pandemic, it was associated with diabetes (particularly diabetic ketoacidosis), immunosuppressive drugs and trauma. Among its various forms, cerebral invasion is considered to be highly fatal even if with long-term treatment. Treatment with injection amphotericin B (Amph-B) with early surgical interventions is highly efficacious. Liposomal preparation is considered to be superior in the context of fewer side effects. Methods We present a single-centre prospective study of 124 patients with MM in a tertiary care hospital. After the approval from the ethics committee, basic information was taken from all patients including all available past history about the COVID-19 infection and treatment. The studied outcomes were discharge, death and number of days of hospitalisation. Secondary objectives were to estimate the association of MM with known risk factors, to find the association of an outcome with various inflammatory markers, to determine adverse events with the use of injection Amph-B and posaconazole and to find the case fatality rate of MM. Results In our study, we observed that the number of patients with MM was double in the less than 60 years age group. However, mortality was 33.3% in the elderly as compared to 15.29% in patients less than 60 years of age. The majority of the patients (69.35%) were males, but no significant difference in mortality was seen between males and females. The case fatality rate was 20.97%. Ocular symptoms such as orbital swelling and pain were the common presenting symptoms. Almost all patients (93.54%) were diabetics. The non-diabetic group consisted of only 8 (6.4%) patients, and therefore, the comparison was not possible. A total of 20 (16%) out of 124 patients who had received high-dose steroids showed higher mortality (55%). Maximum patients (65.32%) had presented with MM following a past COVID-19 infection. However, a significant number of MM patients (20.96%) had a recent COVID infection and had higher mortality (57.69%) compared to their counterparts. The most common site of involvement in our study was the paranasal sinus (50%) and the outcome was the best in those patients whose disease was localised only to the sinuses, although among 14 (11.29%) patients with cerebral involvement, mortality was maximum (42.85%). Renal impairment and dyselectrolytemia were the most common adverse effects of Amph-B, and 46.42% of patients required surgical removal of the local part. Conclusion We saw that diabetes was a major contributory factor in the etiopathogenesis of MM. COVID-19 could also be a major causative factor by impairing the immune system; however, further studies at the molecular level are required to establish an association. The use of steroid cannot be the only independent risk factor, and other associated factors must be present. Treatment with antifungal and early surgical intervention had good outcomes. Treatment with conventional lyophilized Amph-B was equally efficacious as lipid-based solutions, but with more side effects. Hypokalemia and hypocalcemia were the most common electrolyte abnormalities associated with the use of injection Amph-B. Uncontrolled diabetes, the severity of the COVID-19 infection at presentation, acidosis, a high C-reactive protein level (above 100) and local brain involvement were associated with a poor outcome.
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Gupta V, Yadav A, Chilkoti GT, Mohta M, Meena RK. Predictors of Postoperative ICU Admission in Patients With COVID-19-Associated Mucormycosis. Cureus 2022; 14:e29543. [PMID: 36312617 PMCID: PMC9592563 DOI: 10.7759/cureus.29543] [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: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Studies exploring factors predicting postoperative ICU requirement in patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) were not found in the literature. The aim was to evaluate the demographic profile, comorbidities, pattern of steroid received, airway assessment, and intraoperative hemodynamic perturbations associated with ICU requirement amongst patients scheduled for sinonasal debridement. Methods: This is a retrospective cohort study. All CAM patients of ≥18 years were included. The patients’ characteristics, comorbidities, pattern of steroid received, airway assessment, intraoperative hemodynamic perturbations, and outcome data were retrieved. Results: A total of 130 patients were included. Thirty got admitted to ICU, out of which 26 expired. Amongst the various comorbidities, diabetes was the most common (93.85%) and was associated with higher chances of ICU requirement. Of patients with a history of steroid intake, 71% had a significantly higher risk of ICU admission. Out of 30 patients admitted to ICU, 87% (n=26) received invasive ventilation, and the rest were admitted for observation only. Conclusion: Middle age, uncontrolled diabetes, history of steroid intake, increased levels of serum creatinine with low potassium, and increased total leucocyte count are the independent risk factors predicting postoperative ICU admission amongst patients with CAM scheduled for sinonasal debridement.
