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Sayyadi A, Salajegheh F, Dalfardi B, Shafiepour M. Simultaneous endobronchial and mediastinal mucormycosis in a patient with Diabetes Mellitus and SARS-CoV-2: A case report and literature review. Heliyon 2024; 10:e34258. [PMID: 39091948 PMCID: PMC11292536 DOI: 10.1016/j.heliyon.2024.e34258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/05/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Background Mucormycosis can be lethal in people with immunocompromising conditions, especially Diabetes Mellitus. Correction of the underlying disorders, instant initiation of antifungal therapy, and surgical resection are the main components of treatment. Herin, we present the successful medical management of Mucormycosis in a patient with Diabetic Ketoacidosis and positive SARS-CoV-2 test who presented with a less seen condition: the simultaneity of mediastinal mass on one side and an endobronchial mass on the other. Case presentation An 18-year-old male with a history of insulin-dependent DM from 4 years ago presented to our hospital with sudden onset dyspnea, chest pain, sore throat, hoarseness, cough, and sputum. Also, we detected unilateral swelling in the neck and multiple lymph nodes in the neck. Lung auscultation revealed bilateral generalized wheezing. Primary laboratory tests detected high blood sugar, metabolic acidosis, positive urine ketone, high ESR, positive CRP, and leukocytosis; his polymerase chain reaction (PCR) for SARS-CoV-2 was positive. Chest X-ray showed left upper lobe consolidation. Computed tomography scan (CT-scan) of the chest revealed a large collapse consolidation in the left lung, mild left side pleural effusion, mediastinal lymphadenopathy, and distention in the esophagus. With suspicion of malignancy, we performed flexible bronchoscopy and endobronchial Ultrasound (EBUS) which revealed a creamy tumoral lesion in the right main bronchus. The biopsy was consistent with Mucormycosis. We successfully treated Mucormycosis with Amphotericin-B liposomal. Conclusion Mucormycosis can mimic the clinical characteristics of malignancy, and emphasize the importance of considering appropriate differential diagnoses because timely diagnosis and treatment is potentially life-saving in Mucormycosis.
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Affiliation(s)
- Amin Sayyadi
- School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Faranak Salajegheh
- Department of Internal Medicine Clinical Research Development Unit, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Behnam Dalfardi
- Department of Internal Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Shafiepour
- Department of Internal Medicine Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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2
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Li N, Bowling J, de Hoog S, Aneke CI, Youn JH, Shahegh S, Cuellar-Rodriguez J, Kanakry CG, Rodriguez Pena M, Ahmed SA, Al-Hatmi AMS, Tolooe A, Walther G, Kwon-Chung KJ, Kang Y, Lee HB, Seyedmousavi A. Mucor germinans, a novel dimorphic species resembling Paracoccidioides in a clinical sample: questions on ecological strategy. mBio 2024:e0014424. [PMID: 38953355 DOI: 10.1128/mbio.00144-24] [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: 01/16/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
Dimorphism is known among the etiologic agents of endemic mycoses as well as in filamentous Mucorales. Under appropriate thermal conditions, mononuclear yeast forms alternate with multi-nucleate hyphae. Here, we describe a dimorphic mucoralean fungus obtained from the sputum of a patient with Burkitt lymphoma and ongoing graft-versus-host reactions. The fungus is described as Mucor germinans sp. nov. Laboratory studies were performed to simulate temperature-dependent dimorphism, with two environmental strains Mucor circinelloides and Mucor kunryangriensis as controls. Both strains could be induced to form multinucleate arthrospores and subsequent yeast-like cells in vitro. Multilateral yeast cells emerge in all three Mucor species at elevated temperatures. This morphological transformation appears to occur at body temperature since the yeast-like cells were observed in the lungs of our immunocompromised patient. The microscopic appearance of the yeast-like cells in the clinical samples is easily confused with that of Paracoccidioides. The ecological role of yeast forms in Mucorales is discussed.IMPORTANCEMucormycosis is a devastating disease with high morbidity and mortality in susceptible patients. Accurate diagnosis is required for timely clinical management since antifungal susceptibility differs between species. Irregular hyphal elements are usually taken as the hallmark of mucormycosis, but here, we show that some species may also produce yeast-like cells, potentially being mistaken for Candida or Paracoccidioides. We demonstrate that the dimorphic transition is common in Mucor species and can be driven by many factors. The multi-nucleate yeast-like cells provide an effective parameter to distinguish mucoralean infections from similar yeast-like species in clinical samples.
