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Kordjazi M, Bazgir N, Eftekharian K, Farajpour M, Dilmaghani NA. Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2024; 103:145S-152S. [PMID: 36583239 PMCID: PMC9805989 DOI: 10.1177/01455613221143859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. METHODS A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. RESULTS Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. CONCLUSIONS SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.
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Affiliation(s)
- Mohammadsmaeil Kordjazi
- Departmentof Otorhinolaryngology,
Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Narges Bazgir
- School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Kourosh Eftekharian
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Mostafa Farajpour
- Depatement of general surgery, Arak University of Medical
Sciences, Arak, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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Erami M, Raiesi O, Momen-Heravi M, Mirhendi H, Aboutalebian S, Getso MI, Matini AH, Ahsaniarani AH, Ganjizadeh M, Hassani Josheghani H, Amiri S, Pakzad R, Hashemi SJ. COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes. Infect Dis (Lond) 2024; 56:81-90. [PMID: 37816067 DOI: 10.1080/23744235.2023.2267669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran. METHODS A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination. RESULTS We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40-79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O2 required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO2 were also significantly higher in survivors than non-survivors. CONCLUSION Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Raiesi
- Department of Parasitology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Head and Neck Surgery, Department, Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Ganjizadeh
- Kashan Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Sasan Amiri
- Roozbeh hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Pourazizi M, Hakamifard A, Peyman A, Mohammadi R, Dehghani S, Tavousi N, Hosseini NS, Azhdari Tehrani H, Abtahi-Naeini B. COVID-19 associated mucormycosis surge: A review on multi-pathway mechanisms. Parasite Immunol 2024; 46:e13016. [PMID: 37846902 DOI: 10.1111/pim.13016] [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: 02/25/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Mucormycosis is a fungal infection caused by moulds from the Mucorales order. Concerns have been mounting due to the alarming increase in severe morbidity and mortality associated with mucormycosis during the COVID-19 pandemic. This condition, known as COVID-19-associated mucormycosis (CAM), has been linked to various environmental, host-related, and medical factors on a global scale. We have categorized the most significant potential risk factors for developing mucormycosis in individuals with a previous history of coronavirus infection into 10 major categories. These categories include acute hyperglycemia, the impact of cytokine release, immune response deficiencies in COVID-19 patients, microvasculopathy and dysfunction of endothelial cells, imbalances in iron metabolism, metabolic acidosis, organ damage resulting from COVID-19, underlying health conditions (such as diabetes), environmental factors, and medical treatments that can be iatrogenic in nature (such as inappropriate glucocorticoid use). Many of these factors can lead to potentially life-threatening infections that can complicate the treatment of COVID-19. Physicians should be vigilant about these factors because early detection of mucormycosis is crucial for effective management of this condition.
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Affiliation(s)
- Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shakiba Dehghani
- Farabi Eye Hospital, Department of Ophthalmology, Tehran University of Medical Science, Tehran, Iran
| | - Najmeh Tavousi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Xisto MIDDS, Rollin-Pinheiro R, Rochetti VP, de Castro-Almeida Y, Borba-Santos LP, dos Santos-Freitas GMP, Cypriano J, Abreu FDÁ, Rozental S, Barreto-Bergter E. Miltefosine: A Repurposing Drug against Mucorales Pathogens. J Fungi (Basel) 2023; 9:1166. [PMID: 38132767 PMCID: PMC10744482 DOI: 10.3390/jof9121166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Mucorales are a group of non-septated filamentous fungi widely distributed in nature, frequently associated with human infections, and are intrinsically resistant to many antifungal drugs. For these reasons, there is an urgent need to improve the clinical management of mucormycosis. Miltefosine, which is a phospholipid analogue of alkylphosphocholine, has been considered a promising repurposing drug to be used to treat fungal infections. In the present study, miltefosine displayed antifungal activity against a variety of Mucorales species, and it was also active against biofilms formed by these fungi. Treatment with miltefosine revealed modifications of cell wall components, neutral lipids, mitochondrial membrane potential, cell morphology, and the induction of oxidative stress. Treated Mucorales cells also presented an increased susceptibility to SDS. Purified ergosterol and glucosylceramide added to the culture medium increased miltefosine MIC, suggesting its interaction with fungal lipids. These data contribute to elucidating the effect of a promising drug repurposed to act against some relevant fungal pathogens that significantly impact public health.
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Affiliation(s)
- Mariana Ingrid Dutra da Silva Xisto
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
| | - Rodrigo Rollin-Pinheiro
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
| | - Victor Pereira Rochetti
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
| | - Yuri de Castro-Almeida
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
| | - Luana Pereira Borba-Santos
- Laboratório de Biologia Celular de Fungos, Programa de Biologia Celular e Parasitologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.P.B.-S.); (S.R.)
| | - Giulia Maria Pires dos Santos-Freitas
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
| | - Jefferson Cypriano
- Laboratório de Biologia Celular e Magnetotaxia & Unidade de Microscopia Multiusuário, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (J.C.); (F.d.Á.A.)
| | - Fernanda de Ávila Abreu
- Laboratório de Biologia Celular e Magnetotaxia & Unidade de Microscopia Multiusuário, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (J.C.); (F.d.Á.A.)
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos, Programa de Biologia Celular e Parasitologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.P.B.-S.); (S.R.)
| | - Eliana Barreto-Bergter
- Laboratório de Química Biológica de Microrganismos, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (R.R.-P.); (V.P.R.); (Y.d.C.-A.); (G.M.P.d.S.-F.)
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M M, Pillai DS. Correlation of Diabetic Status and Coronavirus Disease 2019 (COVID-19) in Patients With Mucormycosis: A Retrospective Clinical Study. Cureus 2023; 15:e48936. [PMID: 38111411 PMCID: PMC10727452 DOI: 10.7759/cureus.48936] [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: 09/18/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
AIM Coronavirus disease 2019 (COVID-19) and its association with diabetes might lead to mucormycosis, and studies have reported an association between them. This study aims to find the correlation between COVID-19 and diabetic status in patients with mucormycosis and its role in disease progression and prognosis. The objectives of the study are to analyze the clinical range of mucormycosis in those with diabetes and COVID-19 and to correlate the clinical and radiographic findings. MATERIALS AND METHODOLOGY A retrospective cohort analysis was carried out at Saveetha Dental College and Hospitals in Chennai (approval number: IHEC/SDC/OMED-2204/23/218). The data collection was done from the institution's electronic database from April 2019 to April 2023 which included the patients' age and gender and COVID-19 and diabetic status and clinical and radiographic features of mucormycosis. RESULTS From the data analyzed, 25 patients had a history of mucormycosis with diabetes and COVID-19 infections. The patients' average age was 47.76, out of which 22 were males and three were females. The chi-squared test showed no significant association between age (0.178), diabetes (0.465), and COVID-19 (0.583). Spearman's correlation was done showing an association between mucormycosis, diabetes, and COVID-19. Radiographically, 100% of the patients had involvement of the maxillary sinus, followed by the palate (32%), orbit (28%), nasal floor (24%), ethmoidal sinus (16%), sphenoidal sinus (12%), and frontal sinus (8%). CONCLUSION The findings of this study point out the importance of considering the presence of systemic comorbidities like diabetes in COVID-19 patients. Early identification, surgical debridement, and antifungal medications are part of the treatment for increased survival.
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Affiliation(s)
- Madhumitha M
- Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, IND
| | - Devika S Pillai
- Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, IND
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Yang J, Lim KH, Lim KT, Woods JT, Mohabbat AB, Wahner-Roedler DL, Ganesh R, Bauer BA. Complementary and alternative medicine for long COVID: a systematic review of randomized controlled trials. Ther Adv Chronic Dis 2023; 14:20406223231204727. [PMID: 37841213 PMCID: PMC10571674 DOI: 10.1177/20406223231204727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Complementary and alternative medicine (CAM) interventions are growing in popularity as possible treatments for long COVID symptoms. However, comprehensive analysis of current evidence in this setting is still lacking. Objective This study aims to review existing published studies on the use of CAM interventions for patients experiencing long COVID through a systematic review. Design Systematic review of randomized controlled trials (RCTs). Methods A comprehensive electronic literature search was performed in multiple databases and clinical trial registries from September 2019 to January 2023. RCTs evaluating efficacy and safety of CAM for long COVID were included. Methodological quality of each included trial was appraised with the Cochrane 'risk of bias' tool. A qualitative analysis was conducted due to heterogeneity of included studies. Results A total of 14 RCTs with 1195 participants were included in this review. Study findings demonstrated that CAM interventions could benefit patients with long COVID, especially those suffering from neuropsychiatric disorders, olfactory dysfunction, cognitive impairment, fatigue, breathlessness, and mild-to-moderate lung fibrosis. The main interventions reported were self-administered transcutaneous auricular vagus nerve stimulation, neuro-meditation, dietary supplements, olfactory training, aromatherapy, inspiratory muscle training, concurrent training, and an online breathing and well-being program. Conclusion CAM interventions may be effective, safe, and acceptable to patients with symptoms of long COVID. However, the findings from this systematic review should be interpreted with caution due to various methodological limitations. More rigorous trials focused on CAM for long COVID are warranted in the future.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kia Teng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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Satija A, Anand T, Mukherjee A, Velamuri PS, Singh KJ, Das M, Josten K, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Shah PB, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Panda S. Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study. Mycopathologia 2023; 188:745-753. [PMID: 37490256 DOI: 10.1007/s11046-023-00770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.
