The impact of mucormycosis (black fungus) on SARS-CoV-2-infected patients: at a glance

Comprehensive Management of Rhino-Orbito-Cerebral Mucormycosis Post-COVID-19: A Case Report

Post-COVID-19 mucormycosis, particularly the rhino-orbital-cerebral form, can be life-threatening. This case highlights the importance of maintaining high clinical suspicion, especially in patients with recent COVID-19 history. Prompt diagnosis, aggressive surgical debridement, and antifungal therapy are crucial for successful management, even in patients without traditional risk factors.

Precision Detection of Fungal Co-Infections for Enhanced COVID-19 Treatment Strategies Using FESEM Imaging

The treatment of fungal infections presents significant challenges due to the lack of standardized diagnostic procedures, a restricted range of antifungal treatments, and the risk of harmful interactions between antifungal medications and the immunosuppressive drugs used in anti-inflammatory treatment for critically ill patients with COVID-19. Mucormycosis and aspergillosis are the primary invasive fungal infections in patients with severe COVID-19, occurring singly or in combination. Histopathological examination is a vital diagnostic technique that details the presence and invasion of fungi within tissues and blood vessels, and the body's response to the infection. However, the pathology report omits information on the most common fungi associated with the observed morphology, as well as other potential fungi and parasites that ought to be included in the differential diagnosis. This research marks significance in diagnosing fungal infections, such as mucormycosis and aspergillosis associated to COVID-19 by field emission scanning electron microscopy (FESEM) imaging to examine unstained histopathology slides, allowing for a detailed morphological analysis of the fungus. FESEM provides an unprecedented resolution and detail, surpassing traditional Hematoxylin & Eosin (H&E) and Grocott's Methenamine Silver (GMS) staining methods in identifying and differentiating dual fungal infections and diverse fungal species. The findings underscore the critical need for individualized treatment plans for patients severely affected by COVID-19 and compounded by secondary fungal infections. The high-magnification micrographs reveal specific fungal morphology and reproductive patterns. Current treatment protocols largely depend on broad-spectrum antifungal therapies. However this FESEM guided diagnostic approach can help in targeted patient specific anti fungal therapies. Such precision could lead to more effective early interventions, addressing the complex management required for severe COVID-19 cases with coexisting fungal infections. This approach significantly advances disease management and patient recovery, advocating for personalized, precision medicine in tackling this multifaceted clinical challenge.

Graphical Abstract

Retrospective study of patient characteristics and treatment for mucormycosis in post COVID-19 population in a tertiary care hospital

OBJECTIVES

Along with the COVID-19 pandemic, another illness wreaking havoc in India is mucormycosis, also known as black fungus. Mucormycosis was previously known as zygomycotic infection, which is a consequential type of infection caused by several mildews known as Mucoromycetes. It is an invasive type of disease which occurs more commonly in individuals with low and weakened immunity. The main objective of this study was to identify the mucormycosis cases post COVID-19 and to determine the risk factors and treatment for positive cases.

METHODS

Thirty-three patients (61% men, 39% women; mean age 55 years) with mucormycosis were identified in the Department of Oral and Maxillofacial Surgery.

RESULTS

People who received COVID-19 vaccines had a lower rate of infection with the fungus than non-vaccinated people. In steroid users the risk was very high compared with those not taking steroids.

CONCLUSION

The majority of non vaccinated patients with preexisting co-morbidity conditions like diabetes, chronic illnesses and irregular use of steroids during COVID-19, might have greater risks of getting mucormycosis rather than normal COVID-19 positive cases.

Comprehensive Review on the Virulence Factors and Therapeutic Strategies with the Aid of Artificial Intelligence against Mucormycosis

Mucormycosis, a rare but deadly fungal infection, was an epidemic during the COVID-19 pandemic. The rise in cases (COVID-19-associated mucormycosis, CAM) is attributed to excessive steroid and antibiotic use, poor hospital hygiene, and crowded settings. Major contributing factors include diabetes and weakened immune systems. The main manifesting forms of CAM─cutaneous, pulmonary, and the deadliest, rhinocerebral─and disseminated infections elevated mortality rates to 85%. Recent focus lies on small-molecule inhibitors due to their advantages over standard treatments like surgery and liposomal amphotericin B (which carry several long-term adverse effects), offering potential central nervous system penetration, diverse targets, and simpler dosing owing to their small size, rendering the ability to traverse the blood-brain barrier via passive diffusion facilitated by the phospholipid membrane. Adaptation and versatility in mucormycosis are facilitated by a multitude of virulence factors, enabling the pathogen to dynamically respond to various environmental stressors. A comprehensive understanding of these virulence mechanisms is imperative for devising effective therapeutic interventions against this highly opportunistic pathogen that thrives in immunocompromised individuals through its angio-invasive nature. Hence, this Review delineates the principal virulence factors of mucormycosis, the mechanisms it employs to persist in challenging host environments, and the current progress in developing small-molecule inhibitors against them.