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Singhal P, Rawat A, Sharma S, Sharma AK, Jat KS, Agarwal S, Samdani S, Agarwal S, Sharma MP, Bhandari S. Invasive Fungal Infections in Dengue Recovered Patients: A New Phenomenon in the Covid-19 Era. Indian J Otolaryngol Head Neck Surg 2022; 74:3321-3326. [PMID: 36090297 PMCID: PMC9441130 DOI: 10.1007/s12070-022-03152-8] [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] [Received: 02/14/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
Invasive fungal rhinosinusitis was seen to rise to epidemic levels after the 2nd wave of ongoing Covid pandemic, especially in tropical countries, maximally in India. A similar trend is being observed for cases who have recently recovered from dengue virus infection. Post dengue invasive fungal infection is a new presentation and any associations between it and Covid pandemic need to be studied in detail to help prepare for any complications. 3 patients presented to the out-patient department of E.N.T at a tertiary level teaching hospital in East India with complains similar to rhinosinusitis. These patients were then evaluated and diagnosed to be infected from Mucormycosis and Aspergillosis fungal sinusitis after which they were managed with surgical debridement and systemic antifungal therapy. All had a recent history of recovery from Dengue virus infection and a possible association could be suspected. 3 patients presented with complains of pain over upper jaw with orbital swelling and loss of vision developing over a period of 24 days. Two of them had ulceration of hard palate. They were then subjected to Contrast MRI along with CT scan of the Paranasal sinuses which depicted pansinus involvement with intracranial extension in two patients. These were then planned for diagnostic nasal endoscopies along with biopsies which turned out to be Invasive fungal sinusitis in the form of Aspergillosis and Mucormycosis. All the 3 patients had recent history of recovery from Dengue virus infection and did not have any other co-morbidities. Covid Associated Mucormycosis (CAM) is a well-known entity now but no reports of Dengue associated Invasive fungal sinusitis are yet reported. Whether this new phenomenon has anything to do with the interactions between dengue virus and coronavirus is not known at present and needs to be studied in detail so appropriate management protocols can be formulated.
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Affiliation(s)
- Pawan Singhal
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Anshu Rawat
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Shivam Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Anjani Kumar Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Kailash Singh Jat
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Shubham Agarwal
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sunil Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sunita Agarwal
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Man Prakash Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sudheer Bhandari
- Department of Internal Medicine, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
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Ghosh AK, Singh R, Reddy S, Singh S, Rudramurthy SM, Kaur H, Choudhary H, Chakrabarti A. Evaluation of environmental Mucorales contamination in and around the residence of COVID-19-associated mucormycosis patients. Front Cell Infect Microbiol 2022; 12:953750. [PMID: 36118044 PMCID: PMC9478190 DOI: 10.3389/fcimb.2022.953750] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionRecently, India witnessed an unprecedented surge of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) cases. In addition to patient management issues, environmental Mucorales contamination possibly contributed to the outbreak. A recent study evaluated environment contamination by Mucorales in the hospital setting. However, a considerable number of CAM patients were never admitted to a hospital before the development of the disease. The present study, therefore, planned to evaluate Mucorales contamination of patients’ residences.MethodsThe residential environment of 25 patients with CAM living in north India was surveyed. Air samples were collected from indoor and immediate outdoor vicinity of the patients’ residence and cultured on Dichloran Rose–Bengal Chloramphenicol (DRBC) agar with benomyl for selective isolation of Mucorales. Surface swab samples were also collected from the air coolers fitted in those residences and cultured on DRBC agar. The isolates were identified by phenotypic and genotypic methods. Amplified fragment length polymorphism (AFLP) was employed to evaluate the genetic relatedness of the environmental and patients’ clinical isolates.ResultsThe median spore count (mean ± SD, cfu/m3) of Mucorales in the air of patients’ bedrooms was significantly higher than in the air in other rooms in those residences (3.55 versus 1.5, p = 0.003) or the air collected directly from the front of the air cooler (p < 0.0001). The Mucorales spore count in the environment did not correlate with either ventilation of the room or hygiene level of the patients’ residences. Rhizopus arrhizus was isolated from the environment of all patients’ residences (n = 25); other Mucorales species isolated were Cunninghamella bertholletiae (n = 14), Rhizopus microsporus (n = 6), Rhizopus delemar (n = 6), Syncephalastrum racemosum (n = 1), Lichtheimia corymbifera (n = 1), and Mucor racemosus (n = 1). Genetic relatedness was observed between 11 environmental isolates from the patients’ bedrooms and respective clinical isolates from patients.DiscussionThe study supported the view that the patients might have acquired Mucorales from the home environment during the post-COVID-19 convalescence period. Universal masking at home during patients’ convalescence period and environmental decontamination could minimize exposure in those susceptible patients.
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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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A Role of Black Fungus in COVID-19: A Review. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mucormycosis is a rare type of fungal infection commonly known as zygomycosis, the infection tends to crop up more commonly in individuals with low and weakened immunity level, if left untreated, the mucormycosis can be life-threatening and fatal. Mucormycosis previously known as zygomycosis is a consequential type of infection caused by several mildews known as micromycetes. The revised taxonomical studies revealed that the micromycetes causing the infections are classified as the species of phylum Glomeromycota, class Glomeromycetes, subphylum Mucoromycotina, order Mucorales. The genera of Rhizopus, Mucor, Lichtheimia, Cunninghamella, Rhizomucor, and Apophysomyces, constitute the causative agents of the majority of cases of mucormycosis. The angioinvasive type of disorder caused by mucormycosis is further classified as Mucorales. The patients with Diabetes ketoacidosis and diabetes mellitus are at high-risk factors, followed by the patients with organ transplant, immunocompromised disease, and malignancy. The route of exposure to Mucormycosis may be through the wounded infection that can be pneumonic, or dermal in origin. In the ectodermal form, the fungal organism can invade the skin through open or puncture wounds, or the laceration on the skin. However, the infection has a high mortality rate, the key to successful treatment is early diagnosis, and administration of antifungal drugs, with extensive therapy, followed by surgical debridement of the infection. The morbidity and mortality rate are still at a high number, due to the negligence of the patient to seek medical treatment. Hence the early diagnosis and treatment with antifungal drugs with surgical debridement is a must. The efficacy of oral and venous formulations in the treatment of mucorales is still under debate. Despite the aggressive therapy, the mortality rate is increasing worldwide. The studies have to be conducted to invent the fastest treatment protocol for the treatment of Mucormycosis.
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Gupta N, Srinivas S, Harikumar A, Devaraja K, Nallapati VT, Saravu K. Deoxycholate amphotericin for management of mucormycosis: a retrospective cohort study from South India. LE INFEZIONI IN MEDICINA 2022; 30:432-439. [PMID: 36148169 PMCID: PMC9448307 DOI: 10.53854/liim-3003-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis. METHODOLOGY This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained. RESULTS Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients. CONCLUSION Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sourabh Srinivas
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anagha Harikumar
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vishnu Teja Nallapati
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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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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Ghasemi S, Dashti M, Fahimipour A, Daryakenari G, Mirzaei F, Akbari F, Khurshid Z. Onset of Mucormycosis in Patients with COVID-19: A Systematic Review on Patients' Characteristics. Eur J Dent 2022; 17:24-38. [PMID: 36049777 PMCID: PMC9949939 DOI: 10.1055/s-0042-1751003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Mucormycosis has a significant impact on patients' standard of living and, therefore, a high clinical suspicion, prediagnosis, and rapid treatment are critical in easing patients' suffering and fast recovery. Our focus is to conduct an organized review based on various variables on the patients' characteristics having mucormycosis in severe novel coronavirus disease 2019 (COVID-19). We examined Embase, PubMed-Medline, LitCovid, Web of Science, Scopus, and the reference lists of included case reports up to September 20, 2021, using the Medical Subject Heading (MeSH) phrases and other keywords related to this topic. Subsequently, we investigated associated comorbidities, patient characteristics, position of mucormycosis, steroids use, body involvements, and outcomes. Overall, 77 studies were conducted and among these, 72 studies mentioned that the patients' age to be 48.13±14.33 (mean±standard deviation [SD]) years. Diabetes mellitus (DM) was reported in 77.9% (n=60) of cases. Studies showed that central nervous system (CNS) and bone involvement were reported in 62.3 (n=48) and 53.2% (n=41), respectively. More fatalities were observed in patients with mucormycosis with the active form of COVID-19. Also, men infected with mucormycosis significantly affected by COVID-19. In the end, mortality was higher in males with mucormycosis. As a result, a solid investigation into the root cause of mucormycosis, especially in COVID-19, should be included in the study plan. If the patient is COVID-19-positive and immunosuppressed, this opportunistic pathogen diagnostic test should not be overlooked.
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Affiliation(s)
- Shohreh Ghasemi
- Department of Oral and Maxillofacial Surgery, The Dental College of Georgia at Augusta University, Augusta, GA, USA,Department of Craniofacial Reconstruction and Trauma Queen Marry, University of London, London, UK
| | - Mahmood Dashti
- Department of Orthodontics, Georgia School of Orthodontics, Atlanta, Georgia, USA,Address for correspondence Mahmood Dashti, DDS Department of Orthodontics, Georgia School of OrthodonticsAtlanta, GeorgiaUSA
| | - Amir Fahimipour
- Department of Oral Surgery, Medicine and Diagnostics, School of Dentistry, Faculty of Medicine and Health, Westmead Centre for Oral Health, The University of Sydney, Sydney, Australia
| | - Ghazaleh Daryakenari
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Mirzaei
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Akbari
- Department of Dentistry, Mazandaran University of Medical Science, Mazandaran, Iran
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
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Chakravarty J, Gupta MK, Tilak R, Kumar R, Maurya RP, Kumar N, Aggarwal SK, S S, Sharma NK, Dhiman NK, Chaubey M, Singh V, Verma A, Banerjee T, Agrawal NK, Prasad RS. COVID-19-associated Mucormycosis: A clinico-epidemiological study. J Diabetes Complications 2022; 36:108284. [PMID: 35987108 PMCID: PMC9374498 DOI: 10.1016/j.jdiacomp.2022.108284] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND There was an unprecedented increase in COVID-19-associated-Mucormycosis (CAM) cases during the second pandemic wave in India. METHODS This observational study was done to know the epidemiological profile of CAM cases andincluded all patients admitted with mucormycosis between May 2021 and July 2021. RESULTS Out of the enrolled 208 CAM cases (either SARS-CoV-2 RT-PCR or serology positive), 204, three and one had rhino-orbital-cerebral, pulmonary and gastrointestinal mucormycosis, respectively. 95.7 % of the patients had diabetes, out of which 42.3 % were recently diagnosed. Mean HbA1c was 10.16 ± 2.56 %. 82.5 % of the patients were unvaccinated. During their COVID-19 illness, 86.5 % were prescribed antibiotics, 84.6 % zinc preparations, 76.4 % ivermectin, and 64.9 % steroids, while only 39.5 % required oxygen therapy. The frequency of blood groups A, B, O and AB in our CAM patients was 29.5 %, 18.9 %, 38.9 % &12.6 %, respectively. At three months follow up, 60 (28.8 %) patients died, four (1.9 %) stopped antifungal treatment, and 144(69.23 %) were on antifungal treatment. 55 % (n = 33) of deaths occurred within 15 days of admission. Mortality was significantly associated with higher age, RT-PCR positive for SARS-CoV-2, raised serum creatinine and alkaline phosphatase during treatment. At 6 months follow-up, eight more patients died, three due to chronic kidney disease, four patients who had stopped treatment and one patient who was on a ventilator due to COVID-19 associated pneumonia and the rest 140(67.3 %) survived. CONCLUSION Uncontrolled hyperglycemia, SARS-CoV-2 infection, rampant use of antibiotics, zinc supplementation and steroids were some of the risk factors for mucormycosis. Despite the overwhelming number of patients with an uncommon disease like mucormycosis, the six months mortality was much lower than expected.
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Affiliation(s)
| | | | - Ragini Tilak
- Department of Microbiology, IMS BHU, Varanasi, India
| | - Rajesh Kumar
- Department of Otorhinolaryngology, IMS BHU, Varanasi, India
| | | | - Nilesh Kumar
- Department of General Medicine, IMS BHU, Varanasi, India
| | | | - Siva S
- Department of Otorhinolaryngology, IMS BHU, Varanasi, India
| | | | | | | | | | - Ashish Verma
- Department of Radiodiagnosis, IMS BHU, Varanasi, India
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Mittal A, Mahajan N, Pal Singh Dhanota D, Paul BS, Ahluwalia S, Ahluwalia S, Galhotra A, Gupta V, Puri S, Verma R, Munjal M, Goel S, Chopra S, Mahajan R, Ahluwalia A, Saggar K, Singh G. SARS-CoV-19-associated Rhino-orbital and cerebral Mucormycosis: Clinical and Radiological Presentations. Med Mycol 2022; 60:6677975. [PMID: 36029277 PMCID: PMC9494327 DOI: 10.1093/mmy/myac045] [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: 03/11/2022] [Revised: 06/06/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.
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Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitika Mahajan
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Devinder Pal Singh Dhanota
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Srishti Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Saumya Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arnav Galhotra
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjeev Puri
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rohit Verma
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manish Munjal
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sahil Goel
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumeet Chopra
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajesh Mahajan
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, Queen Square Institute of Neurology, London, UK
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Mina S, Yaakoub H, Annweiler C, Dubée V, Papon N. COVID-19 and Fungal Infections: A Double Debacle. Microbes Infect 2022; 24:105039. [PMID: 36030024 PMCID: PMC9400371 DOI: 10.1016/j.micinf.2022.105039] [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: 03/17/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
Fungal infections remain hardly treatable because of unstandardized diagnostic tests, limited antifungal armamentarium, and more specifically, potential toxic interactions between antifungals and immunosuppressants used during anti-inflammatory therapies, such as those set up in critically ill COVID-19 patients. Taking into account pre-existing difficulties in treating vulnerable COVID-19 patients, any co-occurrence of infectious diseases like fungal infections constitutes a double debacle for patients, healthcare experts, and the public economy. Since the first appearance of SARS-CoV-2, a significant rise in threatening fungal co-infections in COVID-19 patients has been testified in the scientific literature. Better management of fungal infections in COVID-19 patients is, therefore, a priority and requires highlighting common risk factors, relationships with immunosuppression, as well as challenges in fungal diagnosis and treatment. The present review attempts to highlight these aspects in the three most identified causative agents of fungal co-infections in COVID-19 patients: Aspergillus, Candida, and Mucorales species.
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Affiliation(s)
- Sara Mina
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.
| | - Hajar Yaakoub
- Univ Angers, Univ Brest, IRF, SFR ICAT, F-49000, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France; Univ Angers, Université de Nantes, LPPL, SFR CONFLUENCES, F-49000 Angers, France
| | - Vincent Dubée
- Univ Angers, Université de Nantes, Inserm, CRCINA, INCIT, SFR ICAT, F-49000 Angers, France; Infectious Diseases Department, Angers University Hospital, Angers, France
| | - Nicolas Papon
- Univ Angers, Univ Brest, IRF, SFR ICAT, F-49000, Angers, 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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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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Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India. PLoS One 2022; 17:e0272042. [PMID: 35939442 PMCID: PMC9359565 DOI: 10.1371/journal.pone.0272042] [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: 01/14/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India.
