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Sigera LSM, Denning DW. A Systematic Review of the Therapeutic Outcome of Mucormycosis. Open Forum Infect Dis 2024; 11:ofad704. [PMID: 38288347 PMCID: PMC10823420 DOI: 10.1093/ofid/ofad704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Background Mucormycosis is a potentially lethal mycosis. We reviewed peer-reviewed publications on mucormycosis to assess therapeutic outcomes. Methods A systematic literature search using the Ovid MEDLINE and EMBASE databases identified manuscripts describing human mucormycosis diagnosed according to European Organization for Research and Treatment of Cancer and the Mycoses Study Group criteria with therapeutic outcomes published from 2000 to 2022. Results In 126 articles, 10 335 patients were described, most from Asia (n = 6632, 66%). Diabetes was the most frequent underlying disease (n = 6188, 60%); 222 (2.1%) patients had no underlying diseases. The dominant clinical form was rhino-orbitocerebral (n = 7159, 69.3%), followed by pulmonary (n = 1062, 10.3%). Of 5364 patients with outcome data, amphotericin B monotherapy (n = 3749, mortality 31.5%) was most frequent, followed by amphotericin B + azole (n = 843, mortality 6.6%; P < .0001), amphotericin B followed by azole (n = 357, mortality 13.7%; P < .0001), posaconazole only (n = 250, mortality 17.2%; P < .0001), and isavuconazole only (n = 65, mortality 24.6%; P = .24). Duration and dose of antifungals varied widely. Documented outcomes from surgical resections in 149 patients found that 47 of 125 died (37.6%), compared with 16 of 24 (66.7%) patients who did not undergo surgery (P = .008). Conclusions Mucormycosis is more frequently reported in Asia than in Europe and is often linked to diabetes. Antifungal therapy, usually with surgery, is frequently effective for mucormycosis.
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Affiliation(s)
- L Shamithra M Sigera
- Manchester Fungal Infection Group, Core Technology Facility, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David W Denning
- Manchester Fungal Infection Group, Core Technology Facility, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Seto K, Nohara R, Sugita Y, Ishibashi H, Okubo K. Pulmonary Mucormycosis Involving the Left Main Bronchus and the Pulmonary Artery. Ann Thorac Cardiovasc Surg 2023; 29:315-318. [PMID: 35387926 PMCID: PMC10767655 DOI: 10.5761/atcs.cr.22-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/27/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary mucormycosis is an extremely rare disease. It often occurs in immunocompromised patients, such as patients with diabetes and those on long-term steroid use. The prognosis of the disease is poor despite the administration of antifungal agents and removal of the necrotic tissue. Herein, we present a successfully treated case of pulmonary mucormycosis in a patient with type 2 diabetes who underwent left pneumonectomy because of the involvement of the left main pulmonary artery and the left main bronchus. Irrespective of the infected organ, complete debridement of the infected tissue and treatment with antifungal agents are essential for treating mucormycosis.
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Affiliation(s)
- Katsutoshi Seto
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rika Nohara
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hironori Ishibashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Okubo
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Shen M, Wang J, Lei M, Wang Z. The outcome and the risk factors of mucormycosis among patients with hematological diseases: a systematic and meta-analysis. Front Med (Lausanne) 2023; 10:1268840. [PMID: 38098845 PMCID: PMC10720036 DOI: 10.3389/fmed.2023.1268840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives Mucorale has come into a significant pathogen over recent decades. Nonetheless, mucormycosis-related mortality rates among patients with hematological disorders remain unascertained. Thus, we conducted a meta-analysis to determine mortality rates of mucormycosis in patients with hematology-related conditions. Methods We scoured PubMed, Embase, and Web of Science for original papers exploring the intersection of Mucormycosis and Hematological Diseases (from 2000 to 2022). We scrutinized the overall mortality across three distinct periods, as well as differentiating between high-income and middle-income nations. We further evaluated the pooled mortality and the risk differential (RD) across several subgroups. Results The overall mortality rate for hematology patients with mucormycosis was 61%, within a 95% confidence interval (CI) of 0.54-0.68. A significant observation was that mortality rates were somewhat lower in high-income countries compared to middle-income countries (0.60 versus 0.64, p = 0.45). Importantly, we discovered that a combination of surgical and medical treatment significantly improved survival rates compared to medical treatment alone [mortality 0.49 versus 0.67, RD -0.19 (95%CI -0.38-0.00, I2 63.7%)]. As might be expected, disseminated mucormycosis posed a significantly higher risk of death compared to isolated mucormycosis [0.60 versus 0.57, RD death 0.16 (95%CI 0.03-0.28)]. Additionally, our analysis showed no discernible differences in survival rates between genders, between patients with and without breakthrough infection, between those who received mucor-active or mucor-inactive drugs prior to mucor infection, or between those on a multi-drug regimen and those on a single drug treatment. Conclusion Despite the high mortality rates associated with mucormycosis in patients with hematological disorders, those receiving both medical and surgical interventions, as well as those with isolated infection sites, exhibited improved survival outcomes. Conversely, factors such as gender, the presence of breakthrough infection, the use of mucor-active drugs before mucor infection, and multi-drug administration did not significantly influence patient outcomes.
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Affiliation(s)
| | | | | | - Zhiming Wang
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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4
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Pandey M, Sachdev J, Yadav RK, Sharad N, Kanodia A, Biswas J, Janani RS, Gupta S, Singh G, Ekka M, Rana B, Gourav S, Thakar A, Biswas A, Sikka K, Mathur P, Pushker N, Jyotsna VP, Kumar R, Soneja M, Wig N, Srivastava MVP, Xess I. Utility of in-house and commercial PCR assay in diagnosis of Covid-19 associated mucormycoss in an emergency setting in a tertiary care center. J Med Microbiol 2023; 72. [PMID: 37624041 DOI: 10.1099/jmm.0.001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Introduction. Invasive mucormycosis (IM) is a potentially fatal infection caused by fungi of the order Mucorales. Histopathology, culture, and radiology are the mainstays of diagnosis, but they are not sufficiently sensitive, resulting in delayed diagnosis and intervention. Recent studies have shown that PCR-based techniques can be a promising way to diagnose IM.Hypothesis/Gap Statement. Early diagnosis of fungal infections using molecular diagnostic techniques can improve patient outcomes, especially in invasive mucormycosis.Aim. The aim of this study was to evaluate the utility of our in-house mould-specific real time PCR assay (qPCR) in comparison with the commercially available real time PCR (MucorGenius PCR), for the early diagnosis of mucormycosis in tissue samples from patients with suspicion of invasive mucormycosis (IM). This in-house assay can detect and distinguish three clinically relevant mould species, e.g. Aspergillus spp., Mucorales and Fusarium spp. in a single reaction with only one pair of primers, without the need for sequencing.Methodology. We enrolled 313 tissue samples from 193 patients with suspected IM in this prospective study. All cases were classified using EORTC/MSGERC guidelines. All samples were tested using traditional methods, in-house qPCR, and MucorGenius PCR.Results. Using direct microscopy as a gold standard, the overall sensitivity and specificity of in-house qPCR for detection of IM was 92.46% and 80% respectively, while that of the MucorGenius PCR was 66.67% and 90% respectively. However, co-infection of IM and IA adversely affected the performance of MucorGenius PCR in detection of IM.The in-house PCR detected Aspergillus spp. in 14 cases and Fusarium spp. in 4 cases which showed clinical and radiological features of fungal sinusitis. The in-house qPCR also performed better in detecting possible cases of IM. This aids early diagnosis and appropriate treatment to improve patient outcomes.Conclusion. Because the in-house PCR is not only sensitive and specific, but also entirely based on SYBR Green for detection of targets, it is less expensive than probe-based assays and can be used on a regular basis for the diagnosis of IM in resource-constrained settings. It can be used to distinguish between mucormycosis and fungal sinusitis caused by Aspergillus and Fusarium in high-risk patients, as well as to accurately detect Mucorales in fungal co-infection cases.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Kumari Yadav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Sharad
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kanodia
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Biswas
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - R Sruti Janani
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonakshi Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Rana
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudesh Gourav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Lynch JP, Zhanel GG. Part 2: Mucormycosis: Focus on Therapy. Expert Rev Anti Infect Ther 2023. [PMID: 37300820 DOI: 10.1080/14787210.2023.2224564] [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: 03/09/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) a rare but life-threatening infection occurs primarily in immunocompromised hosts. Mortality rates with invasive MCR are high (>30-50%), up to 90% with disseminated disease, but lower (10-30%) with localized cutaneous disease. Due to the rarity of MCR, randomized, controlled therapeutic trials are lacking. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy but oral triazoles (posaconazole and isavuconazole) may be effective as step-down therapy or in MCR cases refractory to or intolerant of LFAB. Early surgical debridement or excision play important adjunctive roles in localized invasive disease. Control of hyperglycemia in diabetic patients, correction of neutropenia and reduction of immunosuppressive therapy is critical for optimal survival. AREAS COVERED The authors discuss various therapeutic options for mucormycosis. A literature search of mucormycosis therapies was performed via PubMed (up to December 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; amphotericin B; isavuconazole; posaconazole. EXPERT OPINION Randomized, controlled therapeutic trials are lacking. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy but oral triazoles (posaconazole and isavuconazole) may be effective as step-down therapy, in MCR cases refractory to or intolerant of LFAB. We encourage early surgical debridement or excision as adjunctive measures.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
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Lamoth F. Novel Approaches in the Management of Mucormycosis. CURRENT FUNGAL INFECTION REPORTS 2023; 17:1-10. [PMID: 37360854 PMCID: PMC10165581 DOI: 10.1007/s12281-023-00463-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review Invasive mucormycosis (IM), caused by fungi of the order Mucorales, is one of the deadliest fungal infection among hematologic cancer patients. Its incidence is also increasingly reported in immunocompetent individuals, notably with the COVID-19 pandemic. Therefore, there is an urgent need for novel diagnostic and therapeutic approaches of IM. This review discusses the current advances in this field. Recent Findings Early diagnosis of IM is crucial and can be improved by Mucorales-specific PCR and development of lateral-flow immunoassays for specific antigen detection. The spore coat proteins (CotH) are essential for virulence of the Mucorales and may represent a target for novel antifungal therapies. Adjuvant therapies boosting the immune response, such as interferon-γ, anti-PDR1 or fungal-specific chimeric antigen receptor (CAR) T-cells, are also considered. Summary The most promising perspectives for improved management of IM consist of a multilayered approach targeting both the pathogen and the host immune system.
