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Chen H, Yu L, Wang L, Zhang J, Yan X, Jiang Y. Demographic characteristics and risk factors for invasive fungal sinusitis in the context of COVID-19: A systematic review and meta-analysis. Int J Infect Dis 2024; 144:107054. [PMID: 38614232 DOI: 10.1016/j.ijid.2024.107054] [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: 01/10/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES To identify the demographic characteristics and potential risk factors of invasive fungal sinusitis (IFS) patients with Coronavirus Disease in 2019 (COVID-19). METHODS Web of Science, Embase, the Cochrane Library, and PubMed were searched from database inception to August 2023 using the combination of medical searching heading terms "invasive fungal sinusitis" and "COVID-19" and their free words. The research protocol was registered on PROSPERO (CRD42023467175). RESULTS A total of 53 studies were included. The mean age of IFS patients with COVID-19 was 53.72 (95% credible interval [CI]: 51.08, 56.36), with 66% males (95% CI: 0.62, 0.70), and 81% diabetes (95% CI: 0.77, 0.86). The mean time from COVID-19 diagnosis to IFS onset was 19.09 days (95% CI: 16.96, 21.22). The percentage of patients with COVID-19 PCR positivity was 33% (95% CI: 0.21, 0.45). Overall, 71% of patients receiving steroid therapy during COVID-19 infection (95% CI: 0.63, 0.78). The odds ratio of diabetes mellitus, steroid administration, and COVID-19 PCR positivity were 6.09, 2.21, and 1.82, respectively. COVID-19 infection did not affect the IFS stage. CONCLUSION IFS patients with COVID-19 had an average age of 53.72 years and were predominantly males, with a mean interval of 19.09 days from COVID-19 diagnosis to IFS onset. Diabetes, steroid administration, and COVID-19 PCR positivity were risk factors.
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Affiliation(s)
- Han Chen
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Longgang Yu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lin Wang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jisheng Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xudong Yan
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yan Jiang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Paavai TT, Vasanthi V, Rameshkumar A, Rajkumar K, Krishnakumar Raja VB, Muthusubramanian V. Maxillary Mucormycotic Osteonecrosis as a Manifestation of Post-COVID-19 Infection in Non-diabetic Patients: Report of Two Cases. J Microsc Ultrastruct 2024; 12:99-103. [PMID: 39006044 PMCID: PMC11245128 DOI: 10.4103/jmau.jmau_81_23] [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: 05/29/2023] [Revised: 07/22/2023] [Accepted: 08/06/2023] [Indexed: 07/16/2024] Open
Abstract
Mucormycosis is a rare, opportunistic fungal infection prevalent in the elderly, especially in patients with uncontrolled diabetes or a compromised immune system. However, the outbreak of the pandemic declared by the World Health Organization in late 2019 increased the incidence of mucormycosis cases in COVID-19 patients due to increased steroid usage that resulted in an immunocompromised state. The current report presents two cases of oral mucormycotic osteomyelitis in patients who developed diabetes post-COVID infection, along with a review and relevant literature.
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Affiliation(s)
| | - V. Vasanthi
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Annasamy Rameshkumar
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Krishnan Rajkumar
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - V. B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
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Hossain MS, Rahman MA, Dey PR, Khandocar MP, Ali MY, Snigdha M, Coutinho HDM, Islam MT. Natural Isatin Derivatives Against Black Fungus: In Silico Studies. Curr Microbiol 2024; 81:113. [PMID: 38472456 DOI: 10.1007/s00284-024-03621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/18/2024] [Indexed: 03/14/2024]
Abstract
During this coronavirus pandemic, when a lot of people are already severely afflicted with SARS-CoV-19, the dispersion of black fungus is making it worse, especially in the Indian subcontinent. Considering this situation, the idea for an in silico study to identify the potential inhibitor against black fungal infection is envisioned and computational analysis has been conducted with isatin derivatives that exhibit considerable antifungal activity. Through this in silico study, several pharmacokinetics properties like absorption, distribution, metabolism, excretion, and toxicity (ADMET) are estimated for various derivatives. Lipinski rules have been used to observe the drug likeliness property, and to study the electronic properties of the molecules, quantum mechanism was analyzed using the density functional theory (DFT). After applying molecular docking of the isatin derivatives with sterol 14-alpha demethylase enzyme of black fungus, a far higher docking affinity score has been observed for the isatin sulfonamide-34 (derivative 1) than the standard fluconazole. Lastly, molecular dynamic (MD) simulation has been performed for 100 ns to examine the stability of the proposed drug complex by estimating Root Mean Square Deviation (RMSD), Radius of gyration (Rg), Solvent accessible surface area (SASA), Root Mean Square Fluctuation (RMSF), as well as hydrogen bond. Listed ligands have precisely satisfied every pharmacokinetics requirement for a qualified drug candidate and they are non-toxic, non-carcinogenic, and have high stability. This natural molecule known as isatin derivative 1 has shown the potential of being a drug for fungal treatment. However, the impact of the chemicals on living cells requires more investigation and research.
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Affiliation(s)
- Md Saddam Hossain
- Department of Biomedical Engineering, Islamic University, Kushtia, 7003, Bangladesh
| | - Md Anisur Rahman
- Department of Pharmacy, Islamic University, Kushtia, 7003, Bangladesh
| | - Prithbey Raj Dey
- Department of Industrial and Production Engineering, Dhaka University of Engineering and Technology, Gazipur, 1707, Bangladesh
| | - Md Parvez Khandocar
- Department of Biomedical Engineering, Islamic University, Kushtia, 7003, Bangladesh
| | - Md Yeakub Ali
- Department of Biomedical Engineering, Islamic University, Kushtia, 7003, Bangladesh
| | - Mahajabin Snigdha
- Department of Pharmacy, Islamic University, Kushtia, 7003, Bangladesh
| | | | - Muhammad Torequl Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
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4
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Kiruthiga KG, Kulkarni A, Joshi A, Pradhan A, Naik S. Diagnosis of Mucormycosis Using Frozen Section, Histopathology, Culture, and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Techniques: A Comparative Study. Cureus 2024; 16:e56160. [PMID: 38618301 PMCID: PMC11015875 DOI: 10.7759/cureus.56160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Mucormycosis usually occurs in immunocompromised patients or those with uncontrolled diabetes. Along the third wave of SARS-CoV-2, an associated angioinvasive opportunistic infection with Mucor, a life-threatening fungal infection, was rampant and emerging. With an increase in the usage of steroids in the COVID scenario, the rate of mucormycosis did take a rapid and alarming increase in King Edward Memorial Hospital, Pune, India. Any delay in the diagnosis and management of the disease was life-threatening. The most conventional methods to diagnose mucormycosis are microbiological culture and histopathology of the tissue. The microbiological culture method plays an important role in the diagnosis of mucormycosis. However, the technique is labour-intensive, taking seven to eight days. Histopathology leads to false-negative reports if the tissue is not biopsied from representative sites. On the other hand, molecular methods are rapid, reliable, and applicable to different body samples, such as tissue, paraffin-embedded tissue blocks, plasma, and urine. We aimed to use a reverse transcriptase polymerase chain reaction (RT-PCR) method to detect Mucor in plasma samples. Due to a lack of availability of fresh samples, nucleic acid was extracted from the tissue sections of 69 cases diagnosed as Mucor by histopathology. These samples were subjected to RT-PCR using the MucorGenius kit (Pathonostics, Maastricht, Netherlands). A total of 57 tissue samples were sent for culture, and 49% of our cases were positive by culture and equally by RT-PCR. There was 80% sensitivity and 76% specificity between culture and PCR techniques. However, the use of blood/plasma for RT-PCR for early diagnosis of mucormycosis will be the method of choice.