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Affiliation(s)
| | - Tanu Anand
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | | | - Kripa Josten
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | - D Himanshu
- King George's Medical University, Lucknow, India
| | - Sejal N Mistry
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Jimy D Patel
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Prajwal Rao
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Shalesh Rohatgi
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Soumitra Ghosh
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Radha Annamalai
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | - Mini P Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohammad Shameem
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Nazish Fatima
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | | | | | - Rupa Mehata
- All India Institute of Medical Sciences, Raipur, India
| | | | - Richa Tigga
- All India Institute of Medical Sciences, Raipur, India
| | | | - Vijay Sonkar
- King George's Medical University, Lucknow, India
| | | | - Neeraj Kumar
- King George's Medical University, Lucknow, India
| | - Rajashri Patil
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | | | | | - Preetam Arthur
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - L Somu
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Padma Srikanth
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Pankaj B Shah
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Naresh K Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipti Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Wasil Hasan
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Aftab Ahmed
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | - Yash Kanani
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | - Chhaya Rajguru
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Lalitkumar R Sankhe
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Shrinivas S Chavan
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India.
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Puerner C, Vellanki S, Strauch JL, Cramer RA. Recent Advances in Understanding the Human Fungal Pathogen Hypoxia Response in Disease Progression. Annu Rev Microbiol 2023; 77:403-425. [PMID: 37713457 PMCID: PMC11034785 DOI: 10.1146/annurev-micro-032521-021745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Fungal-mediated disease progression and antifungal drug efficacy are significantly impacted by the dynamic infection microenvironment. At the site of infection, oxygen often becomes limiting and induces a hypoxia response in both the fungal pathogen and host cells. The fungal hypoxia response impacts several important aspects of fungal biology that contribute to pathogenesis, virulence, antifungal drug susceptibility, and ultimately infection outcomes. In this review, we summarize recent advances in understanding the molecular mechanisms of the hypoxia response in the most common human fungal pathogens, discuss potential therapeutic opportunities, and highlight important areas for future research.
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Affiliation(s)
- Charles Puerner
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA;
| | - Sandeep Vellanki
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA;
| | - Julianne L Strauch
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA;
- Department of Biology, Dartmouth College, Hanover, New Hampshire, USA
| | - Robert A Cramer
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA;
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Bahsoun A, Fakih Y, Zareef R, Bitar F, Arabi M. Corticosteroids in COVID-19: pros and cons. Front Med (Lausanne) 2023; 10:1202504. [PMID: 37644981 PMCID: PMC10461317 DOI: 10.3389/fmed.2023.1202504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.
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Affiliation(s)
- Aymen Bahsoun
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yeva Fakih
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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10
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Narra R, Rayapati S. Invasive rhinocerebral mucormycosis: Imaging the temporal evolution of disease in post COVID-19 case with diabetes: A case report. World J Radiol 2023; 15:234-240. [PMID: 37545647 PMCID: PMC10401400 DOI: 10.4329/wjr.v15.i7.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.
CASE SUMMARY A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15th day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient’s poor prognosis and slow recovery.
CONCLUSION Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.
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Affiliation(s)
- Ramakrishna Narra
- Department of Radiodiagnosis, Katuri Medical College, Guntur, Andhra Pradesh 522018, India
| | - Shravya Rayapati
- Department of Radiodiagnosis, Katuri Medical College, Guntur, Andhra Pradesh 522018, India
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11
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Jayagayathri R, Ezhilvathani N, Venkatesh R. Knowledge, attitude, and practice toward mucormycosis among patients discharged from a COVID-19 care tertiary center in South India: A questionnaire-based survey. Indian J Ophthalmol 2023; 71:2818-2821. [PMID: 37417127 PMCID: PMC10491084 DOI: 10.4103/ijo.ijo_131_23] [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: 01/14/2023] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To study the awareness of mucormycosis among discharged inpatients after receiving treatment for COVID-19 infection at a tertiary COVID care center in south India. Methods This was a telephone-based survey conducted using a questionnaire consisting of 38 questions in five sections in the month of June-July 2021. COVID-positive inpatients who had been admitted, treated, and discharged from a government medical college were contacted via phones, and their responses were directly entered into the Google Forms platform. Results A total of 222 participants were included in the study. Among all the participants, a cumulative 66% of participants had some knowledge of mucormycosis and 98/222 (44%) did not have any idea of mucormycosis in spite of being admitted to the hospital. More than 40% of them reported that their prime source of information was through mass communication. Around 81% of the respondents were aware that it can occur after COVID-19 infection. Among them, only 25 knew that systemic steroids were the main risk factor. Sixty-four out of 124 knew that diabetes is a major risk factor. Fifty percent agreed that a vaccine for COVID can prevent mucormycosis. Conclusion Such knowledge, attitude, and practice (KAP) studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 66% of participants had some knowledge of mucormycosis and 34.7% were diabetics who had better knowledge and practice scores than non-diabetics. Sixty-six point nine percent felt that it was possible to prevent this condition.
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Affiliation(s)
| | - Namaskaram Ezhilvathani
- Department of Ophthalmology, Indira Gandhi Medical College and Research Institute, Pondicherry, India
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12
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Alramadhan SA, Sam SS, Young S, Cohen DM, Islam MN, Bhattacharyya I. COVID-related mucormycosis mimicking dental infection. ORAL AND MAXILLOFACIAL SURGERY CASES 2023; 9:100310. [PMID: 37193535 PMCID: PMC10163790 DOI: 10.1016/j.omsc.2023.100310] [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: 03/02/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023] Open
Abstract
A recent increase in the prevalence of mucormycosis of the head and neck in patients who have recovered from COVID-19 following hospitalization has been reported. A Majority of the cases have been reported from India. Conditions such as diabetes mellitus, use of corticosteroids for other autoimmune conditions, organ transplant, immunosuppression, immunodeficiency, and malignancies especially hematologic ones, are all known risk factors for mucormycosis. Recently, hospitalization for COVID-19 has been added to the list of risk factors for opportunistic mucormycosis infection. This is likely attributable to the high doses and prolonged use of corticosteroids in the treatment of hospitalized COVID-19 patients. Case Description: Two patients with post-COVID-19 associated rhinocerebral mucormycosis presented with profound unexplained dental disease including tooth mobility and dental abscess mimicking periodontal disease. The patients were previously hospitalized for COVID-19 and received prolonged treatment with high doses of corticosteroids. The patients responded well to the surgical debridement with or without antifungal therapy. Conclusion: Oral healthcare providers including oral and maxillofacial surgeons, dentists, dental hygienists, and other dental practitioners can play a vital role in the recognition and early diagnosis of rhinocerebral mucormycosis given the large number of patients with severe COVID-19 infection who have recovered following hospitalization and/or received long-term high doses of immunosuppressive treatment.