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Affiliation(s)
- Frederic Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland
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Meli M, Spicuzza L, Comella M, La Spina M, Trobia GL, Parisi GF, Di Cataldo A, Russo G. The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091612. [PMID: 37175003 PMCID: PMC10177819 DOI: 10.3390/diagnostics13091612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. METHODS This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. RESULTS We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating "halo sign" or "reverse halo sign"). CONCLUSIONS Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.
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Affiliation(s)
- Mariaclaudia Meli
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Lucia Spicuzza
- Pulmology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Mattia Comella
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Milena La Spina
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gian Luca Trobia
- Pediatrics and Pediatric Emergency Room, Cannizzaro Emergency Hospital, 95126 Catania, Italy
| | - Giuseppe Fabio Parisi
- Pediatric Pulmology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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Gupta I, Baranwal P, Singh G, Gupta V. Mucormycosis, past and present: a comprehensive review. Future Microbiol 2023; 18:217-234. [PMID: 36970978 DOI: 10.2217/fmb-2022-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Mucormycosis is an emerging opportunistic angioinvasive fungal infection. Predisposing factors such as diabetes, neutropenia, long-term corticosteroid therapy, solid organ transplantation and immunosuppression contribute to its occurrence. This disease was not of significant concern prior to the COVID-19 pandemic, but gained prominence due to infections in COVID-19 patients. Mucormycosis needs special attention and coordinated efforts of the scientific community and medical professionals to reduce morbidity and mortality. Here we present an overview of the epidemiology and prevalence of mucormycosis in the pre- and post-COVID-19 eras, the factors that contributed to the abrupt increase in COVID-19-associated mucormycosis (CAM), the actions taken by the regulatory agencies (including Code Mucor and CAM registry), the existing diagnostic tools and CAM management strategies.
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10
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What Is New in Pulmonary Mucormycosis? J Fungi (Basel) 2023; 9:jof9030307. [PMID: 36983475 PMCID: PMC10057210 DOI: 10.3390/jof9030307] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Mucormycosis is a rare but life-threatening fungal infection due to molds of the order Mucorales. The incidence has been increasing over recent decades. Worldwide, pulmonary mucormycosis (PM) presents in the lungs, which are the third main location for the infection after the rhino-orbito-cerebral (ROC) areas and the skin. The main risk factors for PM include hematological malignancies and solid organ transplantation, whereas ROC infections are classically favored by diabetes mellitus. The differences between the ROC and pulmonary locations are possibly explained by the activation of different mammalian receptors—GRP78 in nasal epithelial cells and integrin β1 in alveolar epithelial cells—in response to Mucorales. Alveolar macrophages and neutrophils play a key role in the host defense against Mucorales. The diagnosis of PM relies on CT scans, cultures, PCR tests, and histology. The reversed halo sign is an early, but very suggestive, sign of PM in neutropenic patients. Recently, the serum PCR test showed a very encouraging performance for the diagnosis and follow-up of mucormycosis. Liposomal amphotericin B is the drug of choice for first-line therapy, together with correction of underlying disease and surgery when feasible. After a stable or partial response, the step-down treatment includes oral isavuconazole or posaconazole delayed release tablets until a complete response is achieved. Secondary prophylaxis should be discussed when there is any risk of relapse, such as the persistence of neutropenia or the prolonged use of high-dose immunosuppressive therapy. Despite these novelties, the mortality rate from PM remains higher than 50%. Therefore, future research must define the place for combination therapy and adjunctive treatments, while the development of new treatments is necessary.
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Answer to January 2023 Photo Quiz. J Clin Microbiol 2023; 61:e0078122. [PMID: 36700691 PMCID: PMC9879118 DOI: 10.1128/jcm.00781-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Read the full article for the answer.
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12
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Rouientan H, Gilani A, Sarmadian R, Rezaei Zadeh Rukerd M. A rare case of an immunocompetent patient with isolated pulmonary mucormycosis. IDCases 2023; 31:e01726. [PMID: 36923658 PMCID: PMC10009052 DOI: 10.1016/j.idcr.2023.e01726] [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: 01/26/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
As one of the most lethal infections caused by fungi, pulmonary mucormycosis usually affects patients who are immunocompromised. Isolated pulmonary mucormycosis in immunocompetent patients is very rare.This report describes a 65-year-old immunocompetent man, who was first treated with antibiotics after being diagnosed with a lung infection, then after the lack of response to treatment, he was diagnosed with mucormycosis in further investigations. Finally, the patient died due to a lack of response to treatment. Despite its rarity, it is important to consider other differential diagnoses such as pulmonary mucormycosis if the pneumonic process does not respond to medical treatment.
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Affiliation(s)
- Hamidreza Rouientan
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Abolfazl Gilani
- Department of Pediatric Surgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Roham Sarmadian
- Infectious Diseases Reseach Center, Arak University of Medical Sciences, Arak, Islamic Republic of Iran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroentrology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran
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Zhang M, Lu W, Xie D, Wang J, Xiao X, Pu Y, Meng J, Lyu H, Zhao M. Metagenomic Next-Generation Sequencing for Diagnostically Challenging Mucormycosis in Patients with Hematological Malignancies. Infect Drug Resist 2022; 15:7509-7517. [PMID: 36570711 PMCID: PMC9784388 DOI: 10.2147/idr.s393201] [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: 10/21/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Metagenomic next-generation sequencing (mNGS) is a fast, sensitive and accurate diagnostic method for pathogens detection. However, reports on the application of mNGS in mucormycosis remain scarce. Methods From January 2019 to December 2021, we recruited 13 patients with hematological malignancies who were suspected of mucormycosis and completed mNGS in D20. Then we retrospectively analyze the clinical data, diagnosis, therapeutic process, and outcomes. In order to evaluate the diagnostic value of mNGS in hematological malignancies patients with suspected mucormycosis. Results All patients had high risk factors of Invasive Fungal Disease, including hematopoietic stem cell transplantation, immunosuppression, glucocorticoids, etc. The clinical presentations were pulmonary (n=9), rhino-orbito-cerebral (n=4). But the manifestations were nonspecific. All enrolled patients completed mNGS. And most (8/13, 61.54%) of the samples were from blood. Fungi can be detected in all specimens, including Rhizopus (n=7), Rhizomucor (n=4) and Mucor (n=2). In addition, 7/13 (53.85%) specimens were detected bacteria at the same time and virus were detected in 5/13 (38.46%). Histopathological examination was completed in 5 patients, 3 of which were completely consistent with the results of mNGS. After treatment, 6 patients were cured, while the other 7 patients died. Conclusion mNGS may be a complementary method for early diagnosis, especially for patients who are not suitable for histopathology examination or unable to obtain culture specimen. mNGS can also help detect bacteria and viruses simultaneously, allowing for appropriate and timely antibiotic administration and thus improving patient outcomes.