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Affiliation(s)
| | - Anusha Kulkarni
- Department of Pathology, King Edward Memorial Hospital, Pune, IND
| | - Aparna Joshi
- Department of Pathology, King Edward Memorial Hospital, Pune, IND
| | - Avinash Pradhan
- Department of Pathology, King Edward Memorial Hospital, Pune, IND
| | - Sadanand Naik
- Department of Biochemistry, King Edward Memorial Hospital, Pune, IND
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Patil R, Mukhida S, Ajagunde J, Khan U, Khan S, Gandham N, Vyawhare C, Das NK, Mirza S. Development of a machine learning model to predict risk of development of COVID-19-associated mucormycosis. Future Microbiol 2024; 19:297-305. [PMID: 38294306 DOI: 10.2217/fmb-2023-0190] [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: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
Aim: The study aimed to identify quantitative parameters that increase the risk of rhino-orbito-cerebral mucormycosis, and subsequently developed a machine learning model that can anticipate susceptibility to developing this condition. Methods: Clinicopathological data from 124 patients were used to quantify their association with COVID-19-associated mucormycosis (CAM) and subsequently develop a machine learning model to predict its likelihood. Results: Diabetes mellitus, noninvasive ventilation and hypertension were found to have statistically significant associations with radiologically confirmed CAM cases. Conclusion: Machine learning models can be used to accurately predict the likelihood of development of CAM, and this methodology can be used in creating prediction algorithms of a wide variety of infections and complications.
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Affiliation(s)
- Rajashri Patil
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Sahjid Mukhida
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Jyoti Ajagunde
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Uzair Khan
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Sameena Khan
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Nageswari Gandham
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Chanda Vyawhare
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Nikunja K Das
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Shahzad Mirza
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
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Jeican II, Horhat DI, Dumitru M, Florea A, Barbu-Tudoran L, Gheban BA, Anton V, Toader C, Aluaș M, Siserman CV, Balica N, Vrînceanu D, Albu S. COVID-19-Associated Rhino-Orbital Mucormycosis: Histological and Electron Microscopy Characteristics. Diagnostics (Basel) 2024; 14:429. [PMID: 38396469 PMCID: PMC10887990 DOI: 10.3390/diagnostics14040429] [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: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19-associated rhino-orbital mucormycosis has become a new clinical entity. This study's aim was to evaluate the histopathological and ultramicroscopic morphological aspects of this fungal infection. This was an observational retrospective study on eight patients from three tertiary centers in Romania. The tissue samples collected during functional endoscopic sinus surgery were studied through histopathological examination, scanning electron microscopy, and transmission electron microscopy. In the histopathological examination, the morphological aspects characteristic of mucormycosis in all cases were identified: wide aseptate hyphae with right-angle ramifications, which invade blood vessels. One case presented perineural invasion into the perineural lymphatics. And in another case, mucormycosis-aspergillosis fungal coinfection was identified. Through scanning electron microscopy, long hyphae on the surface of the mucosa surrounded by cells belonging to the local immune system were identified in all samples, and bacterial biofilms were identified in half of the samples. Through transmission electron microscopy, aseptate hyphae and bacterial elements were identified in the majority of the samples. Rhino-orbital-cerebral mucormycosis associated with COVID-19 produces nasal sinus dysbiosis, which favors the appearance of bacterial biofilms. The way in which the infection develops depends on the interaction of the fungi with cells of the immune system.
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Affiliation(s)
- Ionuț Isaia Jeican
- Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Delia Ioana Horhat
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Mihai Dumitru
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Adrian Florea
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Lucian Barbu-Tudoran
- Electron Microscopy Laboratory Prof. C. Crăciun, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania;
- Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Bogdan-Alexandru Gheban
- Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Department of Pathology, Emergency Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Vlad Anton
- Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Corneliu Toader
- Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania;
| | - Maria Aluaș
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Vasile Siserman
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
- Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Nicolae Balica
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Daniela Vrînceanu
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Silviu Albu
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
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7
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Pintye A, Bacsó R, Kovács GM. Trans-kingdom fungal pathogens infecting both plants and humans, and the problem of azole fungicide resistance. Front Microbiol 2024; 15:1354757. [PMID: 38410389 PMCID: PMC10896089 DOI: 10.3389/fmicb.2024.1354757] [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: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Azole antifungals are abundantly used in the environment and play an important role in managing fungal diseases in clinics. Due to the widespread use, azole resistance is an emerging global problem for all applications in several fungal species, including trans-kingdom pathogens, capable of infecting plants and humans. Azoles used in agriculture and clinics share the mode of action and facilitating cross-resistance development. The extensive use of azoles in the environment, e.g., for plant protection and wood preservation, contributes to the spread of resistant populations and challenges using these antifungals in medical treatments. The target of azoles is the cytochrome p450 lanosterol 14-α demethylase encoded by the CYP51 (called also as ERG11 in the case of yeasts) gene. Resistance mechanisms involve mainly the mutations in the coding region in the CYP51 gene, resulting in the inadequate binding of azoles to the encoded Cyp51 protein, or mutations in the promoter region causing overexpression of the protein. The World Health Organization (WHO) has issued the first fungal priority pathogens list (FPPL) to raise awareness of the risk of fungal infections and the increasingly rapid spread of antifungal resistance. Here, we review the main issues about the azole antifungal resistance of trans-kingdom pathogenic fungi with the ability to cause serious human infections and included in the WHO FPPL. Methods for the identification of these species and detection of resistance are summarized, highlighting the importance of these issues to apply the proper treatment.