Oral health-related quality of life after rehabilitation with maxillary obturators: A comparison of patients with maxillectomy defects associated with cancer and post-COVID-19 mucormycosis

STATEMENT OF PROBLEM

Maxillectomy alters function and esthetics, negatively affecting oral health-related quality of life (OHRQoL). OHRQoL has been assessed after prosthetic rehabilitation in patients with maxillectomy associated with cancer. However, OHRQoL studies after prosthetic rehabilitation in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis are lacking.

PURPOSE

The purpose of this clinical study was to compare OHRQoL before and after rehabilitation with maxillary obturators in patients with maxillectomy defects associated with cancer and post COVID-19 mucormycosis.

MATERIAL AND METHODS

The study was conducted at 2 centers. A total of 47 participants who underwent maxillectomy because of cancer were included from the first center, and 32 participants who underwent maxillectomy because of post COVID-19 associated mucormycosis of the maxilla were included from the second center. Participants were asked to rate their dental problems on a Likert scale using Oral Health Impact Profile-14 (OHIP-14) before and after prosthodontic rehabilitation. The difference between scores among groups for each item and overall score was compared by using the Wilcoxon Rank-Sum test (α=.05). A linear mixed-effects model was fitted to account for the repeated measures within individuals. A random intercept for each participant was included to account for the within-subject correlation.

RESULTS

An overall improvement in the OHRQoL of participants was found in both groups. The mean total OHIP-14 score for the cancer group decreased from 24.2 at the prerehabilitation stage (Pre-R) to 9.5 at the postrehabilitation stage (Post-R). The magnitude of improvement was higher for the post COVID-19 associated mucormycosis group with a reduction in the mean total OHIP-14 score of 52.0 (Pre-R) to 6.5 (Post-R). The mean change in OHIP-14 scores after rehabilitation was 15 (95% CI 10-19) in the cancer group but significantly larger at 45 (95% CI 41-49) in the mucormycosis group. The P value for the mean total OHIP-14 score at Pre-R was <.001 and at Post-R was.031. The interaction term between groups and time was significant, indicating different effects between groups with time.

CONCLUSIONS

Comparison of the OHRQoL after rehabilitation with prostheses among patients with cancer and post COVID-19 associated mucormycosis showed that the OHRQoL scores, although much higher among patients with mucormycosis before rehabilitation (compared with patients with cancer), were almost similar after rehabilitation.

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator

STATEMENT OF PROBLEM

Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL.

PURPOSE

The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy.

MATERIAL AND METHODS

Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05).

RESULTS

A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001).

CONCLUSIONS

Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

Mechanistic inhibition of Monkeypox and Marburg virus infection by O-rhamnosides and Kaempferol-o-rhamnosides derivatives: a new-fangled computational approach

The increasing incidence of Monkeypox virus (Mpox) and Marburg virus (MARV) infections worldwide presents a significant challenge to global health, as limited treatment options are currently available. This study investigates the potential of several O-rhamnosides and Kaempferol-O-rhamnosides as Mpox and MARV inhibitors using molecular modeling methods, including ADMET, molecular docking, and molecular dynamics/MD simulation. The effectiveness of these compounds against the viruses was assessed using the Prediction of Activity Spectra for Substances (PASS) prediction. The study's primary focus is molecular docking prediction, which demonstrated that ligands (L07, L08, and L09) bind to Mpox (PDB ID: 4QWO) and MARV (PDB ID: 4OR8) with binding affinities ranging from -8.00 kcal/mol to -9.5 kcal/mol. HOMO-LUMO based quantum calculations were employed to determine the HOMO-LUMO gap of frontier molecular orbitals (FMOs) and to estimate chemical potential, electronegativity, hardness, and softness. Drug similarity and ADMET prediction assessments of pharmacokinetic properties revealed that the compounds were likely non-carcinogenic, non-hepatotoxic, and rapidly soluble. Molecular dynamic (MD) modeling was used to identify the most favorable docked complexes involving bioactive chemicals. MD simulations indicate that varying types of kaempferol-O-rhamnoside are necessary for successful docking validation and maintaining the stability of the docked complex. These findings could facilitate the discovery of novel therapeutic agents for treating illnesses caused by the Mpox and MARV viruses.

A Review of Hyperglycemia in COVID-19

Diabetes mellitus (DM) is one of the most common chronic metabolic disorders worldwide, which increases the risk of common and opportunistic infections. Following the coronavirus disease 2019 (COVID-19) pandemic, a higher incidence rate, more severe forms of the disease, and exacerbation of hyperglycemia and its complications have been observed in patients with DM. Moreover, stress-induced hyperglycemia has been observed in many hospitalized nondiabetic patients after contracting COVID-19. Hyperglycemia worsens prognosis in both diabetic and nondiabetic patients. In this study, the mechanism of new-onset or exacerbation of hyperglycemia, the effect of the treatments used for COVID-19 on hyperglycemia, the importance and appropriate method of blood glucose (blood sugar (BS)) control during the disease, and the possible fate of new-onset hyperglycemia after recovery from COVID-19 to some extent is expressed.