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Affiliation(s)
- Meng Zhang
- First Center Clinic College of Tianjin Medical University, Tianjin, 300192, People’s Republic of China
| | - Wenyi Lu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China
| | - Danni Xie
- First Center Clinic College of Tianjin Medical University, Tianjin, 300192, People’s Republic of China
| | - Jiaxi Wang
- First Center Clinic College of Tianjin Medical University, Tianjin, 300192, People’s Republic of China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China
| | - Yedi Pu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China
| | - Hairong Lyu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China,Correspondence: Mingfeng Zhao; Hairong Lyu, Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People’s Republic of China, Email ;
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14
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Islam MR, Rahman MM, Ahasan MT, Sarkar N, Akash S, Islam M, Islam F, Aktar MN, Saeed M, Harun-Or-Rashid M, Hosain MK, Rahaman MS, Afroz S, Bibi S, Rahman MH, Sweilam SH. The impact of mucormycosis (black fungus) on SARS-CoV-2-infected patients: at a glance. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:69341-69366. [PMID: 35986111 PMCID: PMC9391068 DOI: 10.1007/s11356-022-22204-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 05/28/2023]
Abstract
The emergence of various diseases during the COVID-19 pandemic made health workers more attentive, and one of the new pathogens is the black fungus (mucormycosis). As a result, millions of lives have already been lost. As a result of the mutation, the virus is constantly changing its traits, including the rate of disease transmission, virulence, pathogenesis, and clinical signs. A recent analysis revealed that some COVID-19 patients were also coinfected with a fungal disease called mucormycosis (black fungus). India has already categorized the COVID-19 patient black fungus outbreak as an epidemic. Only a few reports are observed in other countries. The immune system is weakened by COVID-19 medication, rendering it more prone to illnesses like black fungus (mucormycosis). COVID-19, which is caused by a B.1.617 strain of the SARS-CoV-2 virus, has been circulating in India since April 2021. Mucormycosis is a rare fungal infection induced by exposure to a fungus called mucormycete. The most typically implicated genera are Mucor rhyzuprhizopusdia and Cunninghamella. Mucormycosis is also known as zygomycosis. The main causes of infection are soil, dumping sites, ancient building walls, and other sources of infection (reservoir words "mucormycosis" and "zygomycosis" are occasionally interchanged). Zygomycota, on the other hand, has been identified as polyphyletic and is not currently included in fungal classification systems; also, zygomycosis includes Entomophthorales, but mucormycosis does not. This current review will be focused on the etiology and virulence factors of COVID-19/mucormycosis coinfections in COVID-19-associated mucormycosis patients, as well as their prevalence, diagnosis, and treatment.
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Affiliation(s)
- Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Tanjimul Ahasan
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Nadia Sarkar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shopnil Akash
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mahfuzul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Most. Nazmin Aktar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mohd Saeed
- Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Kawsar Hosain
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Sadia Afroz
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shabana Bibi
- Department of Biosciences, Shifa Tameer-E-Millat University, Islamabad, Pakistan
- Yunnan Herbal Laboratory, College of Ecology and Environmental Sciences, Yunnan University, Kunming, 650091 China
| | - Md. Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka 1213 Bangladesh
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju, 26426 Korea
| | - Sherouk Hussein Sweilam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942 Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, Badr City, 11829 Egypt
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15
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G Hamed M, Hegazy AA, Embaby A, Abdelmoneem S, Al Badea AA, Ali Awad AA, Walaa M, Gobran MA, Awwad O, AbdElmonem D, A Zaitoun N, Abdelmaksoud MA, AbdelAal AA. Identifying Independent Predictors of Mortality in COVID-19 Patients with Mucormycosis. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2022. [DOI: 10.13005/bpj/2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Coronavirus disease 2019 (COVID-19) may lead to immunosuppression, leaving patients vulnerable to secondary invasive fungal infection like mucormycosis. The present study aimed to determine whether there are any risk factors associated with mortality in mucormycosis among COVID-19 patients. Patients and Methods: Patients with COVID-19 diagnosed with mucormycosis who received treatment at University Hospitals were included in the study. Complete blood count (CBC), glycated hemoglobin (HBA1c), C-reactive protein (CRP), serum albumin level, creatinine, ferritin levels, lactate dehydrogenase (LDH), D-dimer and histopathological observations were performed for all participants’ specimens. Results: The number (N) of patients included in the study was 46. About 85 % (39/46) of patients had post-COVID-19 syndrome and the other 7 cases were in the active phase of the disease. CRP, serum ferritin, D-dimer, CRP/albumin ratio and CRP/absolute lymphocyte counts were statistically significant (P<0.05) within non-survivors as compared to survivors. After analysis of multivariate analysis that patients had oxygen support, while elevated CRP/albumin ratios were independent predictors of mortality in COVID-19 patients associated with mucormycosis. Conclusions: Mucormycosis can be caused by immunosuppression conditions associated with COVID-19 infection. Oxygen levels and C-reactive protein/albumin are independent predictors of mortality and morbidity in post COVID-19 patients.
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Affiliation(s)
- Mohamed G Hamed
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | | | - Ahmed Embaby
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Shimaa Abdelmoneem
- 1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amany Abd Al Badea
- 3Otorhinolaryngology Department, Faculty of medicine, Zagazig University, Egypt
| | - Ali Awad Ali Awad
- 3Otorhinolaryngology Department, Faculty of medicine, Zagazig University, Egypt
| | - Mohammad Walaa
- 4Chest Medicine Department. Faculty of Medicine Zagazig University, Egypt
| | - Mai Ahmed Gobran
- 5Pathology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Omnia Awwad
- 6Family Medicine Fellowship in the Egyptian MOHP, Egypt
| | - Doaa AbdElmonem
- 7Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Nahla A Zaitoun
- 8Family Medicine Department, Faculty of Medicine, Zagazig University, Egypt
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16
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Cheruvu VPR, Khan MM. Reconstruction in Rhino-Orbito-Cerebral Mucormycosis Survivors: A Systematic Review. EPLASTY 2022; 22:e20. [PMID: 35873068 PMCID: PMC9275414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of COVID-19-associated mucormycosis. On June 7th, 2021, the Indian Union Health Minister stated that 28,252 cases of mucormycosis were reported from 28 states/Union territories in the country. METHODS A PubMed search was conducted for English-language studies published from 1988 through May 22, 2021 using the terms "reconstruction AND mucormycosis." RESULTS The search yielded 102 results. After excluding the articles not describing reconstruction in mucormycosis, 53 abstracts were screened. Then 34 articles dealing with reconstruction in non-ROC regions were excluded. The full text of 16 articles was reviewed. Additionally, 3 articles were identified from the reference search. Due to the aggressive debridements, rhino-orbito-cerebral mucormycosis survivors may be left with complex tissue defects with significant functional and aesthetic impairments. It is essential to offer reconstructive solutions that improve their quality of life. As far as the timing of reconstruction is concerned, the consensus is in favor of delayed reconstruction after ensuring that the infection has been eliminated/controlled and that there are no recurrences. The most common defects encountered were the ones that resulted from orbital exenteration and excision of a varying extent of the involved contiguous bony and soft tissue structures. Reconstruction with pedicled flaps was preferred rather than free flaps, especially in the cases where the infection was not eliminated completely. Adjuvant antifungal therapy was used in most of the cases. Long-term follow-up was considered essential to detect and treat recurrences. CONCLUSIONS A multitude of options are available for reconstruction in rhino-orbito-cerebral mucormycosis including skin grafts, pedicled flaps, free flaps and in some cases implants and prosthetics. These can be utilized to give as much as functional and aesthetic restoration as possible to the patient.
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Affiliation(s)
| | - Manal M Khan
- All India Institute of Medical Sciences, Bhopal, India
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17
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Cui Q, Dai H, Wu D, He J, Xu Y, Tang X, Xu J. Case Report: A Case of Acute T Lymphoblastic Leukemia With Mixed Infection of Lethal Invasive Mucormycosis and Multi-Drug Resistant Bacteria. Front Med (Lausanne) 2022; 9:854338. [PMID: 35479945 PMCID: PMC9037592 DOI: 10.3389/fmed.2022.854338] [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: 01/13/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Pulmonary mucormycosis (PM) is a rare and life-threatening fungal infection. Here, we report a case of an acute T lymphoblastic leukemia patient with mixed infections of lethal invasive Mucormycosis and multi-drug resistant (MDR) bacteria. After receiving anti-infection drugs to control the patient's fever, he was treated with induction chemotherapy. However, the malignant hematological disease was poorly controlled by the chemotherapy and the patient developed more symptoms of infection. Although the results of multiple β-D-Glucan (G) and Galactomannan (GM) tests remained negative, several pathogens were detected using metagenomic next-generation sequencing (mNGS). In particular, mNGS identified Malassezia pachydermum, Mucor racemosus, and Lauteria mirabilis in the peripheral blood and local secretion samples. The Mucor and bacterial infections were further confirmed via multi-site and repeated fungal and bacterial cultures, respectively. Despite adjusting the anti-infection therapy according to the diagnostic results, the patient's blood disease and symptoms of infection were not alleviated. Additionally, the MDR Acinetobacter baumannii infection/colonization was not confirmed until the seventh culture of the peripheral venous catheter tip. Due to the patient's deteriorating conditions, his family decided to withdraw him from further treatment. Overall, mNGS can facilitate a diagnosis of Mucormycosis by providing clinical and therapeutic information to support conventional diagnostic approaches. For the early and timely diagnosis and treatment of PM, it is also necessary to consider the malignant hematological conditions and repeated tests through multiple detection methods.