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Affiliation(s)
- Alexandra Pintye
- Centre for Agricultural Research, Plant Protection Institute, HUN-REN, Budapest, Hungary
- Department of Plant Anatomy, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Renáta Bacsó
- Centre for Agricultural Research, Plant Protection Institute, HUN-REN, Budapest, Hungary
| | - Gábor M. Kovács
- Centre for Agricultural Research, Plant Protection Institute, HUN-REN, Budapest, Hungary
- Department of Plant Anatomy, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
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Urias-Barreras CM, Rodríguez-Archilla A, Canizalez-Roman A, Bastidas DA, León-Sicairos NM. Maxillary mucormycosis and aspergillosis in post-COVID-19 patients in Mexico: A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101615. [PMID: 37648209 DOI: 10.1016/j.jormas.2023.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Fungal infections, during or as a consequence of SARS-CoV-2 infection, associated with uncontrolled diabetes mellitus and indiscriminate use of corticosteroids have been reported. In the jaw, mostly mucormycosis has been diagnosed in hospitals. METHODS A retrospective, cross-sectional, descriptive study of the clinical, imaging, and histopathologic characteristics of maxillary invasive fungal infection in post-COVID-19 patients diagnosed in a private non-hospital oral pathology service in Mexico during 2020-2022 was conducted. RESULTS We found 20 cases of maxillary invasive fungal infections in post-COVID-19 patients, 75% including a diagnosis of mucormycosis and 25% diagnosed as probable aspergillosis. The most common signs and symptoms were exposed necrotic bone followed by tooth mobility, discharge, and pain. On imaging, unilateral maxillary sinus involvement was observed in 6 cases (30%), and bilateral maxillary sinus involvement was observed in 3 cases (15%). CONCLUSIONS It is essential to consider the association of osteonecrosis of the jaw in post-COVID-19 patients, with aspergillosis, not only mucormycosis, for early diagnosis and appropriate treatment.
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Affiliation(s)
- Cynthia M Urias-Barreras
- School of Dentistry, Autonomous University of Sinaloa, Culiacan, Sinaloa 80013, Mexico; Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Alberto Rodríguez-Archilla
- Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Secretariat of Health, The Women's Hospital, Culiacan, Sinaloa 80020, Mexico
| | - Daniela A Bastidas
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico
| | - Nidia M León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Departamento de Investigación, Hospital Pediátrico de Sinaloa "Dr. Rigoberto Aguilar Pico" Servicios de Salud de Sinaloa. Blvd. Constitución S/N, Colonia Jorge Almada, C.P, Culiacan, Sinaloa 80200, Mexico.
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de Guimarães JA, Boasquevisque GS, Gaspar GG, Podolsky-Gondim GG, Mello FLV, Valera FCP, Chahud F, Cruz AAVE. Progressive chronic calvarial osteomyelitis in rhino-orbital mucormycosis associated with COVID-19. Orbit 2024; 43:119-125. [PMID: 35642653 DOI: 10.1080/01676830.2022.2080233] [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: 02/08/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.
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Affiliation(s)
- Juliana Albano de Guimarães
- Division of Ophthalmology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | | | - Gilberto Gambero Gaspar
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Guilherme Gozzoli Podolsky-Gondim
- Division of Neurosurgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fábio Longarini Veríssimo Mello
- Division of Head and Neck Surgery, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Antonio Augusto Velasco E Cruz
- Division of Ophthalmology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
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Kaur G, Kaur R, Sumanpreet, Kaur M. Association of COVID with Mycosis in General. Infect Disord Drug Targets 2024; 24:e190124225866. [PMID: 38251692 DOI: 10.2174/0118715265266815231130063931] [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: 07/30/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 is a respiratory disease which created havoc worldwide, was accompanied by another peculiar, otherwise rare, secondary fungal infection Mucormycosis which was observed at exceptionally high incidence in India during the second wave of COVID-19. The article explores possible links between the two infectious diseases to understand a higher-than-normal occurrence of Mucormycosis in COVID-19 patients. Coronavirus enters the patients through ACE-2 and many other receptors like- NRP-1, TfR, CD-126, and CD-26. Virus bind to cells possessing these receptors and affect their proper functioning, disturbing homeostatic metabolism and resulting in conditions like hyperglycemia, Diabetic Ketoacidosis (DKA), low serum pH, iron overload, anemia, hypoxia, and immunosuppression as explained in the article. All these outcomes provide a very supportive environment for the attack and spread of Mucormycosis fungi. The major receptor for Mucormycosis in humans is the GRP-78. Its expression is upregulated by coronavirus entry and by hyperferritinemia, hyperglycemia, and acidic conditions prevalent in COVID patients, thus providing an easy entry for the fungal species. Upregulation of GRP-78 furthermore damages pancreatic β-cells and intensifies hyperglycemia, showing quite a synergic relationship. Inordinate rise of Mucormycosis cases in India might be explained by facts like- India possessing a large proportion of diabetic patients, emergence of a very deadly strain of coronavirus- Delta strain, higher doses of steroids and antibodies used to treat patients against this strain, overburdened health care services, sudden much higher need of oxygen supply and use of industrial oxygen could explain the Mucormycosis outbreak observed in India during the second wave of COVID-19. OBJECTIVE The present review discusses the functional interdependence between COVID-19 and Mucormycosis and summarizes the possible synergic links between COVID and Mucormycosis. CONCLUSION The receptors and metabolic pathways affected by COVID-19 result in severe physiological conditions- hyperglycemia, DKA, anemia, iron overload, immunosuppression, and hypoxia. All these conditions not only increase the expression of GRP-78, the major receptor for entry of fungi but also play a crucial role in providing quality media for Mucormycosis fungus to establish and grow. Hence explains the fungal epidemic observed in India during the second wave of COVID-19 in India.