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Affiliation(s)
- Saja A Alramadhan
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Sumita S Sam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Shaun Young
- Private Practice Limited to Oral and Maxillofacial Surgery at MOSAIC Maxillofacial Surgical Arts and Implants Center, Tampa, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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13
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Zhang Z, Xiao Y, Lin Q, Liu C, Liu Q. A case report of multiple artery pseudoaneurysms associated with SARS-CoV-2. Front Cardiovasc Med 2023; 10:1174063. [PMID: 37273866 PMCID: PMC10235476 DOI: 10.3389/fcvm.2023.1174063] [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: 02/25/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Arterial pseudoaneurysms are rare vascular abnormalities that can occur as a complication of infections. Artery pseudoaneurysms associated with SARS-CoV-2 are a rare occurrence in COVID-19 patients, and their rupture can result in significant hemorrhage and sudden death. Few cases of SARS-CoV-2-associated artery pseudoaneurysms have been reported, and their underlying pathophysiological mechanisms remain unclear. This study presents the first reported case of a patient who developed both pulmonary and gallbladder artery pseudoaneurysms following SARS-CoV-2 infection. We investigate the potential pathogenesis of these pseudoaneurysms and aim to improve the understanding of this rare complication.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Institute of Blood Lipid and Atherosclerosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Institute of Blood Lipid and Atherosclerosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Institute of Blood Lipid and Atherosclerosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chan Liu
- International Medical Department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Institute of Blood Lipid and Atherosclerosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, China
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14
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Yang N, Zhang L, Feng S. Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies. J Fungi (Basel) 2023; 9:jof9050592. [PMID: 37233303 DOI: 10.3390/jof9050592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
The incidence rate of invasive mucormycosis (IM) in patients with hematological malignancies (HMs) is increasing year by year, ranging from 0.07% to 4.29%, and the mortality rate is mostly higher than 50%. With the ongoing pandemic of COVID-19, COVID-19-associated mucormycosis (CAM) also became a global health threat. Patients with high risk factors such as active HMs, relapsed/refractory leukemia, prolonged neutropenia may still develop breakthrough mucormycosis (BT-MCR) even under the prophylaxis of Mucorales-active antifungals, and such patients often have higher mortality. Rhizopus spp. is the most common genus associated with IM, followed by Mucor spp. and Lichtheimia spp. Pulmonary mucormycosis (PM) is the most common form of IM in patients with HMs, followed by rhino-orbital-cerebral mucormycosis (ROCM) and disseminated mucormycosis. The prognosis of IM patients with neutrophil recovery, localized IM and receiving early combined medical-surgical therapy is usually better. As for management of the disease, risk factors should be eliminated firstly. Liposome amphotericin B (L-AmB) combined with surgery is the initial treatment scheme of IM. Those who are intolerant to L-AmB can choose intravenous formulations or tablets of isavuconazole or posaconazole. Patients who are refractory to monotherapy can turn to combined antifungals therapy.
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Affiliation(s)
- Nuobing Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
| | - Lining Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
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15
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Aboutalebian S, Erami M, Momen-Heravi M, Charsizadeh A, Hezaveh SJH, Matini AH, Ahsaniarani AH, Fakhrehi M, Mirhendi H. A case of COVID-19-associated mucormycosis due to Lichtheimia ramosa. J Clin Lab Anal 2023:e24895. [PMID: 37183276 DOI: 10.1002/jcla.24895] [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: 01/02/2023] [Revised: 03/25/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening invasive fungal infection in immunocompromised and COVID-19 patients. CASE REPORT Here, we report a fatal rhino-orbito-cerebral mucormycosis caused by Lichtheimia ramosa, in a 79-year-old diabetic female. She was initially admitted to the hospital for COVID-19 infection and received broad-spectrum antibiotics and corticosteroids. After 1 month, she was admitted again because of persistent headaches and decreased right eye movement when the computed tomography scan showed mucosal thickening and opacification of paranasal sinuses. Microbiological investigations, including culture and direct microscopy, and histopathological findings confirmed the diagnosis of proven mucormycosis. The isolated causal agent was identified as Lichtheimia ramosa by sequencing the entire ITS region of nuclear ribosomal DNA. Despite surgical debridement and administration of liposomal amphotericin B 5 mg/kg/day, the patient's level of consciousness suddenly deteriorated; she was intubated and mechanically ventilated in the ICU and died on the same day. CONCLUSION To our knowledge, this is the first worldwide case of COVID-19-associated rhino-orbito-cerebral mucormycosis due to Lichtheimia ramosa.
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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 Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahzad Erami
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, 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
| | - Mojtaba Fakhrehi
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, 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 Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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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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17
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Khoshkhou H, Hasheminasab M, Goudarzi Pour D, Jamali R, Morshedzadeh Tehrani G, Moslemi N. Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report. J Med Case Rep 2023; 17:74. [PMID: 36864491 PMCID: PMC9981442 DOI: 10.1186/s13256-023-03792-6] [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: 09/17/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 makes patients more susceptible to superinfection of fungal disease as a consequence of immunological system impairment. Mucormycosis is a fungal infection that is rare but has a high mortality rate and mostly affects patients with poorly controlled diabetes mellitus or those receiving corticosteroids. CASE PRESENTATION Here, we present a case of post-coronavirus disease 2019 mucormycosis in a 37-year-old Persian male presenting with multiple periodontal abscess with purulent discharge and necrosis of maxillary bone (without oroantral communication). Surgical debridement following antifungal therapy was the treatment of choice. CONCLUSION Early diagnosis and immediate referral are the cornerstone of comprehensive treatment.
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Affiliation(s)
- Hossein Khoshkhou
- Department of Periodontology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboube Hasheminasab
- Department of Orthodontics, Dugoni School of Dentistry, University of the Pacific, San Francisco, USA.,Department of Oral and Maxillofacial Surgery and CranioMaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Daryoush Goudarzi Pour
- Department of Oral & Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Raika Jamali
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Neda Moslemi
- Department of Periodontology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. .,Dental Research Center, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Li X, Mei M, Pu X, Chen X, Li X, Meng F, He S, Li J, Gu W, Yang X, Zhang F, Yu J. Protective effect and mechanism of Polygonatum kingianum against hypoxia-induced injury. Heliyon 2023; 9:e14353. [PMID: 36967867 PMCID: PMC10034467 DOI: 10.1016/j.heliyon.2023.e14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background Hypoxia is an essential cause of fatigue and aging, and is associated with the occurrence and development of many diseases. Polygonatum kingianum (PK) is a deficiency-nourishing Chinese herbal medicine utilized as both medicine and food, and it has long been used to ameliorate human conditions associated with fatigue and aging over 2000 years in China. PK is an important genuine-medicinal-materials cultivated in Yunnan, China, and is used by the Bai, Wa, and Zhuang nationalities as a traditional medicine for enhancing immunity, anti-fatigue, and anti-aging, while the preventive effect of PK on hypoxia-induced injury and the underlying mechanism are indefinite. Aim of the study The present study aimed to evaluate the anti-hypoxia efficacy and understand the corresponding mechanism of PK water extract. Materials and methods The main active ingredients and targets of PK were predicted using network pharmacology, and the anti-hypoxia activities of Gracillin and Liquiritigenin were verified by in vitro experiments. The pharmacodynamic experiments were conducted to evaluate the major signal pathways of PK for detecting anti-hypoxia activity. Results Fifty active ingredients and 371 potential targets were screened by network pharmacology, then, we confirmed that Gracillin and Liquiritigenin were the main active components of PK to exert anti-hypoxia effect in vitro. The pharmacodynamic experiments revealed that PK enhanced the extension rate of the survival time (ERST) and regulated the targets-related biochemical parameters of rats under hypoxia, showing significant anti-hypoxia effects on rats. Conclusion The network pharmacology results suggested that PK exerts its anti-hypoxia effect through a multi-component and multi-target manner. Simultaneously, we also observed that Gracillin (saponins) and Liquiritigenin (flavonoids) are the main active components of PK to play a role in anti-hypoxia. The anti-hypoxia effect of PK could be associated with scavenging excess free radicals, maintaining the activities of antioxidant enzymes, and inhibiting oxidative stress due to lipid peroxidation. These findings provide insight into the Polygonatum kingianum as promising medicines or healthcare products for preventing and treating hypoxia.
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19
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Amalanathan S, Satish Kumar C, Abinaya R, Prathiba K, Kumaran Ramesh C, Kavitha B, Malini A, Amudhasubba R. Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2023; 39:73. [PMCID: PMC10127177 DOI: 10.1186/s43163-023-00430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
Background India witnessed a massive surge of rhino orbital cerebral mucormycosis (ROCM) cases during the second wave of COVID-19, recording the highest number of cases in the world, indeed, an epidemic within the pandemic. Objectives To describe the clinical profile of patients with COVID-19-associated mucormycosis (CAM) and the clinical suspects for mucormycosis. Methods This single-center descriptive, observational study/audit was done at Indira Gandhi Medical College, Pondicherry, South India. This study is about the clinical profile of 7 CAM patients and 14 COVID-19 patients who were suspects of CAM, based on their risk factors and clinical symptoms, and were referred to the ENT department. Statistical analysis All the descriptive variables were summarized as mean, frequency, and percentages for qualitative data. Results All 7 CAM patients were COVID-19 positive and were not vaccinated against COVID-19, All 7 were known diabetic, all 7 had steroid therapy for their COVID status, and 5 out of 7 (71%) had uncontrolled diabetes mellitus at the time of diagnosis. Facial pain, nasal discharge, and eye swelling were the presenting symptoms of CAM. Maxillary and ethmoid sinuses were the most commonly involved para nasal sinuses. Four out of seven (57.1%) CAM patients survived after 16 months of follow-up, after surgical and medical treatment for CAM. Of the 14 clinical suspects who were negative for CAM, 2 were negative for COVID-19, their risk factors were brought under control, 3 expired due to COVID complications, and 9 patients are alive till date. Conclusion Uncontrolled diabetes is a risk factor for ROCM/CAM, another possible risk factor is steroid therapy, and we hypothesize that COVID infection could also be a possible risk factor that needs to be studied more extensively in a larger sample. Early clinical suspicion, withdrawal of steroids, rapid control of diabetes mellitus, appropriate investigations, and early surgical intervention combined with medical treatment offers better outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s43163-023-00430-2.