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Affiliation(s)
- Qingya Cui
- National Clinical Research Center for Hematologic Diseases, Hematology Department, Jiangsu Institute of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Haiping Dai
- National Clinical Research Center for Hematologic Diseases, Hematology Department, Jiangsu Institute of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Hematology Department, Jiangsu Institute of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Jun He
- National Clinical Research Center for Hematologic Diseases, Hematology Department, Jiangsu Institute of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Yang Xu
- Dinfectome Inc., Nanjing, China
| | - Xiaowen Tang
- National Clinical Research Center for Hematologic Diseases, Hematology Department, Jiangsu Institute of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Jie Xu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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18
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Dwivedi S, Choudhary P, Gupta A, Singh S. The cross-talk between mucormycosis, steroids and diabetes mellitus amidst the global contagion of COVID-19. Crit Rev Microbiol 2022; 49:318-333. [PMID: 35324372 DOI: 10.1080/1040841x.2022.2052795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mucormycosis is an opportunistic fungal disease that targets individuals having an impaired immune system due to a wide array of risk factors including HIV-AIDS, immunosuppressive therapy, diabetes mellitus, etc. The current explosive outbreak of coronavirus disease 2019 (COVID-19) has become the latest threat to such patients who are already susceptible to secondary infections. Physiological outcomes of COVID-19 end up in a cascade of grave alterations to the immunological profile and irreparable harm to their respiratory passage, heart and kidneys. Corticosteroidal treatment facilitates faster recovery and alleviates the adverse pathological effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). But clinical reports lend this approach a darker perspective especially if these patients have pre-existing diabetes mellitus. The mucormycotic fungal genera belonging to the order Mucorales not only survive but thrive under the comorbidity of COVID-19 and diabetes, often staying undetected until they have inflicted irreversible damage. Steroidal usage has been noted to be a common thread in the sudden spurt in secondary fungal infections among COVID-19 cases. Once considered a rare occurrence, mucormycosis has now acquired a notoriously lethal status in mainstream medical hierarchy. We set out to investigate whether corticosteroidal therapy against COVID-19 emboldens the development of mucormycosis. We also assess the conditions brought forth by steroidal usage and uncontrolled progression of diabetes in COVID-19 cases and their effect on the susceptibility towards mucormycosis.
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Affiliation(s)
- Shrey Dwivedi
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Princy Choudhary
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Ayushi Gupta
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
| | - Sangeeta Singh
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, India
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19
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Darwish RM, AlMasri M, Al‐Masri MM. Mucormycosis: The Hidden and Forgotten Disease. J Appl Microbiol 2022; 132:4042-4057. [DOI: 10.1111/jam.15487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rula M. Darwish
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy The University of Jordan Amman Jordan
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20
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Samuel SV, George TK, Gopinathan VR, Abraham OC. Community-acquired fungal pyelonephritis with renal infarction and gangrene of the colon: an uncommon diagnosis. BMJ Case Rep 2022; 15:e241685. [PMID: 35131766 PMCID: PMC8823032 DOI: 10.1136/bcr-2021-241685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
A 54-year-old male farmer with a history of long-standing uncontrolled type 2 diabetes mellitus (HbA1c 10.8) presented with a 3-week history of fever, intermittent vomiting, malaise and left flank pain for which he was treated with broad-spectrum antibiotics and oral antifungals for Candida isolated from urine culture. CT of the abdomen revealed predominant involvement of the left kidney and retroperitoneal structures. Nephrectomy was performed due to worsening abdominal pain and features of bowel perforation found on imaging. Pus culture from the necrotic kidney grew aseptate fungal hyphae, and the histopathological examination was suggestive of zygomycosis. He received amphotericin B postoperatively, but his condition deteriorated and he succumbed to nosocomial gram-negative septicaemia.
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Affiliation(s)
- Stephen Varghese Samuel
- Geriatric Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Tarun K George
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - O C Abraham
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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21
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Dogra S, Arora A, Aggarwal A, Passi G, Sharma A, Singh G, Barnwal RP. Mucormycosis Amid COVID-19 Crisis: Pathogenesis, Diagnosis, and Novel Treatment Strategies to Combat the Spread. Front Microbiol 2022; 12:794176. [PMID: 35058909 PMCID: PMC8763841 DOI: 10.3389/fmicb.2021.794176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 01/01/2023] Open
Abstract
The havoc unleashed by COVID-19 pandemic has paved way for secondary ominous fungal infections like Mucormycosis. It is caused by a class of opportunistic pathogens from the order Mucorales. Fatality rates due to this contagious infection are extremely high. Numerous clinical manifestations result in damage to multiple organs subject to the patient's underlying condition. Lack of a proper detection method and reliable treatment has made the management of this infection troublesome. Several reports studying the behavior pattern of Mucorales inside the host by modulation of its defense mechanisms have helped in understanding the pathogenesis of this angio-invasive infection. Many recent advances in diagnosis and treatment of this fungal infection have not been much beneficial. Therefore, there is a need to foster more viable strategies. This article summarizes current and imminent approaches that could aid effective management of these secondary infections in these times of global pandemic. It is foreseen that the development of newer antifungal drugs, antimicrobial peptides, and nanotechnology-based approaches for drug delivery would help combat this infection and curb its spread.
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Affiliation(s)
- Shreya Dogra
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Akanksha Arora
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Aashni Aggarwal
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Gautam Passi
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Akanksha Sharma
- Department of Biophysics, Panjab University, Chandigarh, India
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Ravi P. Barnwal
- Department of Biophysics, Panjab University, Chandigarh, India
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22
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Ghosh D, Dey S, Chakraborty H, Mukherjee S, Halder A, Sarkar A, Chakraborty P, Ghosh R, Sarkar J. Mucormycosis: A new threat to Coronavirus disease 2019 with special emphasis on India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 15:101013. [PMID: 35342843 PMCID: PMC8934183 DOI: 10.1016/j.cegh.2022.101013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 01/03/2023] Open
Abstract
The main reason for the growth of mucormycosis in people with Coronavirus disease-2019 (COVID-19) is mainly produced by Rhizopus spp. The infective mechanisms and issues recognized in Rhizopus spp. are the cell wall, germination proteins, and enzymes assisted to iron sequestration, CotH protein, and positive regulation of the GRP78 cell receptor. Mucormycosis is mainly caused by the Rhizopus spp. such as R. oryzae, R. microsporus, R. arrhizus, R. homothallicus, etc. that are gifted to numerous host defense mechanisms and attribute to the endothelium via specific receptors, GRP78 simplifying their endocytosis and angio-invasion. Factors such as hyperglycemia, elevated iron concentrations, and ketoacidosis have been shown to contribute to the pathogenesis in the tentative situation. The analytical data of 'black fungus disease' or 'mucormycosis', specify India reported for about 42.3% of published cases, followed by the USA about 16.9%, Iraq, Bangladesh, Iran, Paraguay, and 1 case each from Brazil, Mexico, Italy, UK, China, France, Uruguay, Turkey, and Austria. The COVID-19 infection is maybe a predisposing factor for mucormycosis and is related to a high mortality rate. Early recognition and restriction of hyperglycemia, liposomal amphotericin B, and surgical debridement are the bases in the successful managing of mucormycosis.