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Affiliation(s)
- Gurpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Rajinder Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Sumanpreet
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Manpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
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Somkuwar S, Vijayabharathi P, Galhotra V, Rao S, Nagarkar NM, Raghani M, Pathak VK, Mehta R. Clinical, Demographic, and Oral Presentations of COVID-19 Associated Mucormycosis from a Tertiary Care Hospital in India: A Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:1130-1138. [PMID: 38105823 PMCID: PMC10719169 DOI: 10.1007/s12663-023-01970-z] [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: 07/05/2022] [Accepted: 06/26/2023] [Indexed: 12/19/2023] Open
Abstract
Background The black fungus, mucormycosis, is on the list of lethal complications reported in recent times in COVID patients. Methodology This cross-sectional study included all cases of post-COVID-19 mucormycosis. Patients' demographics, clinical presentations, and general health information were collected using a pre-designed form. Results The study included 171 participants with the mean (SD) age as 49 (10) years with the sex distribution as 71% (122/171) male and 29% (49/122) females. About half of the admitted patients (47%) were known cases of Diabetes Mellitus type II with a median (IQR) Glycosylated Haemoglobin (HbA1c) of 9.1% (7-11.1%). Only 28% (48/171) had received the first COVID vaccination, and 2.9% (5/171) were fully vaccinated with two doses. During COVID-19, 76% (130/171) required hospitalisation for a mean (SD) stay of 11 (6.4) days. Eighty percent of the patients (136/171) received steroids during therapy, while 87% (150/171) and 51% (88/171) received antibiotics and antivirals, respectively. Oxygen was administered to 71% of hospitalised patients (120/171), with 39.1% (47/120) receiving it for more than 7 days. About the development of the first symptoms of mucormycosis (headache, nasal congestion, black crusts in the nose, facial pain, swelling in cheeks and eyes, and loss of vision) after being diagnosed with COVID-19, 16% (28/171) reported it within 7 days, 75% (127/171) between 8 and 30th days and 9% (16/171) after a month. On examination, 20% of mucor patients had hard palate findings, eschars, fistulas, and perforations, 38% had periodontal abscesses, and 5% reported tenderness to percussion. Conclusion Generally, oral manifestations involved the palate and included varying degrees of mucosal discolouration, swelling, ulcers, superficial necrotic areas, and bone exposure and necrosis with dark eschars.
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Affiliation(s)
- Surabhi Somkuwar
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - P. Vijayabharathi
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - Virat Galhotra
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
- Department of Dentistry—Pediatric and Preventive Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Santhosh Rao
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Nitin M. Nagarkar
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Manish Raghani
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | | | - Rupa Mehta
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
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Raina D, Rohilla R, Patwal S, Pandita A. The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India. Cureus 2023; 15:e47358. [PMID: 38021725 PMCID: PMC10657149 DOI: 10.7759/cureus.47358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. MATERIAL AND METHODS A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. RESULTS Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. CONCLUSION The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.
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Affiliation(s)
- Dimple Raina
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ranjana Rohilla
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Shiwang Patwal
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ajay Pandita
- Community Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
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Aboutalebian S, Erami M, Ahsaniarani AH, Momen-Heravi M, Sharif A, Hadipour M, Mirhendi H. Diagnosis of mucormycosis using a simple duplex PCR assay: Analysis of 160 clinical samples from COVID-19 patients. Med Mycol 2023; 61:myad091. [PMID: 37715309 DOI: 10.1093/mmy/myad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023] Open
Abstract
Early diagnosis of mucormycosis, a severe and potentially fatal complication in immunocompromised and COVID-19 patients, is crucial for initiating timely antifungal therapy and reducing infection mortality. In this study, the diagnostic performance of a duplex polymerase chain reaction (PCR) assay was evaluated to detect Mucorales-specific and Rhizopus oryzae-specific targets in 160 clinical samples collected from 112 COVID-19 patients suspected of invasive fungal rhinosinusitis (IFRS). During potassium hydroxide (KOH) direct microscopy, non-septate hyphae were observed in 73 out of 160 samples (45.63%); however, using duplex PCR, 82 out of 160 specimens (51.25%) tested positive. Among the positive PCR samples, 67 (81.71%) exhibited a double band (both 175 and 450 base pairs [bp]) indicating the presence of R. oryzae, and 15 (18.29%) showed only a single band (175 bp), suggesting the presence of non-R. oryzae Mucorales. DNAs from 10 microscopically negative samples and 4 samples with septate hyphae in microscopy were successfully amplified in PCR. Considering Calcofluor white fluorescence microscopy as the gold standard for laboratory diagnosis of mucormycosis, the duplex PCR assay utilized in this study exhibited a sensitivity of 93.88%, a specificity of 100%, a negative predictive value of 91.18%, and a positive predictive value of 100% for detecting mucormycosis in IFRS specimens. The duplex PCR assay demonstrated higher sensitivity compared to direct examination with KOH (82 vs. 73) and culture (82 vs. 41), enabling rapid detection/identification of Mucorales even in samples with negative culture or in biopsies with only a few hyphal elements.
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Affiliation(s)
- Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahzad Erami
- Department of Infectious Disease, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Sharif
- Department of Infectious Disease, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Hadipour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities, Isfahan University of Medical Sciences, Isfahan, Iran
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Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
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15
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Kaur A, Kailash SZ, Sureshkumar K, Kulkarni K. Fear of the black fungus: Mucormycosis hypochondria. Ind Psychiatry J 2023; 32:466-467. [PMID: 38161449 PMCID: PMC10756633 DOI: 10.4103/ipj.ipj_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 01/30/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Arshdeep Kaur
- Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Shabeeba Z. Kailash
- Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Kailash Sureshkumar
- Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Karishma Kulkarni
- Department of Psychiatry, University of Melbourne, Victoria, Australia
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16
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Harikrishnan P, Magesh V. Stress Trajectory Variations During Occlusal Loading in Human Skull with a Maxillofacial Defect: A Finite Element Analysis. J Maxillofac Oral Surg 2023:1-5. [PMID: 37362873 PMCID: PMC10122195 DOI: 10.1007/s12663-023-01924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aim Biting forces from the teeth are distributed to the facial bones and to the skull through the stress trajectories. The presence of a bony defect in either the maxilla or mandible might lead to variations in the stress distribution. The aim of this study was to evaluate the stress distribution and variations in stress trajectories from biting forces in a human skull with maxillofacial defect using a finite element (FE) model. Methodology In this study, a cone beam computed tomography (CBCT) of an adult male patient with a maxillectomy defect consequent to surgical treatment of mucormycosis is evaluated for the stress distribution from the biting forces of the remaining posterior teeth. Finite element model without the mandible was constructed from the patient's CBCT data. Occlusal loading forces of 600 N were applied on each side of the maxillary teeth. Stress trajectories were visualised through the stress distribution pattern. Results The results showed deviations in the normal stress distribution during occlusal loading and variations in zygomatic and pterygoid stress trajectories in the maxillofacial and skull regions in our FE model due to the bony defect. Conclusion We conclude that a skeletal maxillofacial defect should be reconstructed to resume proper stress distribution during functional forces to maintain a healthy craniofacial skeleton.