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Affiliation(s)
- Sophia Amalanathan
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - C Satish Kumar
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - R Abinaya
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - K Prathiba
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - Colbert Kumaran Ramesh
- Department of ENT, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - B Kavitha
- Department of Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - A Malini
- Department of Microbiology, Indira Gandhi Medical College & Research Institute, Pondicherry, India
| | - Reddy Amudhasubba
- Department of Ophthalomology, Indira Gandhi Medical College & Research Institute, Pondicherry, India
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20
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Sarohan AR, Edipsoy S, Özkurt ZG, Özlü C, Demir AN, Cen O. Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:153-166. [PMID: 37253944 DOI: 10.1007/5584_2023_774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.
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Affiliation(s)
| | - Sait Edipsoy
- Department of Ophthalmology, Medicina Plus Medical Center, İstanbul, Turkey
| | | | - Can Özlü
- Department of Hematology, Kütahya Health Science University, Evliya Çelebi Education and Research Hospital, Kütahya, Turkey
| | - Ayça Nur Demir
- Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey
| | - Osman Cen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Waubonsee College, Sugar Grove, IL, USA
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21
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A Practical Workflow for the Identification of Aspergillus, Fusarium, Mucorales by MALDI-TOF MS: Database, Medium, and Incubation Optimization. J Clin Microbiol 2022; 60:e0103222. [PMID: 36326257 PMCID: PMC9769873 DOI: 10.1128/jcm.01032-22] [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: 11/06/2022] Open
Abstract
There is an increasing body of literature on the utility of MALDI-TOF MS in the identification of filamentous fungi. However, the process still lacks standardization. In this study, we attempted to establish a practical workflow for the identification of three clinically important molds: Aspergillus, Fusarium, and Mucorales using MALDI-TOF MS. We evaluated the performance of Bruker Filamentous Fungi database v3.0 for the identification of these fungi, highlighting when there would be a benefit of using an additional database, the MSI-2 for further identification. We also examined two other variables, namely, medium effect and incubation time on the accuracy of fungal identification. The Bruker database achieved correct species level identification in 85.7% of Aspergillus and 90% of Mucorales, and correct species-complex level in 94.4% of Fusarium. Analysis of spectra using the MSI-2 database would also offer additional value for species identification of Aspergillus species, especially when suspecting species with known identification limits within the Bruker database. This issue would only be of importance in selected cases where species-level identification would impact therapeutic options. Id-Fungi plates (IDFP) had almost equivalent performance to Sabouraud dextrose agar (SDA) for species-level identification of isolates and enabled an easier harvest of the isolates with occasional faster identification. Our study showed accurate identification at 24 h for Fusarium and Mucorales species, but not for Aspergillus species, which generally required 48 h.
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22
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Kyuno D, Kubo T, Tsujiwaki M, Sugita S, Hosaka M, Ito H, Harada K, Takasawa A, Kubota Y, Takasawa K, Ono Y, Magara K, Narimatsu E, Hasegawa T, Osanai M. COVID-19-associated disseminated mucormycosis: An autopsy case report. World J Clin Cases 2022; 10:10358-10365. [PMID: 36246823 PMCID: PMC9561594 DOI: 10.12998/wjcc.v10.i28.10358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reports of mucormycosis, an infectious disease that commonly affects immunocompromised individuals, have increased during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Disseminated mucormycosis associated with COVID-19 is rare but fatal and is characterized by an aggressive clinical course and delayed diagnosis. Our report documents a case of disseminated mucormycosis after COVID-19 infection. This is a rare pathological autopsy report on COVID-19-associated mucormycosis.
CASE SUMMARY A 58-year-old man was transferred to our hospital with severe COVID-19 pneumonia. During treatment for acute respiratory distress syndrome, he developed intra-abdominal bleeding that required a right hemicolectomy and ileostomy for hemostasis. The ileostoma and surgical wound developed necrosis followed by sepsis and multi-organ failure, which led to death. An autopsy revealed multiple thrombi associated with Rhizopus oryzae infection, which led to the necrosis of multiple infected organs.
CONCLUSION Early suspicion and diagnosis followed by treatment are keys to better outcomes of mucormycosis in patients with severe COVID-19.
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Affiliation(s)
- Daisuke Kyuno
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Terufumi Kubo
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Mitsuhiro Tsujiwaki
- Department of Surgical Pathology, Sapporo Medical University, Sapporo 0608556, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University, Sapporo 0608556, Japan
| | - Michiko Hosaka
- Department of Surgical Pathology, Sapporo Medical University, Sapporo 0608556, Japan
| | - Hazuki Ito
- Department of Emergency Medicine, Sapporo Medical University, Sapporo 0608556, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, Sapporo 0608556, Japan
| | - Akira Takasawa
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Yusaku Kubota
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Kumi Takasawa
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Yusuke Ono
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Kazufumi Magara
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo 0608556, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, Sapporo 0608556, Japan
| | - Makoto Osanai
- Department of Pathology, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
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23
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Vidhyadevi R, Saudhamini S, Padmanaban S, Sundar D, Kannappan S, Suryaprabha G. Association of Risk Factors among Nasal and Orbital Mucormycosis in Coronavirus Disease 2019 Infection: A Cross-Sectional Study. J Curr Ophthalmol 2022; 34:460-464. [PMID: 37180537 PMCID: PMC10170986 DOI: 10.4103/joco.joco_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To study the risk factors of mucormycosis and analyze their association among nasal and orbital mucormycosis in Coronavirus disease 2019 (COVID-19) infection. Methods All patients diagnosed of rhino-orbito-cerebral mucormycosis (ROCM) with previous COVID-19 infection were included in the study. The details such as age, sex, presence of co-morbidities, and serum ferritin levels were collected. ROCM patients were classified into two groups, nasal mucormycosis (stage 1 and 2 of ROCM) and orbital mucormycosis (stage 3 and 4 of ROCM), and data were collected. Duration of COVID-19 symptoms, the time interval between COVID-19 infection and onset of ROCM symptoms, computed tomography severity score (CTSS) and usage of steroids were collected accordingly. The collected data were compared between nasal group and orbital group. Results Among 52 patients, 15 patients had nasal and 37 patients had orbital mucormycosis. Forty-one patients were more than 40 years, 43 patients were males. Seven out of ten risk factors were found to be significant on comparing nasal and orbital group. Patients of age more than 40 years (P = 0.034), elderly diabetics (P = 0.014), poor control of diabetes (P = 0.003), high serum ferritin levels (P = 0.043), duration between COVID-19 and mucormycosis of more than 20 days (P = 0.038), CTSS of more than 9/25 (P = 0.020), and steroid usage during COVID-19 infection (P = 0.034) are prone to develop orbital mucormycosis. On multivariate logistic regression analysis, these variables did not emerge as independent risk factors. Conclusions Patients with severe COVID-19 infection along with other associated risk factors can be prone to develop severe forms of mucormycosis. We did not find them to be statistically significant on multivariate analysis. In the future, large scale studies are needed to know their significance.