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Affiliation(s)
- Deganta Ghosh
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sagardeep Dey
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Himanko Chakraborty
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sneha Mukherjee
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Ankita Halder
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Akash Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Pallab Chakraborty
- Department of Botany, Acharya Prafulla Chandra College, New Barrakpur, Kolkata, West Bengal, India, 700131
| | - Rajdeep Ghosh
- GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India, 533296
| | - Joy Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084,Corresponding author
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23
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Ma X, Li A, Cao W, Li H, Zhang S, Li L, Xing H, Tian W, Jiao P, Chen J, Zhang Q, Xu A, Xing L. Characteristics of Mucormycosis in Hematological Patients and a Death Prediction Model. Front Microbiol 2021; 12:784974. [PMID: 34975805 PMCID: PMC8714886 DOI: 10.3389/fmicb.2021.784974] [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: 09/28/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, associated with high mortality. The aim of our study was to explore the high-risk factors and predict the death of hematological disease complicated with mucormycosis. We retrospectively analyzed clinical data of 31 patients with hematological disease complicated with mucormycosis, adopted random forest to establish the death prediction model, and validated the model in another 15 patients. The median age of the 31 cases was 46 (28–51) years, male to female ratio 1.38:1, and 90-day mortality rate 54.8%. The most common underlying disease was acute myeloid leukemia (58.1%). The main clinical symptoms were fever (100%), cough (87.1%), sputum (80.6%), chest pain (61.3%), and hemoptysis (19.4%). Reversed halo sign (83.9%) was the most common computed tomography sign. A total of 48.4% of patients also had aspergillus or bacterial infections. Discriminative models were constructed by random forest with 17 non-survivors and 14 survivors. Procalcitonin, the duration of intravenous administration of amphotericin B or amphotericin B liposomes, and neutropenia at death or 90 days of survival were the leading risk factors for poor prognosis, with area under the curve of 0.975 (95% CI 0.934–1). We chose 0.6775 as death prediction threshold (with 82.3% sensitivity and 100% specificity) and validated the model successfully in another 15 patients. Chest pain and reversed halo sign are specific clinical and image signs of hematological disease complicated with mucormycosis. Neutropenia, elevated procalcitonin, and insufficient use time of amphotericin B or amphotericin B liposomes are risk factors for death.
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Affiliation(s)
- Xiaoxu Ma
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ang Li
- Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijie Cao
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huiling Li
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suping Zhang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haizhou Xing
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenliang Tian
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengfei Jiao
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiajun Chen
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Qingxian Zhang
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Aiguo Xu
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Aiguo Xu,
| | - Lihua Xing
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Lihua Xing,
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24
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Saleem AI, Alsaedi A, Alharbi M, Abdullah S, Al Rabou A, AlDabbagh M. Mucormycosis in pediatric oncology patients: a hospital outbreak investigation report. Infect Prev Pract 2021; 3:100189. [PMID: 34988423 PMCID: PMC8696282 DOI: 10.1016/j.infpip.2021.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed I.H. Saleem
- Department of Pediatrics, Division of Infectious Disease, King Abdulaziz Medical City (KAMC-Jeddah), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of Health, Saudi Arabia
| | - Asim Alsaedi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Maher Alharbi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Shaker Abdullah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Department of Oncology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ali Al Rabou
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mona AlDabbagh
- Department of Pediatrics, Division of Infectious Disease, King Abdulaziz Medical City (KAMC-Jeddah), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
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25
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Merritt RE. Commentary: Pneumonectomy for resection of pulmonary mucormycosis: Enough is never too much. JTCVS Tech 2021; 11:87-88. [PMID: 35169750 PMCID: PMC8828789 DOI: 10.1016/j.xjtc.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 10/26/2022] Open
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26
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Gangakhedkar MR, Gupta R. Commentary on "Mucormycosis co-infection in the context of global COVID-19 outbreak: A fatal addition to the pandemic spectrum" (Int J Surg 2021, 92:106031) - A pulmonary perspective. Int J Surg 2021; 94:106116. [PMID: 34537396 PMCID: PMC8445849 DOI: 10.1016/j.ijsu.2021.106116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/29/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mihir R Gangakhedkar
- Department of Pulmonary, Sleep and Critical Care Medicine All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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27
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Singh A, Ahmad N, Varadarajan A, Vikram N, Singh TP, Sharma S, Sharma P. Lactoferrin, a potential iron-chelator as an adjunct treatment for mucormycosis - A comprehensive review. Int J Biol Macromol 2021; 187:988-998. [PMID: 34324905 DOI: 10.1016/j.ijbiomac.2021.07.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 01/19/2023]
Abstract
Mucormycosis is a deadly infection which is caused by fungi of the order Mucorales including species belonging to the genus Rhizopus, Mucor, Mycocladus, Rhizomucor, Cunninghamella, and Apophysomyces. Despite antifungal therapy and surgical procedures, the mortality rate of this disease is about 90-100% which is exceptionally high. The hypersensitivity of patients with raised available serum iron indicates that the Mucorales are able to use host iron as a critical factor of virulence. This is because iron happens to be a crucial element playing its role in the growth of cells and development. In this review, we have described Lactoferrin (Lf) as a potential iron-chelator. Lf is a naturally occurring glycoprotein which is expressed in most of the biological fluids. Moreover, Lf possesses exclusive anti-inflammatory effects along with several anti-fungal effects that could prove to be helpful to the pathological physiology of inexorable mucormycosis cases. This literature summarises the biological insights into the Lf being considered as a potential fungistatic agent and an immune regulator. The review also proposes that unique potential of Lf as an iron-chelator can be exploited as the adjunct treatment for mucormycosis infection.
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Affiliation(s)
- Anamika Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nabeel Ahmad
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashwin Varadarajan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Naval Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - T P Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sujata Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pradeep Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India.
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28
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Yousaf M, Salameh S, Haq IU, Alhyassat S, Thomas M, Hussain A, Wani M, Massad E, Hadi HA, Sattar HA, Hameed M. Challenges in the diagnosis of pulmonary mucormycosis in a diabetic with a review of literature. Respir Med Case Rep 2021; 33:101474. [PMID: 34401308 PMCID: PMC8349084 DOI: 10.1016/j.rmcr.2021.101474] [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: 05/29/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022] Open
Abstract
Diabetes Mellitus appears to be the most common underlying condition associated with mucormycosis; a rare opportunistic fungal infection associated with high morbidity and mortality. Pulmonary mucormycosis may mimic pneumonia and thus pose challenges in achieving a timely diagnosis critical to successful outcomes. We present a case of a 65-year-old diabetic who presented with fever and haemoptysis that was managed as pneumonia. A bronchial alveolar lavage grew Rhizopus mould that was thought to be a contaminant as he responded well to antibiotics. He required another admission in 4 weeks due to worsening symptoms. Failure to respond to antibiotics and ongoing clinical and radiological deterioration led to a lobectomy that confirmed a diagnosis of pulmonary mucormycosis. He responded well to surgical resection and antifungal therapy with a complete recovery. Elusive clinical presentation and insensitive conventional diagnostic techniques may make the diagnosis of mucormycosis challenging. Our case reports highlight the issues involved in the diagnosis and management of pulmonary Mucormycosis mimicking as pneumonia.
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Affiliation(s)
- Muhammad Yousaf
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Sarah Salameh
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Irfan Ul Haq
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Samir Alhyassat
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar
| | - Merlin Thomas
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Aisha Hussain
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohd Wani
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Qatar
| | - Ehab Massad
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Qatar
| | | | | | - Mansoor Hameed
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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29
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Fungal Infections in Liver Transplant Recipients. J Fungi (Basel) 2021; 7:jof7070524. [PMID: 34210106 PMCID: PMC8304186 DOI: 10.3390/jof7070524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/25/2021] [Accepted: 06/21/2021] [Indexed: 01/03/2023] Open
Abstract
Invasive fungal infections (IFIs) are one of the most feared complications associated with liver transplantation, with high rates of morbidity and mortality. We discuss the most common invasive fungal infections in the setting of liver transplant, including Candida, Aspergillus, and Cryptococcal infections, and some less frequent but devastating mold infections. Further, we evaluate the use of prophylaxis to prevent invasive fungal infection in this population as a promising mechanism to reduce risks to patients after liver transplant.