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Affiliation(s)
- Pandurangan Harikrishnan
- Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana 122505 India
- Teeth “N” Jaws Center, Lake Area, Nungambakkam, Chennai, Tamil Nadu 600034 India
| | - Varadaraju Magesh
- Department of Mechanical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu 603203 India
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17
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Arora P, Kaur G, Tyagi N, Nair MK. Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus. Proc AMIA Symp 2023; 36:389-391. [PMID: 37091750 PMCID: PMC10120457 DOI: 10.1080/08998280.2023.2177081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained much attention in the post-COVID era. The elucidation of invasive fungal sinusitis with osteomyelitis as a rare aggressive infection that requires prompt diagnosis and treatment to prevent fatal consequences has been noteworthy. Cone-beam computed tomography findings in those patients are central to early diagnosis and management. Here we report a case of post-COVID mucormycosis with osteomyelitis of the maxilla in a 72-year-old woman with a history of recently diagnosed diabetes mellitus.
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Affiliation(s)
- Pallak Arora
- Department of Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, Texas A&M University College of Dentistry, Dallas, Texas
| | - Geetpriya Kaur
- Department of Oral Pathology, Institute of Dental Studies and Technology (IDST), Ghaziabad, India
| | - Nutan Tyagi
- Department of Oral Pathology, Institute of Dental Studies and Technology (IDST), Ghaziabad, India
| | - Madhu K. Nair
- Department of Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, Texas A&M University College of Dentistry, Dallas, Texas
- Baylor University Medical Center, Dallas, Texas
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18
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Sharma A, Bedi M, Patel P, Singh Arora A. Black fungus outbreak in India - A direct consequence of COVID-19 surge: A myth or reality. GONDWANA RESEARCH : INTERNATIONAL GEOSCIENCE JOURNAL 2023; 114:117-123. [PMID: 35153531 PMCID: PMC8816797 DOI: 10.1016/j.gr.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 05/06/2023]
Abstract
The deadly second wave of COVID-19 has seen an unprecedented surge in mucormycosis associated mortality in India, overwhelming the heath authorities with challenges beyond measure. Also known as black fungus, this life-threatening fungal infection usually manifests in the nose, spreads to the eyes, and in some cases also to the brain. Immune suppression, pre-existing conditions, prolonged and indiscriminate use of steroids, and unhygienic environments are some of the widely recognized risk factors for contracting black fungus in individuals recovered from COVID-19. However, diagnosis of the infection remains insufficient due to the lack a holistic understanding of the possible risks, symptoms, and exposure pathways and therefore no definite protocol exists for managing this fatal infection. Here, we synthesize the current state of knowledge on black fungus outbreak in India and identify key gaps in its understanding with respect to potential risk factors leading to the widespread infection. We looked at 3354 black fungus cases in India, enlisting ailment history (particularly diabetes) and steroid usage in COVID-19 patients as the key factors responsible for exacerbating risks associated with the disease. However, we also press on the possibilities that other less studied non-traditional risk factors may also have a role in causing the infection. Black fungus is therefore a reality of COVID-19, with or without diabetes or steroid use needs to be investigated. We believe such a review is imperative for making informed decisions specially around timely diagnosis and channelizing efforts in controlling the spread of COVID-19 associated mucormycosis.
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Affiliation(s)
- Archana Sharma
- Department of Environmental Science and Engineering, Marwadi University, Rajkot 36004, Gujarat, India
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh 15261, PA, USA
| | - Prachi Patel
- Department of Environmental Engineering, University of Ottawa, Ontario, Canada
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19
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Alsayed HH, Al-Qurain A, Alrais Z. Rhino orbital cerebral mucormycosis: A life-threatening complication of coronavirus diseases 2019 in an uncontrolled diabetic patient. Turk J Emerg Med 2023. [DOI: 10.4103/tjem.tjem_308_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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20
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Potential inhibitory activity of phytoconstituents against black fungus: In silico ADMET, molecular docking and MD simulation studies. COMPUTATIONAL TOXICOLOGY 2022; 24:100247. [PMID: 36193218 PMCID: PMC9508704 DOI: 10.1016/j.comtox.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022]
Abstract
Mucormycosis or “black fungus” has been currently observed in India, as a secondary infection in COVID-19 infected patients in the post-COVID-stage. Fungus is an uncommon opportunistic infection that affects people who have a weak immune system. In this study, 158 antifungal phytochemicals were screened using molecular docking against glucoamylase enzyme of Rhizopus oryzae to identify potential inhibitors. The docking scores of the selected phytochemicals were compared with Isomaltotriose as a positive control. Most of the compounds showed lower binding energy values than Isomaltotriose (-6.4 kcal/mol). Computational studies also revealed the strongest binding affinity of the screened phytochemicals was Dioscin (-9.4 kcal/mol). Furthermore, the binding interactions of the top ten potential phytochemicals were elucidated and further analyzed. In-silico ADME and toxicity prediction were also evaluated using SwissADME and admetSAR online servers. Compounds Piscisoflavone C, 8-O-methylaverufin and Punicalagin exhibited positive results with the Lipinski filter and drug-likeness and showed mild to moderate of toxicity. Molecular dynamics (MD) simulation (at 300 K for 100 ns) was also employed to the docked ligand-target complex to explore the stability of ligand-target complex, improve docking results, and analyze the molecular mechanisms of protein-target interactions.
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21
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Management of Mucormycosis in Post COVID-19 Patients and Its Outcome in a Tertiary Care Center: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:3344-3351. [PMID: 36267489 PMCID: PMC9569005 DOI: 10.1007/s12070-022-03197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
To assess the common presentation and extent of disease involvement clinically and radiologically and treatment modalities, sequalae of the disease, complications and treatment response. Mucormycosis is a life-threatening infection that most commonly affects immunocompromised individuals and an exponential increase in the incidence of Rhino-orbital-cerebral mucormycosis was witnessed in the second wave of the COVID-19 pandemic, despite aggressive multimodal treatment carries a significant risk of mortality. A high index of suspicion is required in order to begin the appropriate diagnostic workup and treatment. This study is conducted to access the outcome and management of mucormycosis in post covid 19 patients. The prospective study includes 180 Patients, who are attending to E.N.T. outpatient department, Triage and patients referred from other departments who had suspected/confirmed Rhino-orbital-cerebral mucormycosis/underwent surgery and/or medical treatment or both. In our study mucormycosis predominantly affected age group between 40 and 60 years, more common in males (77.8%) than females (22.2%), 77.8% patients had post covid status. Most common risk factor was diabetes mellitus.76% patients had undergone endoscopic/open surgery and 24% patients underwent only medical treatment. Among 138 patients operated, 40% had recurrence and mortality was 16.1% (significantly reduced). Early diagnosis and prompt intervention is paramount to reduce morbidity and mortality. Liposomal Amphotericin B is most effective antifungal with manageable side effects. Patients who underwent Radical debridement either endoscopically or open approach, had better outcome with minimal recurrence rates. Combined medical and surgical treatment has better outcome, lesser recurrence and mortality.
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22
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Muacevic A, Adler JR. Preliminary Experience in Post-COVID-19 Mycoses: A Pathologist's Perspective. Cureus 2022; 14:e30339. [PMID: 36407132 PMCID: PMC9663879 DOI: 10.7759/cureus.30339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 01/25/2023] Open
Abstract
Background Coronavirus disease is caused by the severe acute respiratory syndrome coronavirus-19. Because of co-morbidities and indiscriminate use of steroids and antibiotics, the incidence of opportunistic fungal infections has increased in COVID-affected individuals. Aims and objectives The aim of the study is to analyze the various tissue reaction patterns of COVID-19-associated mucormycosis in the surgical debridement specimens using routine hematoxylin and eosin (H&E) stain and special stains like periodic acid-Schiff (PAS), Grocott-Gomori's methenamine silver (GMS), Masson trichrome (MT) and Prussian blue (PB), and to understand the pathogenesis of COVID-19 sequelae. Materials and methods This retrospective observational study was conducted after the approval from the Institute Human Ethical Committee (IHEC) on 45 tissue samples of COVID-associated mucormycosis using routine H&E and histochemical stains such as PAS, GMS, MT, and PB. Detailed demographic profiles, clinical information, radiological findings, and relevant microbiological data in available cases, like reports on potassium hydroxide (KOH) mount preparation, and fungal culture reports on Saboraud's Dextrose Agar (SDA) medium were collected. The different histomorphological tissue reaction patterns were observed and analyzed. Results All the surgical debridement specimens from post-COVID cases had histomorphology of mucormycosis displaying broad, aseptate, ribbon-like fungal hyphae with right-angle branching (45/45). Six of the 45 cases also reveal thin, narrow septate, acute angle branching hyphae, indicating co-existing Aspergillosis (6/45). The histological tissue reaction patterns observed were categorized as extensive tissue necrosis (100%), vascular proliferation (82%), angioinvasion (58%), giant cell reaction (53%), fibrin thrombi (47%), septic thrombi and angiodestruction (40%), fungal osteomyelitis (33%), necrotizing granulomas (31%). Conclusion This study infers that post-COVID-19 associated mucormycosis, alterations in the local tissue microenvironment are found to have a favorable effect on colonizing fungi and result in destructive tissue reactions such as angioinvasion, angiodestruction, necrosis, necrotizing granulomas, suppurative inflammation, and iron pigment deposition. The spectrum of morphological changes reflects the host's immune status.
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23
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Sulena S, Dhawan M, Singh N, Arora H, Singh G, Aggarwal V, Tapasvi C. Clinicoradiological profile and outcome of cavernous sinus syndrome with coronavirus disease-2019-associated rhino-orbito-cerebral mucormycosis. J Neurosci Rural Pract 2022; 13:730-739. [PMID: 36743739 PMCID: PMC9894018 DOI: 10.25259/jnrp-2022-2-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along with comparative analysis of CSS negative COVID-19-associated ROCM. Material and Method This was a prospective and observational study conducted from May 1, 2021, to July 31, 2021. Subjects included ROCM with active or recovered COVID-19 (past 6 weeks) and were categorized and staged. CSS was defined as involvement of two or more of third, fourth, fifth, or sixth cranial nerve with one each direct and indirect qualitative neuroradiological features. Clinicoradiological features of CSS-positive and negative COVID-19-associated ROCM groups were compared. Results Incidence of CSS with COVID-19-associated ROCM was 28%. Mean age of subjects was 44 ± 15 years with 60% being males and 73% were proven ROCM. Significant differences seen across the CSS-positive and negative groups were ocular, nasal, and cerebral findings including eyelid and periocular discoloration, ptosis, proptosis, ophthalmoplegia, nasal discharge, mucosal inflammation, and fever. Oculomotor, trochlear, and abducens nerves were significantly involved more in CSS-positive group. Significant radiological findings across two groups included indirect features in orbit, nose, and paranasal sinuses along with direct features in cavernous sinus. Surgical intervention was more common in CSS-positive group. Mortality in CSS-positive group at 8-24 weeks was 13 and 27%, respectively. Conclusion Extension of ROCM to CSS was more common in young males in advanced stages of proven ROCM with concurrent COVID-19. CSS-positive group had significant difference in clinicoradiological features involving orbit, nose, paranasal sinuses, and central nervous system as compared to CSS-negative group. This study highlights the need to develop an objective scoring system considering clinical and radiological features for diagnosis of CSS with COVID-19-associated ROCM.
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Affiliation(s)
- Sulena Sulena
- Department of Neurology, Guru Gobind Singh Medical College, Faridkot, India
| | - Munish Dhawan
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Navchint Singh
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Hobinder Arora
- Department of Community Medicine, Guru Gobind Singh Medical College, Faridkot, India
| | - Gurbax Singh
- Department of ENT, Guru Gobind Singh Medical College, Faridkot, India
| | - Varun Aggarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bathinda, India
| | - Chaitanya Tapasvi
- Department of Radiodiagnosis, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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Mittal A, Mahajan N, Pal Singh Dhanota D, Paul BS, Ahluwalia S, Ahluwalia S, Galhotra A, Gupta V, Puri S, Verma R, Munjal M, Goel S, Chopra S, Mahajan R, Ahluwalia A, Saggar K, Singh G. SARS-CoV-19-associated Rhino-orbital and cerebral Mucormycosis: Clinical and Radiological Presentations. Med Mycol 2022; 60:6677975. [PMID: 36029277 PMCID: PMC9494327 DOI: 10.1093/mmy/myac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.
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Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitika Mahajan
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Devinder Pal Singh Dhanota
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Srishti Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Saumya Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arnav Galhotra
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjeev Puri
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rohit Verma
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manish Munjal
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sahil Goel
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumeet Chopra
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajesh Mahajan
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, Queen Square Institute of Neurology, London, UK
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Balushi AA, Ajmi AA, Sinani QA, Menon V, Berieki ZA, Shezawi AA, Azri SA, Rashdi AA, Jardani AA, Baluki TA, Ghaithi SA, Reesi AA, Al-Za'abi AT, Al’ Balushi MA, Maqbali TA. COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review. Int J Infect Dis 2022; 121:203-210. [PMID: 35533833 PMCID: PMC9075983 DOI: 10.1016/j.ijid.2022.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. METHODS We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. RESULTS The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). CONCLUSION Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.