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Affiliation(s)
- Ramasamy Vidhyadevi
- Department of Ophthalmology, PSGIMSR, Coimbatore, Tamil Nadu, India
- Address for correspondence: Ramasamy Vidhyadevi, Department of Ophthalmology, PSGIMSR, Coimbatore - 641 004, Tamil Nadu, India. E-mail:
| | - S. Saudhamini
- Department of Ophthalmology, PSGIMSR, Coimbatore, Tamil Nadu, India
| | | | | | - Suvetha Kannappan
- Department of Community Medicine, PSGIMSR, Coimbatore, Tamil Nadu, India
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24
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Kurokawa M, Kurokawa R, Baba A, Kim J, Tournade C, Mchugh J, Trobe JD, Srinivasan A, Bapuraj JR, Moritani T. Deadly Fungi: Invasive Fungal Rhinosinusitis in the Head and Neck. Radiographics 2022; 42:2075-2094. [PMID: 36178803 DOI: 10.1148/rg.220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Invasive fungal rhinosinusitis (IFRS) is a serious infection that is associated with high morbidity and mortality rates. The incidence of IFRS has been increasing, mainly because of the increased use of antibiotics and immunosuppressive drugs. Rhino-orbital cerebral mucormycosis has recently reemerged among patients affected by COVID-19 and has become a global concern. The detection of extrasinus involvement in its early stage contributes to improved outcomes; therefore, imaging studies are essential in establishing the degree of involvement and managing the treatment properly, especially in immunocompromised patients. The common sites of extrasinus fungal invasion are the intraorbital, cavernous sinus, and intracranial regions. Fungi spread directly to these regions along the blood vessels or nerves, causing devastating complications such as optic nerve ischemia or compression, optic neuritis or perineuritis, orbital cellulitis, cavernous sinus thrombosis, mycotic aneurysm, vasculitis, internal carotid arterial occlusion, cerebral infarction, cerebritis, and brain abscess. IFRS has a broad imaging spectrum, and familiarity with intra- and extrasinonasal imaging features, such as loss of contrast enhancement of the affected region, which indicates tissue ischemia due to angioinvasion of fungi, and the surrounding anatomy is essential for prompt diagnosis and management. The authors summarize the epidemiology, etiology, risk factors, and complications of IFRS and review the anatomy and key diagnostic imaging features of IFRS beyond the sinonasal regions. ©RSNA, 2022.
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Affiliation(s)
- Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Christopher Tournade
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan Mchugh
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan D Trobe
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jayapalli Rajiv Bapuraj
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
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Arjmand P, Bahrami M, Mohammadie ZE, Taherynejad M, Khorasani NY, Mehrad‐Majd H, Roshanzamir I, Bakhshaee M. Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features. Laryngoscope Investig Otolaryngol 2022; 7:LIO2899. [PMID: 36249085 PMCID: PMC9539365 DOI: 10.1002/lio2.899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Mucormycosis is a rare yet devastating fungal disease with a frequently fatal outcome. The purpose of this study was to compare the prevalence of mucormycosis, evaluate its risk factors, and assess the patients' outcomes in pre-COVID-19 and COVID-19 era. Methods In this retrospective observational study, clinical data of 158 patients with confirmed histopathological diagnosis of mucormycosis were collected from the medical records departments of Imam Reza and Ghaem hospitals, Mashhad, Iran during 2018-2021. The collected data were risk factors associated with mucormycosis including age, gender, underlying diseases, details of corticosteroid administration, and complications such as blindness and mortality. Results Of 158 studied patients, 48 patients were diagnosed in the pre-pandemic period whereas 110 cases were admitted during the pandemic era. COVID-19 associated mucormycosis (CAM) was observed in 58.1% of the pandemic cases. In the pre-pandemic period, cancer (89.5% vs. 39%, p < .001) was significantly more prevalent while during the pandemic era, the prevalence of diabetes mellitus (16.7% vs. 51%, p < .001) was remarkably higher. Moreover, the mortality rate of mucormycosis was considerably reduced after the pandemic (64.6%-45.4%), especially in CAM patients (35.9%). Conclusion The COVID-19 pandemic has led to an increased prevalence of mucormycosis, due to the convergence of interlinked risk factors such as diabetes mellitus, corticosteroid therapy, and COVID-19. Therefore, clinicians must be aware of the probable occurrence of mucormycosis in the first or second week of COVID-19 infection in vulnerable patients and use the steroids cautiously. Level of evidence 4 Laryngoscope Investigative Otolaryngology, 2022.
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Affiliation(s)
- Parisa Arjmand
- Department of Otorhinolaryngology, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Milad Bahrami
- Department of Laboratory Sciences, Faculty of Paramedical SciencesMashhad University of Medical SciencesMashhadIran
| | | | | | | | - Hassan Mehrad‐Majd
- Cancer Molecular Pathology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Imaneh Roshanzamir
- Sinus and Surgical Endoscopic Research Center, Department of OtorhinolaryngologyMashhad University of Medical SciencesMashhadIran
| | - Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Department of OtorhinolaryngologyMashhad University of Medical SciencesMashhadIran
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26
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Pourazizi M, Eshraghi B, Azad R, Afshar K, Mohammadbeigy I. Father–Son
COVID
‐19‐associated mucormycosis: Important role of genetic susceptibility in combination with environmental factors. Clin Case Rep 2022; 10:e6312. [PMID: 36101784 PMCID: PMC9459102 DOI: 10.1002/ccr3.6312] [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: 06/23/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
In this report, a father with a history of diabetes mellitus and his son without a remarkable past medical history, both got COVID‐19‐ associated mucormycosis (CAM) as evidenced by their clinical and radiological findings. This suggests the possible role of genetics in combination with the environment in susceptibility to CAM. The simultaneous infection of a diabetic father and his son who did not have any known risk factors for COVID‐19‐associated mucormycosis (CAM) may indicate the possible role of genetics and the environment in CAM infection.
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Affiliation(s)
- Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Bahram Eshraghi
- Department of Ophthalmology, Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Roya Azad
- Department of Radiology, Faculty of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Kimia Afshar
- Student Research Committee Isfahan University of Medical Sciences Isfahan Iran
| | - Iman Mohammadbeigy
- Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
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27
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Diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis: a systematic review and meta-analysis. J Laryngol Otol 2022; 136:788-798. [PMID: 35514092 PMCID: PMC9203420 DOI: 10.1017/s0022215122001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to compute the pooled prevalence of diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. METHOD A systematic literature review was performed in PubMed, Scopus, Web of Science, Embase and Google Scholar. The cross-sectional studies that reported the frequency of diabetes mellitus in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis were included. RESULTS Eighteen eligible studies with a total number of 3718 patients were included in the current study. The pooled prevalence of diabetes in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis was 89 per cent and with new-onset diabetes was 32 per cent. The pooled prevalence of steroid use was high (79 per cent) too. The all-cause mortality rate was 24 per cent. CONCLUSION Diabetes mellitus was the most frequent underlying condition in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. The second most frequent underlying condition was steroid use during coronavirus disease 2019 infection. The appropriate control of hyperglycaemia and rational prescription of steroids during the treatment of coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis is recommended.
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28
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Baral PK, Aziz MA, Islam MS. Comparative risk assessment of COVID‐19 associated mucormycosis and aspergillosis: A systematic review. Health Sci Rep 2022; 5:e789. [PMID: 36000078 PMCID: PMC9387898 DOI: 10.1002/hsr2.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID‐19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID‐19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA‐associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South‐European and West‐European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre‐existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one‐fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.
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Affiliation(s)
- Prodip Kumar Baral
- Department of Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
| | - Md. Abdul Aziz
- Department of Pharmacy State University of Bangladesh Dhaka Bangladesh
| | - Mohammad Safiqul Islam
- Department of Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
- Laboratory of Pharmacogenomics and Molecular Biology Noakhali Science and Technology University Noakhali Bangladesh
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Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India. PLoS One 2022; 17:e0272042. [PMID: 35939442 PMCID: PMC9359565 DOI: 10.1371/journal.pone.0272042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India.
Methods
We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model.
Results
Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45–59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM.
Conclusions
Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.
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Das AK, Mani SK, Singh SK. Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center. Surg Neurol Int 2022; 13:335. [PMID: 36128146 PMCID: PMC9479606 DOI: 10.25259/sni_374_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations. Methods: This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken. Results: Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach. Conclusion: In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.
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SARS-CoV-2 Infection (COVID-19) and Rhinologic Manifestation: Narrative Review. J Pers Med 2022; 12:jpm12081234. [PMID: 36013183 PMCID: PMC9409980 DOI: 10.3390/jpm12081234] [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: 07/07/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
Patients with severe pneumonia of unknown etiology presented in December 2019 in Wuhan, China. A novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was isolated from the respiratory tracts of these patients. The World Health Organization (WHO) defined respiratory diseases due to SARS-CoV-2 infection as coronavirus disease 2019 (COVID-19). Many researchers have reported that the nasal cavity is an important initial route for SARS-CoV-2 infection and that the spike protein of this virus binds to angiotensin-converting enzyme 2 (ACE2) on epithelial cell surfaces. Therefore, COVID-19 is thought to significantly affect nasal symptoms and various rhinological diseases. In this review, we summarize the association between COVID-19 and various rhinological diseases, such as olfactory dysfunction, rhinosinusitis, and allergic rhinitis.