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30
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Pandey M, Xess I, Singh G, Kumar R, Mahapatra M, Jyotsna VP, Agarwal R, Ghosh A, Iram A, Mani P. Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings. J Med Microbiol 2021; 70. [PMID: 34038342 DOI: 10.1099/jmm.0.001370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction. Invasive mucormycosis (IM) is a life-threatening infection caused by fungi belonging to the order Mucorales. Histopathology, culture and radiology are the mainstay of diagnosis but lack sensitivity, leading to a delay in timely diagnosis and intervention. Recently, PCR-based approaches have been shown to be a promising method in diagnosing IM.Hypothesis/Gap Statement. Molecular-based approaches may be a valuable adjunct to standard conventional methods for diagnosing IM, especially among culture negatives and patients on antifungal therapy.Aim. In the present study we aimed to evaluate the clinical utility of panfungal and Mucorales-specific PCR for diagnosing IM from various clinical specimens.Methodology. This was a prospective study in which 239 clinically suspected cases of IM attending our tertiary care hospital from August 2015 to March 2018 were enrolled. All the cases were defined as 'proven', 'probable' or 'possible' based on EORTC/MSGERC guidelines. In addition to conventional diagnostics (KOH-calcofluor stain and culture), panfungal and Mucorales-specific PCR assays were also performed. The amplified products were sequenced for species identification. In vitro antifungal susceptibility was performed on all the culture-positive isolates.Results. Among 239 clinically suspected cases of IM, only 140 cases were diagnosed by the demonstration of aseptate ribbon-like hyphae on direct microscopy. Culture was positive in 35.7 % (54/140) of direct microscopy-positive samples. Among the proven cases (n=11), the sensitivity for both Mucorales-specific nested PCR and panfungal PCR was 100 %, but specificity was 91.9 and 73.7% respectively. In probable cases (n=129), the sensitivity of both the PCRs was 98.5 % and specificity for panfungal PCR was 73.7 and 91.9 % for Mucorales-specific PCR.Conclusion. Pan fungal PCR in combination with Mucorales-specific PCR, followed by sequencing, may play a significant role in IM diagnosis especially among those negative for both direct microscopy and culture.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Ghosh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Azka Iram
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Mani
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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31
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Nadeem AM, Wahla AS, Al-Tarifi A. Invasive Mediastinal Mucormycosis with Pulmonary and Cardiac Involvement in an Adult with Chronic Granulomatous Disease: Case Report and Review of the Literature. Eur J Case Rep Intern Med 2021; 8:002435. [PMID: 34123938 DOI: 10.12890/2021_002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/05/2022] Open
Abstract
Mucormycosis is a rare fungal infection that often causes rhinocerebral disease. However, there have been rare cases of mediastinal involvement. These patients remain a therapeutic challenge and mortality in this group is very high. We report a case of mediastinal mucormycosis with invasion of the heart and right lung in a patient with chronic granulomatous disease (CGD) and also review the available literature on mediastinal mucormycosis. LEARNING POINTS Mucormycosis is a very rare cause of mediastinal mass, and has a high risk of mortality.Early recognition and treatment will likely increase the patient's chances of survival.Chronic granulomatous disease (CGD) is associated with an increased risk of fungal infections and should be considered for itraconazole prophylaxis.
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Affiliation(s)
- Ashraf M Nadeem
- Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ali Saeed Wahla
- Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ashraf Al-Tarifi
- Department of Critical Care Medicine at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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32
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Kumar S, Joshi D. Pulmonary mucormycosis in immunocompetent hosts diagnosed by bronchioalveolar lavage. BMJ Case Rep 2021; 14:e240180. [PMID: 33846183 PMCID: PMC8047986 DOI: 10.1136/bcr-2020-240180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/03/2022] Open
Abstract
Mucormycosis is a rare infection caused by Mucorales fungi belonging to Zygomycetes class. It can present with spectrum of symptoms and signs based of organ involvement. Common forms of mucormycosis includes rhinocerebral, cutaneous, gastrointestinal, pulmonary, disseminated and miscellaneous forms involving bones, breast, kidney and central nervous system. Pulmonary mucormycosis usually present with fever, cough, haemoptysis and is usually seen in immunocompromised patients like patients with diabetes or leukaemia, or those on chemotherapy or immunosuppressive therapy and rare in immunocompetent patients (6.25% of cases). Pulmonary mucormycosis can be diagnosed by radiological imaging studies, bronchoalveolar lavage (BAL) and histopathological evaluation of biopsy of the lesion; however, the gold standard is a positive fungal culture. Here, we describe two cases of pulmonary mucormycosis diagnosed by BAL in an immunocompetent patient.
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Affiliation(s)
- Sunil Kumar
- Pathology, KS Hegde Medical Academy, Mangalore, India
| | - Divya Joshi
- Pathology, KS Hegde Medical Academy, Mangalore, India
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33
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Godinho G, Abreu I, Alves G, Vaz R, Leal V, Carvalho AC, Sarmento A, Falcão-Reis F. Orbital Apex Syndrome due to Orbital Mucormycosis after Teeth Infection: A Successful Case Report. Case Rep Ophthalmol 2021; 12:110-115. [PMID: 33976666 PMCID: PMC8077525 DOI: 10.1159/000510389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
Rhino-orbital-cerebral mucormycosis is a severe and rapidly progressive fungal infection associated with low survival rates. Early diagnosis and proper management are mandatory. We report the case of a 20-year-old female with diabetic ketoacidosis and teeth infection, who presented with sudden orbital apex syndrome. Several surgical procedures were necessary to provide a definite histopathological diagnosis of the fungal infection. Ultimately, given the progressive aggravation of the infection and the ineffectiveness of antifungal and antibiotic agents, an orbital exenteration was performed. A mycobacteriological examination revealed a polymicrobial culture with Mucorales. One year after the initial presentation, the patient is alive and with a good general health condition.
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Affiliation(s)
- Gonçalo Godinho
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Gonçalo Alves
- Neuroradiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ricardo Vaz
- ORL Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Vitor Leal
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ana Cláudia Carvalho
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
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34
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Jain A, Knoll B, Lim S, Kleinman G, Epelbaum O. For Whom the Atoll Tolls: Targeting the Reversed Halo Sign. Am J Med 2021; 134:e150-e152. [PMID: 33353726 DOI: 10.1016/j.amjmed.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | | | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Westchester Medical Center, Valhalla, NY
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35
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Coomes DS, Logan RL, Backous CA, Adeyemi OA. A 51-Year-Old Woman With a Mediastinal Mass. Chest 2021; 159:e141-e145. [PMID: 33678281 DOI: 10.1016/j.chest.2020.09.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/29/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
CASE PRESENTATION A 51-year-old woman with a medical history of poorly controlled type 1 diabetes mellitus, hyperthyroidism, and tobacco abuse was admitted to the hospital with persistent nausea, vomiting, abdominal discomfort, dry cough, rhinorrhea, and sore throat. She denied fevers, chills, rigors, shortness of breath, hemoptysis, nasal congestion, postnasal drip, and facial pain. She denied any sick contacts, and there was no recent travel outside of Chicago.
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Affiliation(s)
- Daniel S Coomes
- Department of Medicine, Section of Pulmonary and Critical Care, Swedish Hospital part of NorthShore University HealthSystem, Chicago, IL
| | - Rachel L Logan
- Department of Medicine, Section of Pulmonary and Critical Care, Swedish Hospital part of NorthShore University HealthSystem, Chicago, IL
| | - Craig A Backous
- Department of Medicine, Section of Pulmonary and Critical Care, Swedish Hospital part of NorthShore University HealthSystem, Chicago, IL
| | - Oluwadamilola A Adeyemi
- Department of Medicine, Section of Infectious Diseases, Swedish Hospital part of NorthShore University HealthSystem, Chicago, IL; Department of Medicine, Section of Infectious Diseases, Northwestern Medicine Lake Forest Hospital, Lake Forest, IL.
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36
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Beiglboeck FM, Theofilou NE, Fuchs MD, Wiesli MG, Leiggener C, Igelbrink S, Augello M. Managing mucormycosis in diabetic patients: A case report with critical review of the literature. Oral Dis 2021; 28:568-576. [PMID: 33583133 DOI: 10.1111/odi.13802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Rhino-orbito-cerebral mucormycosis (ROCM) is a rare and potentially fatal invasive fungal infection which usually occurs in diabetic and other immunocompromised patients. This infection is associated with high morbidity and mortality rates. Prompt diagnosis and rapid aggressive surgical debridement and antimycotic therapy are essential for the patient's survival. Herein, we reviewed the localization and treatment strategies in patients with ROCM and diabetes as an underlying condition. Furthermore, we report one case of ROCM in our department. MATERIALS AND METHODS From 117 identified studies published in PubMed, 14 publications-containing data from 54 patients-were included. All patients were diagnosed clinically and by histopathological and/or bacteriological analysis for ROCM caused by the order Mucorales. CONCLUSION Uncontrolled diabetes mellitus is one of the main risk factors for ROCM. A successful management of ROCM requires an early diagnosis, a prompt systemic antifungal therapy, and a rapid aggressive surgical debridement including exploration of the pterygopalatine fossa. An orbital exenteration may be necessary.
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Affiliation(s)
- Fabian M Beiglboeck
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland.,Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral- and Maxillofacial Surgery, University Hospital Muenster, Münster, Deutschland
| | - Nantia E Theofilou
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias D Fuchs
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias G Wiesli
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Christoph Leiggener
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Igelbrink
- Department of Oral- and Maxillofacial Surgery, University Hospital Muenster, Münster, Deutschland
| | - Marcello Augello
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
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37
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Panchanatheeswaran K, Ram D, Prasad S, Srinivas BH, Rath D, SaiChandran BV, Munuswamy H. Thoracic mucormycosis in immunocompetent patients. J Card Surg 2021; 36:1183-1188. [PMID: 33470008 DOI: 10.1111/jocs.15332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/17/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mucormycosis is an invasive fungal infection. It is rare and commonly associated with fatal outcomes. METHODS We report two cases of thoracic mucormycosis in immunocompetent patients. First, is an immunocompetent child with mediastinal mass and extension into the pericardium and left atrium. The second is a young woman with a left pulmonary artery pseudoaneurysm. RESULTS The first patient could not be salvaged while the second patient was successfully managed with surgical intervention and systemic antifungal treatment. CONCLUSION Mucormycosis should be considered as a differential diagnosis in the management of immunocompetent patients in patients with pyrexia of unknown origin and a mediastinal mass. Early and aggressive surgical management along with systemic antifungal treatment improves the survival in this subset of patients.
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Affiliation(s)
- Karthik Panchanatheeswaran
- Department of Cardiothoracic Surgery, Velammal Medical College Hospital & Research Institute, Madurai, India
| | - Duvuru Ram
- Green Lane Cardiothoracic Unit, Auckland City Hospital, New Zealand
| | - Sreevathsa Prasad
- Department of Cardiothoracic and Vascular Surgery, JIPMER, Pondicherry, India
| | | | - Durgaprasad Rath
- Department of Cardiothoracic and Vascular Surgery, JIPMER, Pondicherry, India
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38
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Chakrabarti A. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:538-549. [PMID: 33418022 DOI: 10.1016/j.cmi.2020.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM. METHODS We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. RESULTS We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. CONCLUSIONS While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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39
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Sutradhar J, Sarkar B. Manifestations and risk factors of COVID-19 and mucormycosis: A mini-review. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.330739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Pulle MV, Puri HV, Asaf BB, Bishnoi S, Sharma S, Kumar A. Outcomes of early anti-fungal therapy with aggressive surgical resection in pulmonary mucormycosis. Lung India 2021; 38:314-320. [PMID: 34259168 PMCID: PMC8272436 DOI: 10.4103/lungindia.lungindia_758_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives The standard management protocols are lacking in the management of pulmonary mucormycosis (PM). The present study aims at reporting our clinical experience and proposing an algorithm for the management of PM. Materials and Methods This is a retrospective analysis of a prospectively maintained database at a dedicated thoracic surgical unit in New Delhi, India, over 7 years. An analysis of demographic characteristics and perioperative variables including complications was carried out. Various parameters were analyzed to assess the factors affecting mortality after surgical intervention. Results Out of total 19 patients, 15 were males (78.9%) and 4 females (21.1%), with a mean age of 43.8 years (range, 19-72 years). Chronic kidney disease (status postrenal transplant on immunosuppressant therapy) was the most common predisposing factor in 11 patients (57.8%). All patients were initially started on antifungal therapy, and after 7-8 days, the response was assessed by computed tomography scan of the chest, and based on that, 15 patients (78.9%) were operated (surgical group) and the rest 4 (21.1%) were not (nonsurgical group). In the surgical group, lobectomy was required in 12 (80%) and pneumonectomy in 3 patients (20%). Postoperative complications occurred in 5 patients (33.3%). There were 3 perioperative deaths (within 90 days of surgery) (20%). Poor Eastern Cooperative Oncology Group performance status (>2) and longer duration of symptoms (>2 weeks) were independent predictors of mortality after surgery. The survivors in the surgical group are doing well. However, all four patients in the nonsurgical group died due to disease progression. Conclusion After few days of initiation of antifungal therapy, aggressive surgical resection must be performed (wherever feasible) to improve survival outcome in patients with PM.
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Affiliation(s)
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Shikha Sharma
- Department of Anaesthesia, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Longhitano A, Alipour R, Khot A, Bajel A, Antippa P, Slavin M, Thursky K. The role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in assessment of complex invasive fungal disease and opportunistic co-infections in patients with acute leukemia prior to allogeneic hematopoietic cell transplant. Transpl Infect Dis 2020; 23:e13547. [PMID: 33338319 DOI: 10.1111/tid.13547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Individuals diagnosed with acute lymphoid and myeloid malignancies are at significant risk of invasive fungal and bacterial infections secondary to their marked immunocompromised states with a significant high risk of mortality. The role of metabolic imaging with 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) has been increasingly recognized in optimizing the diagnosis of invasive infection, monitoring the response to therapy and guiding the duration of antimicrobial therapy or need to escalate to surgical intervention. METHODS Two distinct cases of pulmonary co-infection of rare fungal and bacterial pathogens are explored in severely immunocompromised individuals where FDG PET/CT aided both patients to make a full recovery and transition to HCT. The first case explores mixed Scedosporium apiospermum and Rhizomucor pulmonary infection on a background of T cell/myeloid mixed phenotype acute leukemia ultimately warranting long-term antifungal therapy and lobectomy prior to HCT. The second case explores Fusarium and Nocardia pulmonary infection on a background of relapsed AML also warranting surgical resection with lobectomy and long-term antimicrobials prior to transition to HCT. DISCUSSION The cases highlight the utility of FDG PET/CT to support the diagnosis of infections, including the presence or absence of disseminated infection, and to provide highly sensitive monitoring of the infection over time. FDG PET/CT played a key role in directing therapy duration decisions and prompted the necessity for surgical intervention. Ultimately, the use of FDG PET/CT allowed for a successful transition to HCT highlighting its value in this clinical setting. CONCLUSION FDG PET/CT has an emerging role in the diagnostic and monitoring pathway for complex infections in high-risk immunocompromised patients.
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Affiliation(s)
- Anthony Longhitano
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Ramin Alipour
- Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Vic., Australia.,Lung Cancer Service, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,National Centre for Antimicrobial Stewardship (NCAS), The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
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Mempin R, Kamangar N. Pulmonary Artery Pseudoaneurysm due to Mucormycosis: Case Report and Literature Review. J Clin Imaging Sci 2020; 10:55. [PMID: 33024610 PMCID: PMC7533101 DOI: 10.25259/jcis_127_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary artery pseudoaneurysm (PAP) is a rare vascular phenomenon with a high mortality rate, as these entities can enlarge, rupture, and lead to asphyxiation. Pulmonary mucormycosis (PM), an underdiagnosed but an increasingly seen entity in the era of chemotherapy and immunosuppression, is a known cause of PAP, and should be suspected in immunosuppressed patients with hemoptysis. We present a case of PAP due to PM in a patient with recently diagnosed diffuse large B-cell lymphoma of the liver who underwent chemotherapy and developed acute cavitary lung disease and hemoptysis. His diagnosis was delayed due to the withholding of iodinated contrast with computer tomography (CT) imaging in the setting of renal failure. He then underwent embolization of his PAP with resolution of his hemoptysis. PAP is an uncommon cause of hemoptysis that can be diagnosed with CT pulmonary angiography, and mucormycosis is a known but rare cause of PAP in patients with malignancy receiving immunosuppression.
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Affiliation(s)
- Roberto Mempin
- Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Nader Kamangar
- Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Shariati A, Moradabadi A, Chegini Z, Khoshbayan A, Didehdar M. An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies. Infect Drug Resist 2020; 13:2329-2354. [PMID: 32765009 PMCID: PMC7369308 DOI: 10.2147/idr.s254478] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
In patients with hematologic malignancies due to immune system disorders, especially persistent febrile neutropenia, invasive fungal infections (IFI) occur with high mortality. Aspergillosis, candidiasis, fusariosis, mucormycosis, cryptococcosis and trichosporonosis are the most important infections reported in patients with hematologic malignancies that undergo hematopoietic stem cell transplantation. These infections are caused by opportunistic fungal pathogens that do not cause severe issues in healthy individuals, but in patients with hematologic malignancies lead to disseminated infection with different clinical manifestations. Prophylaxis and creating a safe environment with proper filters and air pressure for patients to avoid contact with the pathogens in the surrounding environment can prevent IFI. Furthermore, due to the absence of specific symptoms in IFI, rapid and accurate diagnosis reduces the mortality rate of these infections and using molecular techniques along with standard mycological methods will improve the diagnosis of disseminated fungal infection in patients with hematologic disorders. Amphotericin B products, extended-spectrum azoles, and echinocandins are the essential drugs to control invasive fungal infections in patients with hematologic malignancies, and according to various conditions of patients, different results of treatment with these drugs have been reported in different studies. On the other hand, drug resistance in recent years has led to therapeutic failures and deaths in patients with blood malignancies, which indicates the need for antifungal susceptibility tests to use appropriate therapies. Life-threatening fungal infections have become more prevalent in patients with hematologic malignancies in recent years due to the emergence of new risk factors, new species, and increased drug resistance. Therefore, in this review, we discuss the different dimensions of the most critical invasive fungal infections in patients with hematologic malignancies and present a list of these infections with different clinical manifestations, treatment, and outcomes.
