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Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes. J Fungi (Basel) 2021; 8:jof8010044. [PMID: 35049983 PMCID: PMC8781413 DOI: 10.3390/jof8010044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the published literature comprises of either case reports or case series with no long-term data available. The aim of this review paper is to present the characteristics of COVID-19 related mucormycosis and associated clinical features, outcome, diagnostic and management strategies. A prompt diagnosis and aggressive treatment planning can surely benefit these patients.
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Bhatt M, Soneja M, Fazal F, Vyas S, Kumar P, Jorwal P, Raj U, Sachdev J, Singh G, Xess I, Alam S, Biswas A. Two cases of Osteoarticular Mucor menace: A diagnostic and management conundrum. Drug Discov Ther 2019; 12:374-378. [PMID: 30674773 DOI: 10.5582/ddt.2018.01064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mucormycosis is an uncommon aggressive fungal infection usually seen in immunocompromised hosts or patients with burns and trauma. The common presentations include rhino-orbital-cerebral and pulmonary involvement. Osteoarticular involvement is a rare presentation of this disease. We present two cases of osteoarticular mucormycosis of pelvis and long bones of the lower limb, one in a patient with burn injury and other one in a patient with chronic granulomatous disease, hitherto a rarely reported association. Delayed diagnosis in a setting where tuberculosis is a common cause of chronic osteomyelitis, challenges in medical and surgical management of these patients are discussed in this report.
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Affiliation(s)
- Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences
| | - Farhan Fazal
- Department of Medicine, All India Institute of Medical Sciences
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences
| | - Prabhat Kumar
- Department of Medicine, All India Institute of Medical Sciences
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences
| | - Upendra Raj
- Department of Medicine, All India Institute of Medical Sciences
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences
| | - Shah Alam
- Department of Orthopedics, All India Institute of Medical Sciences
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences
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Bernardo RM, Gurung A, Jain D, Malinis MF. Therapeutic Challenges of Hepatic Mucormycosis in Hematologic Malignancy: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:484-9. [PMID: 27406045 PMCID: PMC4948661 DOI: 10.12659/ajcr.898480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 58 Final Diagnosis: Hepatic mucormycosis Symptoms: Abdominal pain • fever Medication: Amphotericin • posaconazole Clinical Procedure: IR-guided aspiration Specialty: Infectious Diseases
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Affiliation(s)
- Raffaele M Bernardo
- Section of Infectious Diseases, Yale University, School of Medicine, New Haven, CT, USA
| | - Ananta Gurung
- Department of Pathology, Yale University, School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, School of Medicine, New Haven, CT, USA
| | - Maricar F Malinis
- Section of Infectious Diseases, Yale University, School of Medicine, New Haven, CT, USA
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Sheybani F, Naderi H, Sarvghad M, Ghabouli M, Arian M. How should we manage a patient with invasive mucoromycosis who develops life-threatening reaction to amphotericin B? Report of two cases and literature review. Med Mycol Case Rep 2015; 8:29-31. [PMID: 25834786 PMCID: PMC4366442 DOI: 10.1016/j.mmcr.2015.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/01/2015] [Indexed: 12/02/2022] Open
Abstract
This report presents two cases of invasive rhino-orbital mucormycosis who had life-threatening reactions to amphotericin B. Both cases were treated with a combination of posaconazole–caspofungin favorably with no evidence of recurrence upon long-term follow-up. To our knowledge, this is the first report of successful treatment of invasive mucormycosis with azole–echinocandin combination. It may suggest that caspofungin exerts additional or even synergistic antimucoral effects to posaconazole.
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Affiliation(s)
- Fereshte Sheybani
- Department of infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza Teaching Hospital, Mashhad 9137913316, Iran
| | - HamidReza Naderi
- Department of infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza Teaching Hospital, Mashhad 9137913316, Iran
| | - MohammadReza Sarvghad
- Department of infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza Teaching Hospital, Mashhad 9137913316, Iran
| | - MohammadJavad Ghabouli
- Department of infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza Teaching Hospital, Mashhad 9137913316, Iran
| | - Mahnaz Arian
- Department of infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza Teaching Hospital, Mashhad 9137913316, Iran
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Campbell A, Cooper C, Davis S. Disseminated mucormycosis in a paediatric patient: Lichthemia corymbifera successfully treated with combination antifungal therapy. Med Mycol Case Rep 2014; 6:18-21. [PMID: 25379392 PMCID: PMC4216331 DOI: 10.1016/j.mmcr.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 12/01/2022] Open
Abstract
Mucormycosis is a severe fungal infection that largely affects immunocompromised individuals. It carries a high morbidity and mortality rate and is characterised by extensive angioinvasion and necrosis of host tissue. This case report details success in treating disseminated mucormycosis in a paediatric patient with an underlying haematological malignancy. Treatment included institution of combination antifungal therapy with liposomal amphotericin B and caspofungin, aggressive surgical debridement of infected tissue and reversal of underlying immunosuppression.