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Davies GE, Thornton CR. Development of a Monoclonal Antibody and a Serodiagnostic Lateral-Flow Device Specific to Rhizopus arrhizus (Syn. R. oryzae), the Principal Global Agent of Mucormycosis in Humans. J Fungi (Basel) 2022; 8:jof8070756. [PMID: 35887511 PMCID: PMC9325280 DOI: 10.3390/jof8070756] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. Though a number of different species can cause mucormycosis, the principal agent of the disease worldwide is Rhizopus arrhizus, which accounts for the majority of rhino-orbital-cerebral, pulmonary, and disseminated infections in immunocompromised individuals. It is also the main cause of life-threatening infections in patients with poorly controlled diabetes mellitus, and in corticosteroid-treated patients with SARS-CoV-2 infection, where it causes the newly described disease, COVID-19-associated mucormycosis (CAM). Diagnosis currently relies on non-specific CT, a lengthy and insensitive culture from invasive biopsy, and a time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests for the disease that detect biomarkers of infection, and which allow point-of-care diagnosis. Here, we report the development of an IgG1 monoclonal antibody (mAb), KC9, which is specific to Rhizopus arrhizus var. arrhizus (syn. Rhizopus oryzae) and Rhizopus arrhizus var. delemar (Rhizopus delemar), and which binds to a 15 kDa extracellular polysaccharide (EPS) antigen secreted during hyphal growth of the pathogen. Using the mAb, we have developed a competitive lateral-flow device (LFD) that allows rapid (30 min) and sensitive (~50 ng/mL running buffer) detection of the EPS biomarker, and which is compatible with human serum (limit of detection of ~500 ng/mL) and bronchoalveolar lavage fluid (limit of detection of ~100 ng/mL). The LFD, therefore, provides a potential novel opportunity for the non-invasive detection of mucormycosis caused by Rhizopus arrhizus.
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Affiliation(s)
- Genna E. Davies
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Christopher R. Thornton
- MRC Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
- Correspondence:
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Jain V, Senetar AJ, Maciel CB, Remley W, Islam S, Fredenburg KM, Babi MA, Robinson CP. A 40-Year-Old Woman With COVID-19 and Bilateral Vision Loss. Neurohospitalist 2022; 12:664-668. [PMID: 36147755 PMCID: PMC9280117 DOI: 10.1177/19418744221114209] [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] [Indexed: 11/16/2022] Open
Abstract
Mucormycosis is a fast-spreading angioinvasive fungal infection with a very high mortality rate. It is associated with immunodeficiency, diabetes mellitus, iron overload, stem cell transplantation and the use of steroids. As cultures and histopathological biopsy may have low yield in invasive fungal infections, new generation sequencing of cfDNA (cell free deoxyribonucleic acid) has become a cornerstone for diagnosis. Over the past 18 months, increasing reports of COVID-19 associated Mucormycosis have emerged, most specifically in India and other nearby developing countries. Awareness and knowledge of this newly discovered association is of high importance and clinical relevance as the global COVID-19 pandemic continues. Herein, we present a case of a patient who was treated with steroids for COVID-19 in the outpatient setting and presented with unilateral periorbital pain and blurry vision. She progressively developed bilateral vision loss, fixed bilateral mydriasis, ophthalmoplegia and coma. Imaging findings included leptomeningeal, vascular, and subcortical enhancement accompanied with multifocal infarction. Subsequent biopsy of the paranasal sinuses revealed broad type fungal elements and cfDNA sequencing identified the pathogen as Rhizopus species. She was treated with intravenous amphotericin B, but succumbed to the infection.
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Affiliation(s)
- Varun Jain
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alexander J. Senetar
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - William Remley
- Medical Student, Lake Erie College of Osteopathic Medicine, Gainesville, FL, USA
| | - Shehla Islam
- Department of Infectious Diseases, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kristianna M. Fredenburg
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Marc A Babi
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher P. Robinson
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
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Jayagayathri R, Mohanty P, Yadalla D, Bakthavatchalam J, Rangarajan V, Maneksha V, Tanwar M, Venkatesh R, Jayashree S. Knowledge, attitude, and practice toward mucormycosis among patients presenting to six tertiary eye care hospitals in South India - A multicentric online questionnaire-based survey. Indian J Ophthalmol 2022; 70:2158-2162. [PMID: 35648003 PMCID: PMC9359275 DOI: 10.4103/ijo.ijo_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To study the awareness on mucormycosis among outpatients who visited six tertiary eye care hospitals at Madurai, Pondicherry, Coimbatore, Tirunelveli, Chennai, and Tirupati. Methods: This was a telephone-based survey conducted using questionnaires consisting of 38 questions in five sections from July 5 to 25, 2021. Patients visiting the eye hospitals for an examination were contacted over their phones and responses were directly entered onto the Google forms platform. Results: A total of 4573 participants were included in the study. Among all participants, a cumulative 83% of participants had some knowledge of mucormycosis. More than 80% of them reported that their prime source of information was through mass communication like television or radio. Around 34.8% of the respondents were aware that it can occur after treatment for coronavirus disease 2019 (COVID-19) infection, only half of them (54.3%) knew that systemic steroids were the main risk factor. The knowledge scores were higher for participants who were diabetics (n = 1235) or had been affected by COVID-19 earlier (n = 456) or whose friends had mucormycosis earlier (n = 312). Knowledge, attitude, and practice (KAP) scores of nonprofessional health-care workers (n = 103) were much better compared to patients. Conclusion: Such KAP studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 83% of participants had some knowledge of mucormycosis and 86% knew that this was an emergency. More than 50% of the participants were not aware that diabetes is a risk factor for mucormycosis.
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Affiliation(s)
| | - Preeti Mohanty
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Tirupati, Andhra Pradesh, India
| | - Dayakar Yadalla
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | | | - Viji Rangarajan
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Velu Maneksha
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meghana Tanwar
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Rengaraj Venkatesh
- Chief Medical Officer, Department of Glaucoma, Aravind Eye Hospital, Pondicherry, India
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Sharma L, Gupta S, Chopra L, Dhamija P. Pneumonitis and Pulmonary Mucormycosis in a Covid-19 Positive Patient-A Case Report. Acad Forensic Pathol 2022; 12:58-64. [PMID: 35799994 DOI: 10.1177/19253621221106885] [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: 02/15/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
In the wake of second wave of coronavirus disease (Covid-19), an increased number of mucormycosis cases were reported by the Ministry of Health and Family Welfare in India. A total of 45 432 cases of mucormycosis were reported till mid-July 2021, with 4252 fatalities. Mucormycosis and other fungal infections are most commonly seen as an opportunistic infection. They are found in those with low underlying immunity either due to a diabetes, cancers particularly hematological malignancies, and so on, or as a side effect of prolonged/irrational use of certain drugs like steroids, immunosuppressive drugs for management of other disorders including Covid-19. The Health Authorities in India stated that although it is not a new disease, its true incidence during the beginning of the second wave was unknown as it was not a notifiable disease. As per reports, the most common presentations of mucormycosis included rhinocerebral (77.6%), cutaneous (4.3%), and pulmonary (3.0%). We present a case of pulmonary mucormycosis and pneumonitis in a Covid-19 positive patient brought for autopsy. The patient was an under trial prisoner sent for treatment to our facility who was reported Covid positive.
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Sekar N, Sundaresan KT. The Co-infection of Mild COVID-19 and Rhinocerebral Mucormycosis in a Patient Without Diabetes or Prior Steroid Use. Cureus 2022; 14:e24986. [PMID: 35719782 PMCID: PMC9189617 DOI: 10.7759/cureus.24986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
In a fast-evolving COVID-19 pandemic, co-infection with mucormycosis has been reported in some parts of the world. It is still unknown whether one of the either diseases makes the patient susceptible to developing the other. The co-occurrence of them significantly elevates the mortality risk and is commonly reported in immunocompromised individuals. We herein report a case of COVID-19 infection with rhinocerebral mucormycosis without prior steroid use or underlying immunosuppressive diseases.