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Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Moradabadi
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Khoshbayan
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
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Brunet K, Rammaert B. Mucormycosis treatment: Recommendations, latest advances, and perspectives. J Mycol Med 2020; 30:101007. [PMID: 32718789 DOI: 10.1016/j.mycmed.2020.101007] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022]
Abstract
Mucormycosis are life-threatening fungal infections especially affecting immunocompromised or diabetic patients. Despite treatment, mortality remains high (from 32 to 70% according to organ involvement). This review provides an update on mucormycosis management. The latest recommendations strongly recommend as first-line therapy the use of liposomal amphotericin B (≥5mg/kg) combined with surgery whenever possible. Isavuconazole and intravenous or delayed-release tablet forms of posaconazole have remained second-line. Many molecules are currently in development to fight against invasive fungal diseases but few have demonstrated efficacy against Mucorales. Despite in vitro efficacy, combinations of treatment have failed to demonstrate superiority versus monotherapy. Adjuvant therapies are particularly complex to evaluate without prospective randomized controlled studies, which are complex to perform due to low incidence rate and high mortality of mucormycosis. Perspectives are nonetheless encouraging. New approaches assessing relationships between host, fungi, and antifungal drugs, and new routes of administration such as aerosols could improve mucormycosis treatment.
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Affiliation(s)
- K Brunet
- INSERM U1070, Poitiers, France; Faculté de médecine et pharmacie, université de Poitiers, Poitiers, France; Service de mycologie-parasitologie, département des agents infectieux, CHU de Poitiers, Poitiers, France.
| | - B Rammaert
- INSERM U1070, Poitiers, France; Faculté de médecine et pharmacie, université de Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France
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Claustre J, Larcher R, Jouve T, Truche AS, Nseir S, Cadiet J, Zerbib Y, Lautrette A, Constantin JM, Charles PE, Daubin C, Coudroy R, Dellamonica J, Argaud L, Phelouzat P, Contou D, Pocquet J, Voiriot G, Navellou JC, Lavagne P, Durand M, Cornet M, Schwebel C, Terzi N. Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy. Ann Intensive Care 2020; 10:74. [PMID: 32514787 PMCID: PMC7280386 DOI: 10.1186/s13613-020-00673-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001). Conclusion Overall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.
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Affiliation(s)
- Johanna Claustre
- Service de Pneumologie, CH Annecy Genevois, 1 Avenue de l'hôpital, 74370, Epagny Metz-Tessy, France.
| | - Romaric Larcher
- Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France
| | - Thomas Jouve
- Université Grenoble Alpes, Grenoble, France.,Service Hospitalo-universitaire de Néphrologie, CHU Grenoble Alpes, Grenoble, France
| | - Anne-Sophie Truche
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Saad Nseir
- Réanimation Médicale, CHU Lille, Lille, France
| | - Julien Cadiet
- Service de médecine intensive Réanimation, CHU Nantes, Nantes, France
| | | | | | | | | | | | - Remi Coudroy
- Réanimation médicale, CHU Poitiers, Poitiers, France
| | - Jean Dellamonica
- Médecine Intensive Réanimation, CHU Nice, Université Côte d'Azur, Nice, France
| | | | | | - Damien Contou
- Réanimation polyvalente, CH Argenteuil, Argenteuil, France
| | | | | | | | - Pierre Lavagne
- Réanimation Polyvalente Chirurgicale, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Réanimation Cardio-vasculaire et Thoracique, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Cornet
- Université Grenoble Alpes, Grenoble, France.,Laboratoire de Mycologie-Parasitologie, CHU Grenoble Alpes, Grenoble, France
| | - Carole Schwebel
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Nicolas Terzi
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
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Seifert S, Wiley J, Kirkham J, Lena S, Schiers K. Pulmonary mucormycosis with extensive bronchial necrosis and bronchomediastinal fistula: A case report and review. Respir Med Case Rep 2020; 30:101082. [PMID: 32461882 PMCID: PMC7240283 DOI: 10.1016/j.rmcr.2020.101082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
Mucormycosis is a life-threatening infection caused by fungi in the Mucorales species. It most often affects immunocompromised hosts, including diabetics patients. It can affect a variety of organ systems with pulmonary manifestations being the second most common. In severe cases, significant bronchial necrosis and angioinvasion can be seen. Due to its rarity, such extensive cases are not often reported in literature. We present a case of a 32-year-old man who presented with severe bronchial necrosis, including bronchomediastinal fistula, due to Rhizopus. Despite prompt treatment, he developed massive hemoptysis from invasion of the pulmonary vasculature and died. We also provide a brief review of mucormycosis.
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Affiliation(s)
- S Seifert
- Department of Pulmonary Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - J Wiley
- Department of Pulmonary and Critical Care Medicine, Jefferson Health New Jersey, Sewell, NJ, USA
| | - J Kirkham
- Department of Pulmonary and Critical Care Medicine, Jefferson Health New Jersey, Sewell, NJ, USA
| | - S Lena
- Department of Pulmonary Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Schiers
- Department of Pulmonary and Critical Care Medicine, Jefferson Health New Jersey, Sewell, NJ, USA
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Agrawal R, Yeldandi A, Savas H, Parekh ND, Lombardi PJ, Hart EM. Pulmonary Mucormycosis: Risk Factors, Radiologic Findings, and Pathologic Correlation. Radiographics 2020; 40:656-666. [PMID: 32196429 DOI: 10.1148/rg.2020190156] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pulmonary mucormycosis (PM) is an uncommon fungal infection most often seen in immunocompromised patients. The fungus grows on decaying food, soil, and animal excrement. Patients usually become infected by inhalation of spores. The most common risk factors include diabetes mellitus, hematologic malignancy, and solid organ or stem cell transplant. PM can have a nonspecific appearance at imaging. For example, early imaging may show peribronchial ground-glass opacity. Later, the disease progresses to consolidation, nodules, or masses. Because patients are usually immunocompromised, the differential diagnosis often includes invasive pulmonary aspergillosis (IPA). Various radiologic findings suggestive of PM have been identified to help differentiate it from IPA. For example, the reverse halo sign is more closely associated with PM than with IPA. The reverse halo sign is an area of ground-glass opacity surrounded by a rim of consolidation. In addition, the presence of pleural effusions and more than 10 nodules is more suggestive of PM than it is of IPA. PM can progress rapidly in neutropenic patients. Identification of the hyphae in tissue by using endobronchial or percutaneous sampling can allow differentiation from IPA and help confirm the diagnosis of mucormycosis. Because of the high mortality rate associated with PM, early identification of the disease is critical for an improved likelihood of survival. A multimodality treatment approach with antifungal agents and surgical débridement has been shown to improve outcomes. The authors review the risk factors for PM, describe its imaging appearance and disease process, and describe the treatment of the disease. ©RSNA, 2020.
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Affiliation(s)
- Rishi Agrawal
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Anjana Yeldandi
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Hatice Savas
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Nishant D Parekh
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Pamela J Lombardi
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Eric M Hart
- From the Departments of Radiology (R.A., H.S., N.D.P., P.J.L., E.M.H.) and Pathology (A.Y.), Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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Shao W, Zhang J, Ma S, Feng H, Zhang Z, Liang C, Liu D. Characteristics of pulmonary mucormycosis and the experiences of surgical resection. J Thorac Dis 2020; 12:733-740. [PMID: 32274139 PMCID: PMC7139020 DOI: 10.21037/jtd.2019.12.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection Methods We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018. Results Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150–390 min], the median intraoperative blood loss was 500 mL (IQR, 100–1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0–1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively. Conclusions PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.
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Affiliation(s)
- Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Jun Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Shanwu Ma
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
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A Rare Case of Fatal Endobronchial Mucormycosis Masquerading as Endobronchial Tuberculosis. ACTA ACUST UNITED AC 2020; 56:medicina56020064. [PMID: 32041089 PMCID: PMC7074438 DOI: 10.3390/medicina56020064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/22/2020] [Accepted: 02/02/2020] [Indexed: 11/17/2022]
Abstract
Pulmonary mucormycosis is a relatively rare but often fatal opportunistic fungal infection that occurs mostly in immunocompromised patients. Endobronchial mucormycosis, a distinct clinical form of pulmonary mucormycosis, is very rare, and only a few cases have been reported. The most common bronchoscopic findings in patients with endobronchial mucormycosis are stenosis, erythematous mucosa and airway obstruction. Here, we present a case of fatal endobronchial mucormycosis mimicking actively caseating endobronchial tuberculosis in a young diabetic patient living in a country with an intermediate tuberculosis burden.
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