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Affiliation(s)
- Anita Campbell
- Women׳s and Children׳s Hospital: Infectious Diseases and Microbiology Department, 72 King William Road, North Adelaide 5006, Australia
| | - Celia Cooper
- Women׳s and Children׳s Hospital: Infectious Diseases and Microbiology Department, 72 King William Road, North Adelaide 5006, Australia
| | - Stephen Davis
- Women׳s and Children׳s Hospital: Infectious Diseases and Microbiology Department, 72 King William Road, North Adelaide 5006, Australia
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Bhatt VR, Viola GM, Ferrajoli A. Invasive fungal infections in acute leukemia. Ther Adv Hematol 2013; 2:231-47. [PMID: 23556092 DOI: 10.1177/2040620711410098] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Invasive fungal infection (IFI) is among the leading causes for morbidity, mortality, and economic burden for patients with acute leukemia. In the past few decades, the incidence of IFI has increased dramatically. The certainty of diagnosis of IFI is based on host factors, clinical evidence, and microbiological examination. Advancement in molecular diagnostic modalities (e.g. non-culture-based serum biomarkers such as β-glucan or galactomannan assays) and high-resolution radiological imaging has improved our diagnostic approach. The early use of these diagnostic tests assists in the early initiation of preemptive therapy. Nonetheless, the complexity of IFI in patients with leukemia and the limitations of these diagnostic tools still mandate astute clinical acumen. Its management has been further complicated by the increasing frequency of infection by non-Aspergillus molds (e.g. zygomycosis) and the emergence of drug-resistant fungal pathogens. In addition, even though the antifungal armamentarium has expanded rapidly in the past few decades, the associated mortality remains high. The decision to initiate antifungal treatment and the choice of anti-fungal therapy requires careful consideration of several factors (e.g. risk stratification, local fungal epidemiologic patterns, concomitant comorbidities, drug-drug interactions, prior history of antifungal use, overall cost, and the pharmacologic profile of the antifungal agents). In order to optimize our diagnostic and therapeutic management of IFI in patients with acute leukemia, further basic research and clinical trials are desperately needed.
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Affiliation(s)
- Vijaya R Bhatt
- Department of Internal Medicine, Staten Island University Hospital, New York, USA
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Combination Antifungal Therapy: Is it for everyone and every mycosis? INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gastrointestinal Mucormycosis following a Streptococcus pyogenes Toxic Shock Syndrome in a Previously Healthy Patient: A Case Report. Case Rep Infect Dis 2012; 2012:476719. [PMID: 22900216 PMCID: PMC3414004 DOI: 10.1155/2012/476719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/25/2012] [Indexed: 12/02/2022] Open
Abstract
Mucormycosis is an uncommon opportunistic infection and the gastrointestinal form is the rarest. Rhizopus sp. is the most frequent pathogen and infection occurs almost exclusively in immunocompromised patients. We describe the first case of intestinal mucormycosis occurring after a Streptococcus pyogenes toxic shock syndrome in a previously healthy patient caused by Rhizopus microsporus var. azygosporus.
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Rammaert B, Lanternier F, Poirée S, Kania R, Lortholary O. Diabetes and mucormycosis: A complex interplay. DIABETES & METABOLISM 2012; 38:193-204. [DOI: 10.1016/j.diabet.2012.01.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/09/2012] [Indexed: 01/13/2023]
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Ribeiro LC, Wanke B, da Silva M, Dias LB, Mello R, Canavarros FAPB, Leite DP, Hahn RC. Mucormycosis in Mato Grosso, Brazil: a case reports, caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis. Mycopathologia 2011; 173:187-92. [PMID: 21952835 DOI: 10.1007/s11046-011-9472-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.