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Alemayehu FM, Abate HK, Soboka TA, Huluka DK, Worke AB, Abrie MT, Dibaba DK, Asnake YB. Rhino-Orbital-Cerebral Mucormycosis in a Young Diabetic Patient with COVID-19 in Ethiopia: A Case Report. Int Med Case Rep J 2022; 15:251-257. [PMID: 35615254 PMCID: PMC9126225 DOI: 10.2147/imcrj.s364591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background There has been a rise in secondary invasive fungal infections reported in COVID-19 patients globally. We report the first published case of COVID-19 associated rhino-orbital-cerebral mucormycosis in Africa in a newly diagnosed diabetic female who presented with diabetic ketoacidosis (DKA) and discuss the prevalence and risk factors of fungal co-infection with the clinical presentation, diagnosis, and management of mucormycosis in COVID-19. Case Presentation A 39 years old female patient was admitted to ICU with a diagnosis of severe COVID-19 and newly diagnosed diabetes mellitus (DM) with DKA based on HgbA1c of 13.8% and positive RT-PCR. The patient was treated with dexamethasone in line with evidence in the RECOVERY trial and developed right facial and orbital swelling on her second hospital day. Brain MRI showed characteristic peri-sinonasal invasion with central nervous system (CNS) involvement, features suggestive of invasive fungal infection. Despite all medical and surgical treatments including liposomal amphotericin B and debridement, the patient died within 7 days of symptom onset. Conclusion Clinicians should be aware of the potential for Rhino-Orbital-Cerebral Mucormycosis (ROCM) as a complication of COVID-19, especially in steroid taking diabetics who develop periorbital swelling and sinusitis. Timely diagnosis and multidisciplinary treatment are very critical.
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Affiliation(s)
- Fikremariam Melkeneh Alemayehu
- General Practitioner, Intensive Care Unit Trained, Department of Intensive Care Unit, Ministry of Health (MOH) Eka Kotebe General Hospital, Addis Ababa, Ethiopia
- Correspondence: Fikremariam Melkeneh Alemayehu, PO Box 100571, Kirkos Sub City, Addis Ababa, Ethiopia, Tel +251921467414, Email
| | - Hannibal Kassahun Abate
- Internal Medicine Chief Resident (PGY-3), Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tariku Assefa Soboka
- Anesthesiologist and Intensivist, Department of Intensive Care Unit, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Dawit Kebede Huluka
- Internist, Pulmonologist and Critical Care Subspecialist, Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Bedane Worke
- Radiologist, Subspecialist in Body Imaging and Neuroradiology, Department of Radiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Tsegaye Abrie
- Head and Chief General Ophthalmologist, Department of Ophthalmology, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Dawit Kebebaw Dibaba
- Otorhinolaryngologist, Department Head of Otorhinolaryngology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yilkal Birhanu Asnake
- Ophthalmologist, Department of Ophthalmology, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia
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COVID-19 and Mucormycosis Coinfection: How Challenging It Is. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:8617212. [PMID: 35432662 PMCID: PMC9010177 DOI: 10.1155/2022/8617212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/12/2022] [Accepted: 03/27/2022] [Indexed: 12/15/2022]
Abstract
Recently, cases of rhinoorbital mucormycosis in people diagnosed with COVID-19 have been reported from India particularly. Diabetes mellitus though happens to be an independent risk factor both for severe COVID-19 and mucormycosis, administration of steroids is attributed as a precipitating factor for acquiring the comorbid condition. This opportunistic fungal infection is highly angioinvasive in nature because of which, clinical outcome of infection is invariably poor, especially with rhinocerebral or rhinoorbitocerebral variety of mucormycosis. However, effective management depends upon timely and accurate diagnosis and parenteral administration of amphotericin B. At the same time, judicious use of steroids is a key factor. In addition, glycemic control in those who are severely diabetic is strongly advocated. Exenteration of an eyeball may be indicated if cavernous sinus and intracranial spread are anticipated. Therefore, in order to facilitate faster healing and better penetration of antifungal drugs, surgical debridement of the paranasal sinus cavities and removal of dead tissue from the sinuses are recommended.
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İşlek A, Şimşek S. A fatal rhino-orbit-cerebral mucormycosis infection aggravated by coronavirus disease-2019. Rev Soc Bras Med Trop 2022; 55:e06662021. [PMID: 35416883 PMCID: PMC9009871 DOI: 10.1590/0037-8682-0666-2021] [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: 11/29/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Akif İşlek
- Acıbadem Eskişehir Hospital, Otolaryngology-Head & Neck Surgery Clinic, Eskişehir, Turkey
| | - Sadullah Şimşek
- Dicle University, Department of Radiology, Diyarbakır, Turkey
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Molaei H, Shojaeefar E, Nemati E, Khedmat L, Mojtahedi SY, Jonaidi Jafari N, Izadi M, Einollahi B. Iranian patients co-infected with COVID-19 and mucormycosis: the most common predisposing factor, clinical outcomes, laboratory markers and diagnosis, and drug therapies. Infect Dis (Lond) 2022; 54:600-613. [PMID: 35389322 DOI: 10.1080/23744235.2022.2058604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The newly emerged pandemic of coronavirus disease-2019 (COVID-19) is the world's main health challenge because infected patients become vulnerable to a variety of opportunistic diseases. OBJECTIVE This study aimed to assess clinical outcomes, diagnosis, utilized drug therapies, and ongoing COVID-19 practices in Iranian cases co-infected with COVID-19 and mucormycosis. PARTICIPANTS AND METHODS A case-series analysis was conducted in the presence of 10 patients with COVID-19 and mucormycosis co-infection (two men and eight women; mean age of 48.8 years) from March to October 2020. Demographic variables, signs/symptoms, and comorbidities of all patients were recorded. COVID-19 was confirmed with reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab tests and high-resolution computed tomography (HR-CT)_ scans. RESULTS All patients had a positive RT-PCR for SARS-CoV-2. Eight patients had a history of diabetes, while three of them exhibited a hypertension history. Remarkable laboratory findings were elevated fasting blood sugar in 6 cases and anaemia in four patients. A rhino-orbital-cerebral of mucormycosis in all patients was detected based on HR-CT scans and otorhinolaryngological or ophthalmological examinations. Neurological disorders including facial, trigeminal, optic, and oculomotor nerve involvement resulted in paraesthesia, pain, ptosis, no light perception, blurred vision, and papilledema in five cases. Maxillary and ethmoid sinuses were the most common sites of involvement. CONCLUSION Vulnerable COVID-19 patients with comorbidities, any facial involvements, or treated by excessive doses of glucocorticoids and antibiotics should undergo precise examinations during the appearance of early signs and hospitalization to diagnose and treat mucormycosis using the standard care and antifungal treatments.
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Affiliation(s)
- Hamideh Molaei
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ehsan Shojaeefar
- Immunology Board for Transplantation and Advanced Cellular Therapeutics (ImmunoTACT), Universal Scientific and Education Network (USERN), Tehran, Iran
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nematollah Jonaidi Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Kaya T, Dilek A, Ozaras R, Balcik OS, Leblebicioglu H. COVID 19 and febrile neutropenia: Case report and systematic review. Travel Med Infect Dis 2022; 47:102305. [PMID: 35272019 PMCID: PMC8901240 DOI: 10.1016/j.tmaid.2022.102305] [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: 11/13/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
Objectives In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis. Methods We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science. Results A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies. Conclusion In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression.
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Affiliation(s)
- Taner Kaya
- Department of Internal Medicine, VM Medicalpark Samsun Hospital, Samsun, Turkey.
| | - Ahmet Dilek
- Intensive Care Unit, VM Medicalpark Samsun Hospital, Samsun, Turkey; Istinye University, Faculty of Medicine, Istanbul, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases, Medilife Health Group, Istanbul, Turkey.
| | - Ozlem Sahin Balcik
- Department of Hematology, VM Medicalpark Samsun Hospital, Samsun, Turkey.
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey.
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Gherlan GS, Hoara MC, Smadu SG, Popescu CP, Ionescu P, Florescu SA. Histopathologically Confirmed Pulmonary Mucormycosis as a Complication of COVID-19: a Case Report from Romania and Insight into Pathology. MAEDICA 2022; 17:215-225. [PMID: 35733728 DOI: 10.26574/maedica.2022.17.1.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
COVID-19 has proven to be an independent risk factor for secondary infectious complications. Amongst them, mucormycosis has recently been noticed more frequently than in the past. Caused by molds belonging to the Mucorales order, this is a rare, but potentially fatal infection unless adequately treated. Ear, nose and throat involvement is prevalent with often expansion to the orbit, sinuses or brain. Pulmonary, cutaneous and gastrointestinal infections are also recognized. Classical risk factors for progression to angioinvasive disease include poorly controlled diabetes mellitus, defects in phagocytic function (prolonged neutropenia, glucocorticoid treatment), immunosuppressive therapy associated with transplantation, malignancy, elevated levels of free iron as well as iron chelators (deferoxamine). In addition, immune dysregulation rendered by COVID-19 itself may contribute or solely lead to invasive mold disease. The largest experience comes from India, which has dealt with a challenging epidemic of COVID-19-associated mucormycosis (CAM). To our knowledge, no previous studies have reported CAM in Romania. We therefore present a case of severe COVID-19 pneumonia initially complicated by bacterial superinfection and secondary sepsis at admission in an unvaccinated 61-year-old male who presented in our clinic with respiratory failure and digestive symptoms. Although improvement occurred rapidly following antiviral, empiric large spectrum Intraantibiotics and pathogenic medication, unfavorable clinical course ensued later on. Biological and imaging investigations were consistent with pulmonary superinfection in the form of multiple different-sized upper right field opacities, which eventually evolved to form cavities. Differential diagnosis was thoroughly performed. Since unable to sterilize the lung by means of medication alone, the patient underwent major thoracic surgery with removal of the entire right lung. Microscopic study of the damaged tissue was able to determine the presence of broad, aseptate hyphae which morphologically belong to Mucorales. A diagnosis of pulmonary mucormycosis was established and proper antifungal treatment was initiated, with full recovery of the patient.