Altered infective competence of the human gut microbiome in COVID-19

BACKGROUND

Infections with SARS-CoV-2 have a pronounced impact on the gastrointestinal tract and its resident microbiome. Clear differences between severe cases of infection and healthy individuals have been reported, including the loss of commensal taxa. We aimed to understand if microbiome alterations including functional shifts are unique to severe cases or a common effect of COVID-19. We used high-resolution systematic multi-omic analyses to profile the gut microbiome in asymptomatic-to-moderate COVID-19 individuals compared to a control group.

RESULTS

We found a striking increase in the overall abundance and expression of both virulence factors and antimicrobial resistance genes in COVID-19. Importantly, these genes are encoded and expressed by commensal taxa from families such as Acidaminococcaceae and Erysipelatoclostridiaceae, which we found to be enriched in COVID-19-positive individuals. We also found an enrichment in the expression of a betaherpesvirus and rotavirus C genes in COVID-19-positive individuals compared to healthy controls.

CONCLUSIONS

Our analyses identified an altered and increased infective competence of the gut microbiome in COVID-19 patients. Video Abstract.

A potential host and virus targeting tool against COVID-19: Chemical characterization, antiviral, cytoprotective, antioxidant, respiratory smooth muscle relaxant effects of Paulownia tomentosa Steud

COronaVIrus Disease 2019 (COVID-19) is a newly emerging infectious disease that spread across the world, caused by the novel coronavirus Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). Despite the advancements in science that led to the creation of the vaccine, there is still an urgent need for new antiviral drugs effective against SARS-CoV-2. This study aimed to investigate the antiviral effect of Paulownia tomentosa Steud extract against SARS-CoV-2 and to evaluate its antioxidant properties, including respiratory smooth muscle relaxant effects. Our results showed that P. tomentosa extract can inhibit viral replication by directly interacting with both the 3-chymotrypsin-like protease and spike protein. In addition, the phyto complex does not reduce lung epithelial cell viability and exerts a protective action in those cells damaged by tert-butyl hydroperoxide , a toxic agent able to alter cells' functions via increased oxidative stress. These data suggest the potential role of P. tomentosa extract in COVID-19 treatment, since this extract is able to act both as an antiviral and a cytoprotective agent in vitro.

Anti-viral drug discovery against monkeypox and smallpox infection by natural curcumin derivatives: A Computational drug design approach

Background

In the last couple of years, viral infections have been leading the globe, considered one of the most widespread and extremely damaging health problems and one of the leading causes of mortality in the modern period. Although several viral infections are discovered, such as SARS CoV-2, Langya Henipavirus, there have only been a limited number of discoveries of possible antiviral drug, and vaccine that have even received authorization for the protection of human health. Recently, another virial infection is infecting worldwide (Monkeypox, and Smallpox), which concerns pharmacists, biochemists, doctors, and healthcare providers about another epidemic. Also, currently no specific treatment is available against Monkeypox. This research gap encouraged us to develop a new molecule to fight against monkeypox and smallpox disease. So, firstly, fifty different curcumin derivatives were collected from natural sources, which are available in the PubChem database, to determine antiviral capabilities against Monkeypox and Smallpox.

Material and method

Preliminarily, the molecular docking experiment of fifty different curcumin derivatives were conducted, and the majority of the substances produced the expected binding affinities. Then, twelve curcumin derivatives were picked up for further analysis based on the maximum docking score. After that, the density functional theory (DFT) was used to determine chemical characterizations such as the highest occupied molecular orbital (HOMO), lowest unoccupied molecular orbital (LUMO), softness, and hardness, etc.

Results

The mentioned derivatives demonstrated docking scores greater than 6.80 kcal/mol, and the most significant binding affinity was at -8.90 kcal/mol, even though 12 molecules had higher binding scores (-8.00 kcal/mol to -8.9 kcal/mol), and better than the standard medications. The molecular dynamic simulation is described by root mean square deviation (RMSD) and root-mean-square fluctuation (RMSF), demonstrating that all the compounds might be stable in the physiological system.

Conclusion

In conclusion, each derivative of curcumin has outstanding absorption, distribution, metabolism, excretion, and toxicity (ADMET) characteristics. Hence, we recommended the aforementioned curcumin derivatives as potential antiviral agents for the treatment of Monkeypox and Smallpox virus, and more in vivo investigations are warranted to substantiate our findings.

Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature

Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration.