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dos Santos VM, dos Santos LAM, Sugai TAM. COVID-19 associated mucormycosis - a recent challenge. Autops Case Rep 2023; 13:e2023427. [PMID: 37101552 PMCID: PMC10124556 DOI: 10.4322/acr.2023.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Vitorino Modesto dos Santos
- Hospital das Forças Armadas (HFA), Department of Medicine, Brasília, DF, Brasil
- Universidade Católica de Brasília, Medical Course, Brasília, DF, Brasil
| | - Lister Arruda Modesto dos Santos
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Advanced General Surgery and Oncosurgery, São Paulo, SP, Brasil
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Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives. J Clin Med 2022; 11:jcm11133620. [PMID: 35806905 PMCID: PMC9267579 DOI: 10.3390/jcm11133620] [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: 03/11/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.
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Bupha-Intr O, Butters C, Reynolds G, Kennedy K, Meyer W, Patil S, Bryant P, Morrissey CO. Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:177-219. [PMID: 34937139 DOI: 10.1111/imj.15592] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
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Affiliation(s)
- Olivia Bupha-Intr
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand
| | - Coen Butters
- Department of General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Sushrut Patil
- Malignant Haematology and Stem Cell Transplantation Service, Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Penelope Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine O Morrissey
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Imran M, A S A, Tauseef M, Khan SA, Hudu SA, Abida. Mucormycosis medications: a patent review. Expert Opin Ther Pat 2021; 31:1059-1074. [PMID: 34082658 DOI: 10.1080/13543776.2021.1939308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mucormycosis is an uncommon but life-threatening infection with nonspecific clinical manifestations that make its diagnosis/treatment difficult. The current literature indicates that mucormycosis case incidences are on the rise in developing and developed countries, and, unfortunately, there are only a few treatments available. Accordingly, it is essential to provide more treatment options for mucormycosis. AREA COVERED This patent review focuses on the granted patents and patent applications related to medication for mucormycosis treatment from the publication year of the amphotericin-B patent application (1958) till 30 January 2021. EXPERT OPINION Mucormycosis has few available treatments, including amphotericin-B, isavuconazonium sulfate, posaconazole, or their combination. A few anti-mucormycosis medicines are under clinical development. The exact burden of mucormycosis is unknown, but it is expected to be higher than the reported cases because of mucormycosis epidemiological changes. This patent review has shown that scientists are progressing toward developing a new treatment for mucormycosis in the form of new chemical compounds, new drug combinations, and dosage forms, vaccines, plant products, drug repurposing, and derivatives of the biomolecules. This progress is encouraging to fight this devastating illness.
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Affiliation(s)
- Mohd Imran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Alshrari A S
- Department of Biological Science, Faculty of Science, Northern Border University, Arar, Saudi Arabia
| | - Mohammad Tauseef
- Department of Pharmaceutical Sciences, College of Pharmacy, Chicago States University, Chicago, United States
| | - Shah Alam Khan
- College of Pharmacy, National University of Science and Technology, Muscat, Oman
| | - Shuaibu Abdullahi Hudu
- Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Abida
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha, Saudi Arabia
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Combination Therapy for the Treatment of Mucormycosis: Examining the Evidence. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0222-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mendoza L, Vilela R, Voelz K, Ibrahim AS, Voigt K, Lee SC. Human Fungal Pathogens of Mucorales and Entomophthorales. Cold Spring Harb Perspect Med 2014; 5:cshperspect.a019562. [PMID: 25377138 DOI: 10.1101/cshperspect.a019562] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In recent years, we have seen an increase in the number of immunocompromised cohorts as a result of infections and/or medical conditions, which has resulted in an increased incidence of fungal infections. Although rare, the incidence of infections caused by fungi belonging to basal fungal lineages is also continuously increasing. Basal fungal lineages diverged at an early point during the evolution of the fungal lineage, in which, in a simplified four-phylum fungal kingdom, Zygomycota and Chytridiomycota belong to the basal fungi, distinguishing them from Ascomycota and Basidiomycota. Currently there are no known human infections caused by fungi in Chytridiomycota; only Zygomycotan fungi are known to infect humans. Hence, infections caused by zygomycetes have been called zygomycosis, and the term "zygomycosis" is often used as a synonym for "mucormycosis." In the four-phylum fungal kingdom system, Zygomycota is classified mainly based on morphology, including the ability to form coenocytic (aseptated) hyphae and zygospores (sexual spores). In the Zygomycota, there are 10 known orders, two of which, the Mucorales and Entomophthorales, contain species that can infect humans, and the infection has historically been known as zygomycosis. However, recent multilocus sequence typing analyses (the fungal tree of life [AFTOL] project) revealed that the Zygomycota forms not a monophyletic clade but instead a polyphyletic clade, whereas Ascomycota and Basidiomycota are monophyletic. Thus, the term "zygomycosis" needed to be further specified, resulting in the terms "mucormycosis" and "entomophthoramycosis." This review covers these two different types of fungal infections.
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Affiliation(s)
- Leonel Mendoza
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48424-1031 Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan 48424-1031
| | - Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan 48424-1031 Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, CEP33400000 Belo Horizonte, Brazil Belo Horizonte Brazil; Superior Institute of Medicine (ISMD), Minas Gerais, CEP33400000 Belo Horizonte, Brazil
| | - Kerstin Voelz
- Institute of Microbiology and Infection & School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom The National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom B15 2WB
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Harbor-University of California Los Angeles Medical Center, St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502 David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology and University of Jena, Faculty of Biology and Pharmacy, Institute of Microbiology, Neugasse 25, 07743 Jena, Germany
| | - Soo Chan Lee
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina 27710
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Ibrahim AS. Host-iron assimilation: pathogenesis and novel therapies of mucormycosis. Mycoses 2014; 57 Suppl 3:13-7. [PMID: 25178879 DOI: 10.1111/myc.12232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Mucormycosis is a fungal infection caused by organisms belonging to the order Mucorales. Although considered uncommon, mucormycosis has been steadily increasing in incidents for the last two decades. Mortality of the disease is unacceptably high despite antifungal therapy and surgical interventions. The lack of understanding of the pathogenesis of the disease and the absence of rapid diagnostic assay contribute to the poor prognosis of mucormycosis. The hyper susceptibility of patients with elevated available serum iron points to the critical role of the ability of Mucorales to acquire host iron as a critical virulence factor. Specifically patients with deferoxamine-therapy, hyperglycaemic with or without ketoacidosis, or other forms of acidosis are uniquely predisposed to mucormycosis. In this review, we discuss the molecular mechanisms of infection in these patient categories in an attempt to identify novel therapies for a disease with poor prognosis. Emphasis on the effect of glucose and free iron on host-pathogen interactions are also covered.
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Affiliation(s)
- Ashraf S Ibrahim
- The Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles (UCLA) Medical Center and the St. John's Cardiovascular Research Center, Torrance, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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