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Affiliation(s)
- George Sebastian Gherlan
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Maria Cristina Hoara
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Sebastian George Smadu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Corneliu Petru Popescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Petronela Ionescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Simin-Aysel Florescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
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SeyedAlinaghi S, Karimi A, Barzegary A, Pashaei Z, Afsahi AM, Alilou S, Janfaza N, Shojaei A, Afroughi F, Mohammadi P, Soleimani Y, Nazarian N, Amiri A, Tantuoyir MM, Oliaei S, Mehraeen E, Dadras O. Mucormycosis infection in patients with
COVID
‐19: A systematic review. Health Sci Rep 2022; 5:e529. [PMID: 35252593 PMCID: PMC8885749 DOI: 10.1002/hsr2.529] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Several reports previously described mucormycosis co‐infection in patients with COVID‐19. As mucormycosis and COVID‐19 co‐infection might adversely affect patients' outcomes, we aimed to systematically review the related evidence and the subsequent outcomes. Methods We conducted a systematic review of relevant articles searching the keywords in the online databases of PubMed, Scopus, Embase, Cochrane, and Web of Science. All the records from the start of the pandemic until June 12th, 2021 underwent title/abstract and then full‐text screening process, and the eligible studies were included. We did not include any language or time restrictions for the included studies. Results We found 31 eligible studies reporting 144 total cases of COVID‐19 and mucormycosis co‐infection. The nose, cranial sinuses, and orbital cavity were the most commonly involved organs, although the cerebrum, lungs, and heart were also involved in the studies. Pre‐existing diabetes mellitus (DM), as well as corticosteroid use, were the most commonly identified risk factors, but other underlying conditions and immunomodulatory drug use were also present in several cases. Aspergillus was the most commonly reported micro‐organism that caused further co‐infections in patients with concurrent COVID‐19 and mucormycosis. As most of the studies were case reports, no reliable estimate of the mortality rate could be made, but overall, 33.6% of the studied cases died. Conclusion Early diagnosis of mucormycosis co‐infection in COVID‐19 patients and selecting the right treatment plan could be a challenge for physicians. Patients with underlying co‐morbidities, immunocompromised patients, and those receiving corticosteroids are at higher risk of developing mucormycosis co‐infection and it is crucial to have an eye examination for early signs and symptoms suggesting a fungal infection in these patients.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Amirali Karimi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | - Zahra Pashaei
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Amir Masoud Afsahi
- Department of Radiology School of Medicine, University of California, San Diego (UCSD) San Diego California USA
| | - Sanam Alilou
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Nazanin Janfaza
- Internal Medicine Department Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences Tehran Iran
| | - Alireza Shojaei
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Fatemeh Afroughi
- School of Medicine Islamic Azad University Tehran Iran
- Pars Hospital Iran University of Medical Sciences Tehran Iran
| | - Parsa Mohammadi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | | | - Ava Amiri
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Marcarious M. Tantuoyir
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Biomedical Engineering Unit University of Ghana Medical Center (UGMC) Accra Ghana
| | - Shahram Oliaei
- HBOT Research Center Golestan Hospital, Islamic Republic of Iran, Navy and AJA Medical University Tehran Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology Ardebil University of Medical Sciences Ardebil Iran
| | - Omid Dadras
- Department of Global Health and Socioepidemiology Graduate School of Medicine, Kyoto University Kyoto Japan
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Busca A, Marchesi F, Cattaneo C, Trecarichi EM, Delia M, Del Principe MI, Candoni A, Pagano L. When Viruses Meet Fungi: Tackling the Enemies in Hematology. J Fungi (Basel) 2022; 8:jof8020184. [PMID: 35205938 PMCID: PMC8875273 DOI: 10.3390/jof8020184] [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: 12/07/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Unit, AOU Citta’ della Salute e della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, University “Magna Graecia”—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy;
| | | | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University of Udine-ASUFC, 33100 Udine, Italy;
| | - Livio Pagano
- Unità di Ematologia Geriatrica ed Emopatie Rare, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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46
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Azhar A, Khan WH, Khan PA, Al-hosaini K, Owais M, Ahmad A. Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach. J Infect Public Health 2022; 15:466-479. [PMID: 35216920 PMCID: PMC8855610 DOI: 10.1016/j.jiph.2022.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
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47
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Wong K, Farooq Alam Shah MU, Khurshid M, Ullah I, Tahir MJ, Yousaf Z. COVID-19 associated vasculitis: A systematic review of case reports and case series. Ann Med Surg (Lond) 2022; 74:103249. [PMID: 35039779 PMCID: PMC8754903 DOI: 10.1016/j.amsu.2022.103249] [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: 12/14/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
Vasculitis is one of the complications of COVID-19. We conducted a systematic review analysing the association of COVID-19 with vasculitis. We searched Google Scholar and PubMed from December 1, 2019, to October 11, 2021. The review included 8 studies (7 case reports and 1 case series) reporting 9 cases of vasculitis secondary to COVID-19. The mean age was 29.17 ± 28.2 years, ranging from 6 months to 83 years. The male to female ratio was 4:5. Maculopapular, violaceous, papular and erythematous rash were common. Heparin(n = 2), corticosteroids (n = 6) (methylprednisolone) and intravenous immunoglobulin (n = 4) were prescribed in these patients. Significant clinical improvement was observed in 8 out of 9 patients. One person died during treatment. Our study discusses vasculitis as one of the complications of COVID-19. Furthermore, the pathophysiology, clinical presentation, and management of COVID-19 associated vasculitis is discussed. This is a systematic review of all published cases of vasculitis secondary to COVID-19 from the start of COVID-19 outbreak to date. Most common forms of vasculitis reported were Kawasaki disease Vasculitis, IgA vasculitis and Leucocytoclastic Vasculitis with symptoms being predominantly skin limited. Steroids, LMWH and IVIG were the most common line of treatment. An good overall prognosis was seen following treatment.
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Affiliation(s)
| | | | - Maman Khurshid
- Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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48
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Leung EH, Fan J, Flynn HW, Albini TA. Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare. Clin Ophthalmol 2022; 16:1-13. [PMID: 35018092 PMCID: PMC8742614 DOI: 10.2147/opth.s336963] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.
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Affiliation(s)
| | - Jason Fan
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Thomas A Albini
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
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49
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Samson R, Dharne M. COVID-19 associated mucormycosis: evolving technologies for early and rapid diagnosis. 3 Biotech 2022; 12:6. [PMID: 34900512 PMCID: PMC8647065 DOI: 10.1007/s13205-021-03080-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
The post-coronavirus disease (COVID-19) mucormycosis is a deadly addition to the pandemic spectrum. Although it’s a rare, aggressive, and opportunistic disease, the associated morbidity and mortality are significant. The complex interplay of factors aggravating CAM is uncontrolled diabetes, irrational and excessive use of antibiotics, steroids, and an impaired immune system. Recently, India has been witnessing a rapid surge in the cases of coronavirus disease-associated mucormycosis (CAM), since the second wave of COVID-19. The devastating and lethal implications of CAM had now become a matter of global attention. A delayed diagnosis is often associated with a poor prognosis. Therefore, the rapid and early diagnosis of infection would be life-saving. Prevention and effective management of mucormycosis depend upon its early and accurate diagnosis followed by a multimodal therapeutic approach. The current review summarizes an array of detection methods and highlights certain evolving technologies for early and rapid diagnosis of CAM. Furthermore, several potential management strategies have also been discussed, which would aid in tackling the neglected yet fatal crisis of mucormycosis associated with COVID-19.
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50
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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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