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Affiliation(s)
- Asma Al Balushi
- Infectious Diseases Unit, Internal Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman,Corresponding author: Asma Al Balushi: Address: Infectious Diseases Unit, Internal Medicine Department, Sultan Qaboos University Hospital, Muscat, Seeb, Alkhoudh, P. O. Box 35, Postal Code 123, Oman. Mobile number: (+968) 92319222
| | - Ahmed Al Ajmi
- Oral and Maxillofacial Surgery Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Qais Al Sinani
- Ear, Nose and Throat Surgical Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Varna Menon
- Histopathology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Zainab Al Berieki
- Radiology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Asma Al Shezawi
- Radiology Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Saleh Al Azri
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Azza Al Rashdi
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Amina Al Jardani
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Thuwaiba Al Baluki
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Salem Al Ghaithi
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | - Ali Al Reesi
- Internal Medicine Department, Sohar Hospital, Ministry of Health, Sohar, Oman
| | | | | | - Talib Al Maqbali
- Ear, Nose and Throat Surgical Department, Sohar Hospital, Ministry of Health, Sohar, Oman
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Iqtadar S, Hashmat M, Chaudhry MNA, Mumtaz SU, Abaidullah S, Pascual-Figal DA, Khan A. Unnecessary Use of Corticosteroids for managing early mild symptoms of COVID-19 may lead to Rhino-ortibal-cerebral mucormycosis in Patients with Diabetes – a case series from Lahore, Pakistan. Ther Adv Infect Dis 2022; 9:20499361221097417. [PMID: 35547833 PMCID: PMC9083038 DOI: 10.1177/20499361221097417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Rhino-orbital-cerebral mucormycosis (ROCM), a rare but fatal fungal infection, has recently emerged as a serious complication after corticosteroids therapy in COVID-19 patients, predominantly in diabetic and immunocompromised patients. The World Health Organization (WHO) COVID-19 current guidelines recommend corticosteroids administration in hospitalized COVID-19 patients requiring supplementary oxygen or mechanical ventilation. Herein, we report a case series of seven patients with COVID-19; three mild, three moderate, and one severe, from Lahore, Pakistan; all were using corticosteroids for managing their early mild symptoms of COVID-19 at home for around 2–3 weeks without a physician’s advise, presented, and admitted with ROCM to Mayo hospital, Lahore, from March to June 2021. Out of the seven patients, five patients had uncontrolled diabetes mellitus (DM) as comorbidity. Eye pain, facial swelling and pain, nasal blockage, and black coloration around eyes, on palate, and oral mucosa were the presenting complaints at the time of admission. All the patients had radiographic imaging, including computed tomography (CT), paranasal sinuses (PNS), or brain magnetic resonance imaging (MRI) carried out at the hospital, which confirmed mucosal thickening and adjacent sinus bony erosions with intracranial extension. All the patients were treated with local debridement of the infected necrotic tissue along with intravenous liposomal Amphotericin B and Posaconazole or Amphotericin B depending on the case. Due to timely management, in six out of seven patients, prognosis was good due to early diagnosis and treatment, while one patient with severe COVID-19 illness deteriorated and died. The misuse of corticosteroids for managing early mild symptoms of COVID-19 in diabetic and other immunocompromised patients can lead to fatal ROCM, which can further increase their risk of developing severe COVID-19 and mortality. It is stressed that only physician’s recommended therapeutic advice should be followed for managing early mild symptoms of COVID-19 in self-isolation and avoid the unnecessary use of corticosteroids. This case series also emphasizes that COVID-19 diabetic patients treated with corticosteroids need more vigilant monitoring and high suspicion of early diagnosis and treatment of invasive fungal infection. Early diagnosis and management can reduce morbidity and mortality.
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Affiliation(s)
- Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Masooma Hashmat
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Sami Ullah Mumtaz
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sajid Abaidullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Amjad Khan
- INEOS Oxford Institute for AMR Research, University of Oxford, UK
- Nuffield Division of Clinical and Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, UK
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27
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First Molecular Identification of Three Clinical Isolates of Fungi Causing Mucormycosis in Honduras. Infect Dis Rep 2022; 14:258-265. [PMID: 35447883 PMCID: PMC9027499 DOI: 10.3390/idr14020031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Mucormycoses are rare but serious opportunistic fungal infections caused by filamentous organisms of the order Mucorales. Here we report the first molecular identification of Rhizopus oryzae (heterotypic synonym Rhizopus arrhizus), R. delemar, and Apophysomyces ossiformis as the etiological agents of three cases of severe mucormycosis in Honduras. Conventional microbiological cultures were carried out, and DNA was extracted from both clinical samples and axenic cultures. The ITS ribosomal region was amplified and sequenced. Molecular tools are suitable strategies for diagnosing and identifying Mucorales in tissues and cultures, especially in middle-income countries lacking routine diagnostic strategies.
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28
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Arakeri G, Patil S, Rao Us V, Amaral Mendes R, Oeppen RS, Brennan PA. Pathogenesis of COVID-19-associated mucormycosis (CAM) in India: probing the triggering factors. Br J Oral Maxillofac Surg 2022; 60:e533-e534. [PMID: 35351328 PMCID: PMC8591848 DOI: 10.1016/j.bjoms.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Gururaj Arakeri
- Department of Head and Neck Oncology, Centre for Academic Research, HCG Cancer Center, Bengaluru, Karnataka, India; Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka, India.
| | - Shreyas Patil
- Department of Medicine, RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Vishal Rao Us
- Department of Head and Neck Oncology, Centre for Academic Research, HCG Cancer Center, Bengaluru, Karnataka, India
| | - Rui Amaral Mendes
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, Cleveland, Ohio, United States; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Rachel S Oeppen
- Department of Clinical Radiology, University Hospital Southampton, SO16 6YD, United Kingdom
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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29
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Ahmed OF, Al-Neaimy S, Kakamad FH, Ali RK, Mikael TM, Hamasaeed AG, mohammed SH, Salih RQ, Salh AM, Hamasaeed MG. COVID-19 associated with pulmonary mucormycosis; a case series. Ann Med Surg (Lond) 2022; 76:103434. [PMID: 35261764 PMCID: PMC8891121 DOI: 10.1016/j.amsu.2022.103434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has evolved as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). With the rise of cases worldwide, plenty of potential COVID-19 complications have emerged, including increased susceptibility to subsequent bacterial and fungal infections. This study aims to report four cases of COVID-19 associated with pulmonary mucormycosis. Method This is a multi-center case series study. Diagnosis of COVID-19 was confirmed by reverse transcriptase-polymerase chain reaction. Result A total of 4 patients infected with SARS-CoV2 were involved in this study. The majority of the cases were female, aged >42 years old. All patients developed severe symptoms. All of the patients had received steroids, half of them had co-morbidities. The most common computerized tomography (CT) scan findings were pulmonary cavitation and empyema. All of the cases were treated with a combination of surgery and antifungal treatment. Conclusion As the number of COVID-19 cases rises, enhanced surveillance for co-infections with unusual pathogens should be continued. Clinicians should raise awareness of these deadly infections, which can further aggravate severe COVID-19. Aspergillosis and Candidiasis are the most common fungal infections associated with COVID-19 infection. COVID-19 has generated an inflammatory storm that has weakened individuals' immune system. The current study addresses occurrence of mucormycosis with COVID-19 infection.