Methods
We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model.
Results
Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45–59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM.
Conclusions
Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.
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136
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Das AK, Mani SK, Singh SK. Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center. Surg Neurol Int 2022; 13:335. [PMID: 36128146 PMCID: PMC9479606 DOI: 10.25259/sni_374_2022] [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: 04/23/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations. Methods: This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken. Results: Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach. Conclusion: In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.
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Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AAR, Kumar RV, Kumar S, Manusrut M, Kumar SCR, Rathod R, Babu DM, Gonuguntla HK, Yedlapati GK, Mallu GR, Reddy YS, Reddy VV, Alwala S, Bongu VK, Kamalesh A, Kumar RNK, Jaishetwar GS, Bagapally RS, Srinivas JS, Balasubramaniam A, Rajagopalan BK, Pullikanti B, Prakasham SP, Nimmala P, Nagaraju B, Sahoo PR. COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection 2022; 51:407-416. [PMID: 35922704 PMCID: PMC9362592 DOI: 10.1007/s15010-022-01891-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
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Affiliation(s)
- Monalisa Sahu
- Department of Infectious Diseases, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India.
| | - Milap Shah
- Department of Pathology, Yashoda Hospital, Hyderabad, India
| | | | - Venkat Raman Kola
- Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | - R Vijay Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Sairaj Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Manusrut Manusrut
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - S Ch Raghu Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Rajkumar Rathod
- Department of Laboratory and Transfusion Medicine, Yashoda Hospital, Hyderabad, 500003, India
| | - Dilip M Babu
- Department of Nephrology, Yashoda Hospital Somajiguda, Hyderabad, 500028, India
| | | | | | | | - Y Sai Reddy
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Vedire Vishnu Reddy
- Department of Anaesthesia, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Surendar Alwala
- Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | - A Kamalesh
- Department of Medicine, Yashoda Hospital, Hyderabad, India
| | - R N Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Ganesh S Jaishetwar
- Department of Hematology and BMT, Yashoda Hospital, Somajiguda, Hyderabad, 500082, India
| | - Ravi Shankar Bagapally
- Department of Gastroenterology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Jammula S Srinivas
- Department of Plastic and Cosmetic Surgery, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | | | | | - Pavani Nimmala
- Department of Microbiology, Yashoda Hospital, Hyderabad, India
| | - Barla Nagaraju
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Pradipt R Sahoo
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
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Abstract
Coronavirus disease 2019 (COVID-19)-associated invasive fungal infections are an important complication in a substantial number of critically ill, hospitalized patients with COVID-19. Three groups of fungal pathogens cause co-infections in COVID-19: Aspergillus, Mucorales and Candida species, including Candida auris. Here we review the incidence of COVID-19-associated invasive fungal infections caused by these fungi in low-, middle- and high-income countries. By evaluating the epidemiology, clinical risk factors, predisposing features of the host environment and immunological mechanisms that underlie the pathogenesis of these co-infections, we set the scene for future research and development of clinical guidance. Hoenigl and colleagues review the epidemiology, immunology and clinical risk factors contributing to COVID-19-associated fungal infections.
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139
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Balushi AA, Ajmi AA, Sinani QA, Menon V, Berieki ZA, Shezawi AA, Azri SA, Rashdi AA, Jardani AA, Baluki TA, Ghaithi SA, Reesi AA, Al-Za'abi AT, Al’ Balushi MA, Maqbali TA. COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review. Int J Infect Dis 2022; 121:203-210. [PMID: 35533833 PMCID: PMC9075983 DOI: 10.1016/j.ijid.2022.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. METHODS We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. RESULTS The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). CONCLUSION Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.
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Affiliation(s)
- Asma Al Balushi
- Infectious Diseases Unit, Internal Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman,Corresponding author: Asma Al Balushi: Address: Infectious Diseases Unit, Internal Medicine Department, Sultan Qaboos University Hospital, Muscat, Seeb, Alkhoudh, P. O. Box 35, Postal Code 123, Oman. Mobile number: (+968) 92319222
| | - Ahmed Al Ajmi
- Oral and Maxillofacial Surgery Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Qais Al Sinani
- Ear, Nose and Throat Surgical Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Varna Menon
- Histopathology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Zainab Al Berieki
- Radiology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Asma Al Shezawi
- Radiology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Saleh Al Azri
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Azza Al Rashdi
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Amina Al Jardani
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Thuwaiba Al Baluki
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Salem Al Ghaithi
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Ali Al Reesi
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | | | | | - Talib Al Maqbali
- Ear, Nose and Throat Surgical Department, Sohar Hospital, Ministry of Health, Sohar, Oman
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Chastain DB, Kung VM, Golpayegany S, Jackson BT, Franco-Paredes C, Vargas Barahona L, Thompson GR, Henao-Martínez AF. Cryptococcosis among hospitalised patients with COVID-19: A multicentre research network study. Mycoses 2022; 65:815-823. [PMID: 35657109 PMCID: PMC9348105 DOI: 10.1111/myc.13476] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
It is unclear if there is an association between COVID-19 and cryptococcosis. Therefore, this study aimed to describe the clinical features, risk factors, and outcomes associated with cryptococcosis in hospitalised patients with COVID-19. The objectives of this study were to determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID-19. We used TriNetX to identify and sort patients 18 years and older hospitalised with COVID-19 into two cohorts based on the presence or absence of a diagnosis of cryptococcosis following diagnosis of COVID-19. Outcomes of interest included the incidence of cryptococcosis following the diagnosis of COVID-19 as well as the proportion of patients in each group who had underlying comorbidities, received immunomodulatory therapy, required ICU admission or mechanical ventilation (MV), or died. Propensity score matching was used to adjust for confounding. Among 212,479 hospitalised patients with COVID-19, 65 developed cryptococcosis. The incidence of cryptococcosis following COVID-19 was 0.022%. Patients with cryptococcosis were more likely to be male and have underlying comorbidities. Among cases, 32% were people with HIV. Patients with cryptococcosis were more likely to have received tocilizumab (p < .0001) or baricitinib (p < .0001), but not dexamethasone (p = .0840). ICU admission (38% vs 29%), MV (23% vs 11%), and mortality (36% vs 14%) were significantly higher among patients with cryptococcosis. Mortality remained elevated after adjusted propensity score matching. Cryptococcosis occurred most often in hospitalised patients with COVID-19 who had traditional risk factors, comparable to findings in patients without COVID-19. Cryptococcosis was associated with increased ICU admission, MV, and mortality.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Vanessa M Kung
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Sahand Golpayegany
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Brittany T Jackson
- Department of Pharmacy, The Mount Sinai Hospital, New York, New York, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
- Hospital Infantil de México, México City, Mexico
| | | | - George R Thompson
- Department of Medicine, Division of Infectious Diseases, Davis Medical Center, University of California, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, Davis Medical Center, University of California, Sacramento, California, USA
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141
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Niyazi D, Toncheva B, Tonchev T, Dzhenkov D, Kalchev K, Stoeva T. First report of rhino-orbital-cerebral mucormycosis after COVID-19 infection in Bulgaria. Future Microbiol 2022; 17:1107-1113. [PMID: 35899489 PMCID: PMC9332908 DOI: 10.2217/fmb-2022-0030] [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] [Indexed: 12/02/2022] Open
Abstract
Mucormycosis is a relatively rare infection but with a high mortality rate due to the difficult and time-consuming diagnostic and therapeutic process. The authors present the first case of rhino-orbital-cerebral mucormycosis, histologically and microbiologically proven, in a patient after COVID-19 infection in Bulgaria.
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Affiliation(s)
- Denis Niyazi
- Laboratory of Clinical Microbiology, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
| | - Borislava Toncheva
- Maxillofacial Surgery Clinic, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
| | - Tsvetan Tonchev
- Maxillofacial Surgery Clinic, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
| | - Deyan Dzhenkov
- General & clinical pathology clinic, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
| | - Kalin Kalchev
- General & clinical pathology clinic, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
| | - Temenuga Stoeva
- Laboratory of Clinical Microbiology, University Hospital 'St. Marina', Varna, Bulgaria.,Medical University, Varna, Bulgaria
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142
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Saneesh PS, Morampudi SC, Yelamanchi R. Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience. World J Radiol 2022; 14:209-218. [PMID: 36160626 PMCID: PMC9350613 DOI: 10.4329/wjr.v14.i7.209] [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: 03/28/2022] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 02/06/2023] Open
Abstract
Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.
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Affiliation(s)
- P S Saneesh
- Department of Radiology, Aster MIMS, Kannur 670007, Kerala, India
| | - Satya Chowdary Morampudi
- Department of Radiodiagnosis, Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram 521101, Andhra Pradesh, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, Delhi, India
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143
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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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144
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Sharma R, Kumar P, Rauf A, Chaudhary A, Prajapati PK, Emran TB, Gonçalves Lima CM, Conte-Junior CA. Mucormycosis in the COVID-19 Environment: A Multifaceted Complication. Front Cell Infect Microbiol 2022; 12:937481. [PMID: 35923801 PMCID: PMC9339637 DOI: 10.3389/fcimb.2022.937481] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
The second wave of coronavirus disease 2019 (COVID-19) caused severe infections with high mortality. An increase in the cases of COVID-19-associated mucormycosis (CAM) was reported predominantly in India. Commonly present in immunocompromised individuals, mucormycosis is often a life-threatening condition. Confounding factors and molecular mechanisms associated with CAM are still not well understood, and there is a need for careful research in this direction. In this review, a brief account of the diagnosis, management, and advancement in drug discovery for mucormycosis has been provided. Here, we summarize major factors that dictate the occurrence of mucormycosis in COVID-19 patients through the analysis of published literature and case reports. Major predisposing factors to mucormycosis appear to be uncontrolled diabetes, steroid therapy, and certain cancers. At the molecular level, increased levels of iron in COVID-19 might contribute to mucormycosis. We have also discussed the potential role and regulation of iron metabolism in COVID-19 patients in establishing fungal growth. Other factors including diabetes prevalence and fungal spore burden in India as contributing factors have also been discussed.