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Affiliation(s)
- Na Li
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Guizhou Medical University, Guiyang, China
- Key Laboratory of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
- RadboudUMC-CWZ Center for Expertise in Mycology, Nijmegen, the Netherlands
| | - Jennifer Bowling
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sybren de Hoog
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Guizhou Medical University, Guiyang, China
- Key Laboratory of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
- RadboudUMC-CWZ Center for Expertise in Mycology, Nijmegen, the Netherlands
| | - Chioma I Aneke
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jung-Ho Youn
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sherin Shahegh
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Kanakry
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Rodriguez Pena
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah A Ahmed
- RadboudUMC-CWZ Center for Expertise in Mycology, Nijmegen, the Netherlands
| | | | - Ali Tolooe
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
- Vet Veterinary Diagnostic Laboratory, Tehran, Iran
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Kyung J Kwon-Chung
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Yingqian Kang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Guizhou Medical University, Guiyang, China
- Key Laboratory of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
- Institution of One Health Research, Guizhou Medical University, Guiyang, China
| | - Hyang Burm Lee
- Environmental Microbiology Laboratory, Department of Agricultural Biological Chemistry, College of Agriculture and Life Sciences, Chonnam National University, Gwangju, South Korea
| | - Amir Seyedmousavi
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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3
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Casalini G, Giacomelli A, Antinori S. The WHO fungal priority pathogens list: a crucial reappraisal to review the prioritisation. THE LANCET. MICROBE 2024; 5:717-724. [PMID: 38608682 DOI: 10.1016/s2666-5247(24)00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/14/2024]
Abstract
In October, 2022, WHO published the first fungal priority pathogen list, which categorised 19 fungal entities into three priority groups (critical, high, and medium), for prioritisation of research efforts. The final ranking was determined via multiple criteria decision analysis, considering both research and development needs and perceived public health importance. In this Personal View, we discuss the positioning of the fungal pathogens, namely, Mucorales, Candida spp, Histoplasma spp, Coccidioides and Paracoccidioides spp, Fusarium spp, eumycetoma causative agents, Talaromyces marneffei, and Pneumocystis jirovecii, while expressing concerns about potential disparities between the WHO fungal priority pathogen list ranking and the actual disease burden associated with these pathogens. Finally, we propose a revised prioritisation list that also considers the regional disparities in the burden of fungal diseases.
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Affiliation(s)
- Giacomo Casalini
- Department of Biomedical and Clinical Sciences, DIBIC, Università degli Studi di Milano, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, DIBIC, Università degli Studi di Milano, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy.
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4
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Troyer BS, Kovacic Scherrer N, Garavaglia J. Tocilizumab Versus Baricitinib for the Treatment of COVID-19 in Patients With Obesity. J Pharm Pract 2024; 37:632-636. [PMID: 36803310 PMCID: PMC9941001 DOI: 10.1177/08971900231158931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Background: Tocilizumab and baricitinib have emerged as potential treatments for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following the findings of the Recovery Group and the results of the COV-BARRIER study. Unfortunately, there is a lack of guidance regarding the use of these agents in high-risk patients, such as those with obesity. Objective: To compare the outcomes of tocilizumab and baricitinib as potential treatments for obese patients infected with SARS-CoV-2. Methods: This was a multi-center retrospective analysis comparing outcomes of obese patients who received the standard of care plus tocilizumab or baricitinib for the treatment of SARS-CoV-2. Included patients had a BMI >30 kg/m2, needed ICU level care, and required non-invasive or invasive ventilatory support. Results: This study included 64 patients who received tocilizumab and 69 patients who received baricitinib. When examining the primary outcome, patients who received tocilizumab had a shorter duration of ventilatory support (10.0 vs 15.0 days, P = .016) than patients who received baricitinib. Our secondary outcome of in-hospital mortality was lower in the tocilizumab group as well (23.4% vs 53.6%, P < .001). Tocilizumab was also associated with a non-significant reduction in new positive blood cultures (13.0% vs 3.1%, P = .056) and new invasive fungal infection (7.3% vs 1.6%, P = .210). Conclusions: This retrospective review showed a reduced duration of ventilatory support in obese patients who received tocilizumab vs baricitinib. In the future, additional studies should be conducted to further examine and confirm these results.