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Affiliation(s)
| | - Saoud Al-Neaimy
- Cardiothoracic and Vascular Surgery department, Tikrit Teaching Hospital, Iraq
| | - Fahmi H. Kakamad
- Smart Health Tower, François Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
- Corresponding author. Doctor City, Building 11, Apartment 50, Sulaimani, Iraq.
| | | | - Tomas M. Mikael
- Smart Health Tower, François Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Ahmed Gh Hamasaeed
- Smart Health Tower, François Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, University of Sulaimani, Kurdistan, Iraq
| | - Shvan H. mohammed
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Rawezh Q. Salih
- Smart Health Tower, François Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M. Salh
- Smart Health Tower, François Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
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Dehghanpisheh L, Eghbal M, Salari M, Shahriarirad R, Borzou N, Vatankhah P. Evaluation and Comparison of Mucormycosis Patients' Features Undergoing Functional Endoscopic Sinus Surgery Prior to and during the COVID-19 Pandemic: A Case-Control Study. Int J Clin Pract 2022; 2022:1248325. [PMID: 35693548 PMCID: PMC9175093 DOI: 10.1155/2022/1248325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rhinocerebral mucormycosis is a serious invasive fungal infection that is one of the most aggressive and lethal of invasive mycoses. The coronavirus disease (COVID-19) has been linked to immune dysregulation, and patients with COVID-19 have been reported to be at risk for developing invasive fungal infections. This study is conducted to evaluate the concurrence of mucormycosis among COVID-19 patients. METHODS In this retrospective, cross-sectional study, hospital records of patients with mucormycosis, as well as COVID-19 admitted to Khalili Hospital, as the major referral center for functional endoscopic sinus surgery (FESS) in southern Iran, were collected. Demographic and clinical information was extracted and subsequently analyzed. RESULTS Among 59 mucormycosis patients undergoing FESS, 41 (69.5%) were during the COVID-19 pandemic, while 18 (30.5%) were during one year before the COVID-19 pandemic. The average age was 49.33 ± 20.52, and 64.4% had diabetes mellitus, while 62.7% had COVID-19. The most common presentation was periorbital edema (56.9%), followed by necrotic tissue (48.3%). Although the total number of cases increased during the COVID-19 period compared to the case before the pandemic, the overall pattern and features of the patients had no significant difference, except regarding a significant increase in the presentation of necrotic tissue and also the use of corticosteroids. Most cases developed mucormycosis two weeks after COVID-19. The overall mortality was 36.8%, which is not statistically associated with COVID-19. CONCLUSION Even in the absence of comorbidities, physicians should be aware of the risk of secondary fungal infections in patients with COVID-19 who were treated with corticosteroids.
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Affiliation(s)
- Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadhossein Eghbal
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Salari
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Niloofar Borzou
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Vatankhah
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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31
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Bari MS, Hossain MJ, Akhter S, Emran TB. Delta variant and black fungal invasion: A bidirectional assault might worsen the massive second/third stream of COVID-19 outbreak in South-Asia. ETHICS, MEDICINE, AND PUBLIC HEALTH 2021; 19:100722. [PMID: 34514076 PMCID: PMC8416648 DOI: 10.1016/j.jemep.2021.100722] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/26/2021] [Indexed: 04/12/2023]
Abstract
BACKGROUND Here, we have shortly reported the recent updates on the disastrous progressions of the deadly delta variant and a virulent coinfection or post-COVID-19 infection of black fungus in India and its neighbouring countries. METHODOLOGY We searched by utilizing appropriate keywords in Google Scholar, PubMed and other scholarly databases alongside several national and international newspapers to collect the latest data regarding the targeted topic. RESULTS Recently, the delta variant is wreaking havoc in India, UK, and other countries around the globe and has also exhibited successful infections in around 20 to 55% of the people who have already recovered from COVID-19 originating from the different strains. Besides, a significant catch is the prevalence of 85.5% and 64.11% of Mucormycosis infections being co-morbid with COVID-19 and diabetes, respectively in South-Asian regions. CONCLUSIONS To avert the emergence of an epidemic amid the pandemic, prompt actions from concerned authorities are warranted. Proper education on black fungus infection and associated risks from the COVID-19 and diabetes, adequate public awareness, and sufficient healthcare assistance to battle such fungal infections effectively should be ensured as quickly as possible.
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Affiliation(s)
- M S Bari
- Department of Pharmacy, State University of Bangladesh, 77 Satmasjid Road, Dhanmondi, Dhaka 1205, Bangladesh
| | - M J Hossain
- Department of Pharmacy, State University of Bangladesh, 77 Satmasjid Road, Dhanmondi, Dhaka 1205, Bangladesh
| | - S Akhter
- Department of Pharmacy, State University of Bangladesh, 77 Satmasjid Road, Dhanmondi, Dhaka 1205, Bangladesh
| | - T B Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
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32
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Chavda VP, Apostolopoulos V. Reply to the letter 'Mucormycosis and black fungus: Breaking the myth'. Maturitas 2021; 159:71. [PMID: 34836748 DOI: 10.1016/j.maturitas.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad, Gujarat 380008, India.
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia.
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33
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Additional insights on COVID-associated mucormycosis. Br J Oral Maxillofac Surg 2021; 60:e531-e532. [PMID: 35120786 PMCID: PMC8591849 DOI: 10.1016/j.bjoms.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022]
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34
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Panta P, Stone N. COVID-associated mucormycosis (CAM) in India is a multidimensional problem. Br J Oral Maxillofac Surg 2021; 59:1332-1333. [PMID: 34728106 DOI: 10.1016/j.bjoms.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, Malla Reddy Institute of Dental Sciences, Suraram X Roads, Jeedimetla, Quthbullapur, Hyderabad, Telangana 500055, India.
| | - Neil Stone
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London W1T 7NF, UK
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35
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COVID-associated mucormycosis (CAM): is the Delta variant a cause? Br J Oral Maxillofac Surg 2021; 60:e529-e530. [PMID: 35115202 PMCID: PMC8443309 DOI: 10.1016/j.bjoms.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
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