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Affiliation(s)
- Rohit Sharma
- Department of Rasa shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
- *Correspondence: Rohit Sharma, ; ; Praveen Kumar, ; ; Carlos Adam Conte-Junior,
| | - Praveen Kumar
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
- *Correspondence: Rohit Sharma, ; ; Praveen Kumar, ; ; Carlos Adam Conte-Junior,
| | - Abdur Rauf
- Department of Chemistry, University of Swabi, Swabi, Pakistan
| | - Ashun Chaudhary
- Department of Plant Science (Botany), Central University of Himachal Pradesh, Dharamshala, India
| | - Pradeep Kumar Prajapati
- Department of Rasashastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | | | - Carlos Adam Conte-Junior
- Center for Food Analysis (NAL), Technological Development Support Laboratory (LADETEC), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil
- *Correspondence: Rohit Sharma, ; ; Praveen Kumar, ; ; Carlos Adam Conte-Junior,
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145
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Nazari T, Sadeghi F, Izadi A, Sameni S, Mahmoudi S. COVID-19-associated fungal infections in Iran: A systematic review. PLoS One 2022; 17:e0271333. [PMID: 35816494 PMCID: PMC9273100 DOI: 10.1371/journal.pone.0271333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives
This systematic review aims to summarize the mycological and clinical features of COVID-19-associated fungal infections (CAFIs) in Iran.
Methods
PubMed, Web of Science, Scopus, Cochrane Library, SID, Magiran, IranDoc, and Google Scholar were searched for Persian and English articles published from January 1, 2020, to November 5, 2021, using a systematic search strategy. Studies on Iranian patients suffering from CAFIs were included in the review.
Results
Twenty-two studies comprising 169 patients were retrieved. Reported CAFIs included candidiasis (85, 50.30%), mucormycosis (35, 20.71%), aspergillosis (29, 17.16%), fusariosis (6, 3.55%), three cases caused by rare pathogens (Rhodotorula mucilaginosa, Diaporthe foeniculina, and Sarocladium kiliense) and 11 (6.51%) uncharacterized mold infections. The most common underlying diseases were diabetes (67/168, 39.88%), cardiovascular diseases (55/168, 32.74%), and hypertension (43/168, 25.59%). The use of antibiotics (111/124, 89.52%), corticosteroids (93/132, 70.44%), and mechanical ventilation (66, 51.16%) were the most common predisposing factors. Totally, 72 (50.35%) of 143 patients with CAFIs died (data were not available for 26 patients).
Conclusion
Fungal infections are evident to be a complication of COVID-19 in Iran; thus, clinicians should consider them as a differential diagnosis, especially in patients with comorbidities and previous antibiotic or corticosteroid use.
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Affiliation(s)
- Tina Nazari
- Department of Medical Geriatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadeghi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Izadi
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Setayesh Sameni
- Department of Medical Sciences, Shahrood Branch, Islamic Azad University, Shahrood, Iran
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: ,
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146
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Weller JM, Messmer E. Focus on Ophthalmopathology - Orbital Infections from Hordeolum to Necrotizing Fasciitis. Klin Monbl Augenheilkd 2022; 239:886-893. [PMID: 35858598 DOI: 10.1055/a-1709-6152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.
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Affiliation(s)
- Julia M Weller
- Augenheilkunde, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Elisabeth Messmer
- Augenklinik, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Deutschland
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147
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Kumar S, Bhavana K, Kumar V, Kumar A, Mahto M. Endovascular Infusion of Amphotericin B for the Treatment of Rhino-Orbito-Cerebral Mucormycosis: A Pilot Study Assessing Technical Feasibility and Safety. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1757783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Objectives The aim of this study was to assess the technical feasibility and safety of intra-arterial infusion of amphotericin B for the management of rhino-orbito-cerebral mucormycosis in patients unable to receive full dose and schedule of intravenous amphotericin B and/or unsuitable for surgery.
Materials and Methods Five consecutive patients underwent five sessions of intra-arterial infusion each via both external carotid arteries on alternate days. Liposomal amphotericin B (50 mg) was infused at each session. The baseline and follow-up investigations as well as local and systemic complications were charted.