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Affiliation(s)
- Bradley S. Troyer
- Department of Pharmacy Practice, University of Charleston School of Pharmacy, Charleston, WV, USA
| | | | - Jeffrey Garavaglia
- Critical Care Pharmacy Department, West Virginia University Hospitals, Morgantown, WV, USA
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5
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Nissim Y, Simon E. Navigating Uncertainty: Teachers' Insights on Their Preservice Training and Its Influence on Self-Efficacy during the COVID-19 Pandemic. Behav Sci (Basel) 2024; 14:135. [PMID: 38392488 PMCID: PMC10886182 DOI: 10.3390/bs14020135] [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: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
This quantitative study investigates teachers' perceptions of self-efficacy during the COVID-19 pandemic and explores the correlation between these perceptions and the preservice training they received. The research addresses the cognitive connection between teachers' current self-efficacy, particularly their satisfaction with and appreciation of preservice lecturers. The connection between self-efficacy and "cognitive connection" lies in the intricate interplay of cognitive processes, observational learning, and the formation of beliefs and perceptions. The way individuals cognitively process information, make connections between experiences, and interpret feedback significantly influences their self-efficacy beliefs and behaviors. Utilizing a retrospective lens, the study reveals a significant correlation between teachers' evaluation of their preservice training, especially their appreciation of lecturers, and their present self-efficacy. The findings highlight that teachers, amidst the challenges of the pandemic, evaluated their self-efficacy at a remarkably high level. This underscores their resilience during a period of unprecedented uncertainty demanding substantial personal and professional adaptability. The nuanced interplay observed suggests that teachers' sense of self-efficacy serves as a predictive variable of their mental and professional resilience when confronting uncertainty and navigating rapid and profound changes, as exemplified by the exigencies of the COVID-19 pandemic.
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Affiliation(s)
- Yonit Nissim
- Department of Education and Learning, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Eitan Simon
- Department of Education and Learning, Tel Hai College, Qiryat Shemona 1220800, Israel
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6
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Kurien R, Varghese L, Cherian LM, Inja RR, Thampi M, Chowdhary S, Bright RR, Abraham L, Panicker R, Rajendran N, Ganesan P, Sahu S, Irodi A, Manesh A, Peter J, Michael JS, Thomas M, Karuppusami R, Varghese GM, Rupa V. A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 2024; 76:611-619. [PMID: 38440599 PMCID: PMC10909060 DOI: 10.1007/s12070-023-04226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.
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Affiliation(s)
- Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Ranjeetha Racheal Inja
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Manu Thampi
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Stuti Chowdhary
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Rakesh R Bright
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Abraham
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Raga Panicker
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Nithya Rajendran
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Priya Ganesan
- Department of Emergency Medicine, Christian Medical College, Vellore, 632004 India
| | - Shalini Sahu
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Aparna Irodi
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College, Vellore, 632004 India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, 632004 India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002 India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
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7
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Andreescu M, Moldovan C, Lespezeanu DA, Mocanu AI, Schipor MA, Mocanu H. COVID-19-Associated Rhinocerebral Mucormycosis, an Incidental Finding or a Matter of Concern - Mixed-Method Systematic Review. Infect Drug Resist 2024; 17:387-402. [PMID: 38312523 PMCID: PMC10838509 DOI: 10.2147/idr.s445458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
With the advent of COVID-19, the number of patients diagnosed with mucormycosis has increased, especially in developing countries. The reason behind this increase is that COVID-19 causes hypoxia that promotes the growth of fungus. To identify the association between mucormycosis and COVID-19, in critically ill or immunocompromised COVID-19 patients. The literature included in the review was researched from October 1, 2021, to November 1, 2022, by using the Google Scholar database as the search engine. Of the 20 articles included, there were 4 case reports, 2 case series, 10 narrative reviews, and 4 quantitative studies. Mucormycetes growth is caused by several factors, including hyperglycemia owing to previously existing diabetes or excessive use of steroids, increased ferritin levels owing to the inflammatory cascade initiated by COVID-19, and immunosuppression caused by the use of steroids or other immunosuppressive therapy. Reduced white-cell count and activity in COVID-19 leads to increased germination of fungal spores hence developing a catastrophic picture of rhinocerebral mucormycosis. Considering that the hematological patient is frequently treated with cortisone, immunosuppressed due to the underlying condition, but also through the administered therapy, the association with a possible diabetes makes this patient susceptible to developing rhinocerebral mucormycosis during COVID-19 infection. Despite being severe, the association between mucormycosis and COVID-19 is specific and treatable. Development of mucormycosis in hematological patients suffering from severe COVID-19 disease is dangerous, yet not compulsory and can be prevented. Using a common steroid-dose protocol with hyperbaric oxygen and necessary preventive measure reveals the disease as a superadded infection. Hypoxia, poor glycemic control and overuse of steroids or immunosuppressive drugs cause it.