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Affiliation(s)
- Luciano Corrêa Ribeiro
- Mycology Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
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Pitman SK, Drew RH, Perfect JR. Addressing current medical needs in invasive fungal infection prevention and treatment with new antifungal agents, strategies and formulations. Expert Opin Emerg Drugs 2011; 16:559-586. [DOI: 10.1517/14728214.2011.607811] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev 2011; 24:411-45. [PMID: 21482731 DOI: 10.1128/cmr.00056-10] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Rhizopus, Mucor, and Lichtheimia (formerly Absidia) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all cases. In contrast, Cunninghamella, Apophysomyces, Saksenaea, Rhizomucor, Cokeromyces, Actinomucor, and Syncephalastrum species individually are responsible for fewer than 1 to 5% of reported cases of mucormycosis. In this review, we provide an overview of the epidemiology, clinical manifestations, diagnosis of, treatment of, and prognosis for unusual Mucormycetes infections (non-Rhizopus, -Mucor, and -Lichtheimia species). The infections caused by these less frequent members of the order Mucorales frequently differ in their epidemiology, geographic distribution, and disease manifestations. Cunninghamella bertholletiae and Rhizomucor pusillus affect primarily immunocompromised hosts, mostly resulting from spore inhalation, causing pulmonary and disseminated infections with high mortality rates. R. pusillus infections are nosocomial or health care related in a large proportion of cases. While Apophysomyces elegans and Saksenaea vasiformis are occasionally responsible for infections in immunocompromised individuals, most cases are encountered in immunocompetent individuals as a result of trauma, leading to soft tissue infections with relatively low mortality rates. Increased knowledge of the epidemiology and clinical presentations of these unusual Mucormycetes infections may improve early diagnosis and treatment.
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Role of early diagnosis and multimodal treatment in rhinocerebral mucormycosis: experience of 4 cases. J Oral Maxillofac Surg 2011; 70:354-62. [PMID: 21680075 DOI: 10.1016/j.joms.2011.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 12/30/2010] [Accepted: 02/03/2011] [Indexed: 12/18/2022]
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Shoham S, Magill SS, Merz WG, Gonzalez C, Seibel N, Buchanan WL, Knudsen TA, Sarkisova TA, Walsh TJ. Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol 2010; 48:511-7. [DOI: 10.3109/13693780903311944] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Pagano L, Valentini CG, Caira M, Fianchi L. ZYGOMYCOSIS: Current approaches to management of patients with haematological malignancies. Br J Haematol 2009; 146:597-606. [DOI: 10.1111/j.1365-2141.2009.07738.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48:1743-51. [PMID: 19435437 DOI: 10.1086/599105] [Citation(s) in RCA: 319] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mucormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.
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Affiliation(s)
- Brad Spellberg
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles Medical Center, 1124 West Carson St., RB2, Torrance, CA 90502, USA.
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Salavert-Lletí M, Zaragoza-Crespo R. [Future role of micafungin in the treatment of invasive mycoses caused by filamentous fungi]. Rev Iberoam Micol 2009; 26:81-9. [PMID: 19463284 DOI: 10.1016/s1130-1406(09)70015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Micafungin is a echinocandin. It inhibits beta-1,3-D-glucan synthesis, thus achieving fungicidal activity against virtually all Candida spp., including those resistant to fluconazole, and fungistatic activity against Aspergillus spp., as well as several but not all pathogenic molds. Results from in vitro studies, animal models, small clinical trials, hint at possible future indications such as invasive aspergillosis and empirical viantifungal therapy, although currently there is little information published. AIMS To describe published data of micafungin as treatment against invasive mold infections, specially analysing its role in the inmunodepressed host and critical care setting. METHODS A systematic review of literature using the principal medical search engines was performed. Terms such as micafungin, aspergillosis, zygomycosis, invasive fungal infections, emerging fungal infections, antifungal treatment or therapy, antifungal prophylaxis, empiric or pre-emptive therapy were crossed. Febrile neutropenia patients were excluded. RESULTS Several studies in these setting were identified and were described in this review. Although there were no blinded randomized clinical trials published, treatment or prophylaxis of invasive aspergillosis and other invasive mould infections with micafungin described in open clinical studies were analyzed. CONCLUSIONS Micafungin could play a future important role as a primary or rescue therapy, alone or in combination, in the treatment or prophylaxis of invasive fungal infections caused by moulds. New randomized clinical trials are needed to confirm their efficacy.
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