Results Procedure could be completed for all participants without any local complications. One patient had transient and another had progressive deterioration in renal parameters during the follow-up period of 30 days.
Conclusions Authors conducted successfully a pilot study of multisession intra-arterial infusion of amphotericin B, with the premise that it can provide high concentration of drug at the desired site with reduced systemic complications. They recommend further larger randomized studies to evaluate its efficacy for the management of advanced rhino-oculo-cerebral mucormycosis.
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Affiliation(s)
- Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kranti Bhavana
- Department of ENT, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Vijay Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Amarjeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Mala Mahto
- Department of Biochemistry, All India Institute of Medical Sciences, Patna, Bihar, India
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148
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MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis. Eur J Radiol 2022; 152:110341. [PMID: 35569303 PMCID: PMC9074238 DOI: 10.1016/j.ejrad.2022.110341] [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: 12/28/2021] [Revised: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 01/31/2023]
Abstract
In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.
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149
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Patel AK, Bakshi H, Shah K, Patel S, Patel T, Patel K, Patel KK. 'Risk factors for COVID-19 associated mucormycosis in India: A case control study.'. Med Mycol 2022; 60:6609445. [PMID: 35709394 PMCID: PMC9214138 DOI: 10.1093/mmy/myac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/11/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic had led to an increase surge of mucormycosis in COVID-19 patients, especially in India. Diabetes and irrational usage of corticosteroid to treat COVID-19 were some of the factors implicated for COVID-19 associated mucormycosis (CAM). We designed this case control study to identify risk factors for mucormycosis in COVID-19 patients. The study was conducted at a private tertiary care center in western India. Data was extracted from records of COVID 19 patients (Jan to May 2021) and divided into two groups: Those with proven or probable mucormycosis, and those without mucormycosis with a ratio of 1:3. A binary logistic regression analysis was done to assess potential risk factors for CAM. A total of 64 CAM and 205 controls were included in the analysis. Age and sex distribution were similar in cases and controls with the majority of males in both the groups (69.9%) and the mean age was 56.4 (±13.5) years. We compared the comorbidities and treatment received during acute COVID-19, specifically the place of admission, pharmacotherapy (steroids, tocilizumab, remdesivir), and requirement of oxygen as a risk factor for CAM. In a multivariate analysis, risk factors associated with increased odds of CAM were new-onset diabetes (v/s non-diabetics, adjusted OR 48.66, 95% CI 14.3-166), pre-existing diabetes (v/s Non-Diabetics, aOR 2.93, 95% CI 1.4-6.1), corticosteroid therapy (aOR 3.64, 95% CI 1.2-10.9) and home isolation (v/s Ward admission, aOR 4.8, 95% CI 2-11.3). Diabetes, especially new onset, along with corticosteroid usage and home isolation were the predominant risk factors for CAM.
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Affiliation(s)
- Atul K Patel
- Director, Infectious Diseases Department, Sterling Hospital, Ahmedabad, 380052, India
| | - Harsh Bakshi
- Assistant Professor, Dept of Community Medicine, GMERS Medical College Sola, Ahmedabad, India
| | - Kahaan Shah
- Intern Doctor, Department of Infectious diseases, Sterling Hospital, Ahmedabad, 380052, India
| | - Saloni Patel
- Medical Student, B J Medical College, Ahmedabad. 380016India
| | - Tushar Patel
- Consultant, Department of pulmonary and critical care medicine, Sterling Hospital, Ahmedabad, 380052, India
| | - Kamlesh Patel
- Director, Department of Microbiology, Sterling Hospital, Ahmedabad, India, 380052
| | - Ketan K Patel
- Consultant, Infectious Diseases Department, Sterling Hospital, Ahmedabad, 380052, India
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150
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Sarda R, Swain S, Ray A, Wig N. Response to: COVID-19-associated mucormycosis and evolving evidence. QJM 2022; 115:422. [PMID: 34264346 PMCID: PMC8344648 DOI: 10.1093/qjmed/hcab191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Sarda
- From the Department of Medicine, All India Institute
of Medical Sciences, Room no: 3070A, 3rd Floor Teaching
Block, Ansari Nagar, New Delhi 110029, India
| | - S Swain
- From the Department of Medicine, All India Institute
of Medical Sciences, Room no: 3070A, 3rd Floor Teaching
Block, Ansari Nagar, New Delhi 110029, India
| | - A Ray
- From the Department of Medicine, All India Institute
of Medical Sciences, Room no: 3070A, 3rd Floor Teaching
Block, Ansari Nagar, New Delhi 110029, India
- Address correspondence to Dr A. Ray, Department of
Medicine, All India Institute of Medical Sciences, Room no: 3070A, 3rd Floor
Teaching Block, Ansari Nagar, New Delhi 110029, India.
| | - N Wig
- From the Department of Medicine, All India Institute
of Medical Sciences, Room no: 3070A, 3rd Floor Teaching
Block, Ansari Nagar, New Delhi 110029, India
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