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Affiliation(s)
- Mihaela Andreescu
- Department of Hematology, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, 031593, Romania
- Department of Hematology, Colentina Clinical Hospital, Bucharest, 01171, Romania
| | - Cosmin Moldovan
- Department of Medical Surgical Disciplines, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest, 010243, Romania
| | - Delia-Andreea Lespezeanu
- Doctoral School, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, 031593, Romania
- "Ion Pavel" Diabetes Center, National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof.Dr.N.C. Paulescu", Bucharest, 030167, Romania
| | - Adela-Ioana Mocanu
- Doctoral School, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, 031593, Romania
- Department of ENT&HNS, Polimed Medical Center, Bucharest, 040067, Romania
| | - Mihai-Adrian Schipor
- Institute of Space Technology and Space Applications, University of the Bundeswehr, München, 85579, Germany
| | - Horia Mocanu
- Department of ENT&HNS, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, 031593, Romania
- Department of ENT&HNS, Găești City Hospital, Găești, Dâmbovița, 135200, Romania
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8
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Ulloque-Badaracco JR, Copaja-Corzo C, Hernandez-Bustamante EA, Cabrera-Guzmán JC, Huayta-Cortez MA, Carballo-Tello XL, Seminario-Amez RA, Hueda-Zavaleta M, Benites-Zapata VA. Fungal infections in patients after recovering from COVID-19: a systematic review. Ther Adv Infect Dis 2024; 11:20499361241242963. [PMID: 38706456 PMCID: PMC11070125 DOI: 10.1177/20499361241242963] [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: 11/28/2023] [Accepted: 03/13/2024] [Indexed: 05/07/2024] Open
Abstract
Background and aims The presence of fungal infections has been described in patients after recovering from COVID-19. This study aims to conduct a systematic review of studies that reported fungal infections (Mucor spp., Pneumocystis jirovecii, or Aspergillus spp.) in adults after recovering from COVID-19. Methods We performed a systematic review through PubMed, Web of Science, OVID-Medline, Embase, and Scopus. The study selection process was performed independently and by at least two authors. We performed a risk of bias assessment using the Newcastle-Ottawa Scale for cohort and case-control studies, and the Joanna Briggs Institute's Checklists for Case Series and Case Reports. Results The systematic search found 33 studies meeting all inclusion criteria. There was a total population of 774 participants, ranging from 21 to 87 years. From them, 746 developed a fungal infection. In 19 studies, Mucor spp. was reported as the main mycosis. In 10 studies, P. jirovecii was reported as the main mycosis. In seven studies, Aspergillus spp. was reported as the main mycosis. Regarding the quality assessment, 12 studies were classified as low risk of bias and the remaining studies as high risk of bias. Conclusion Patients' clinical presentation and prognosis after recovering from COVID-19 with fungal infection differ from those reported patients with acute COVID-19 infection and those without COVID-19 infection.
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Affiliation(s)
| | | | - Enrique A. Hernandez-Bustamante
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
| | | | | | | | | | | | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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9
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Shahin IG, Mohamed KO, Taher AT, Elsebaei MM, Mayhoub AS, Kassab AE, Elshewy A. New Phenylthiazoles: Design, Synthesis, and Biological Evaluation as Antibacterial, Antifungal, and Anti-COVID-19 Candidates. Chem Biodivers 2023; 20:e202301143. [PMID: 37857580 DOI: 10.1002/cbdv.202301143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
The combination of antibacterial and antiviral agents is becoming a very important aspect of dealing with resistant bacterial and viral infections. The N-phenylthiazole scaffold was found to possess significant anti-MRSA, antifungal, and anti-COVID-19 activities as previously published; hence, a slight refinement was proposed to attach various alkyne lipophilic tails to this promising scaffold, to investigate their effects on the antimicrobial activity of the newly synthesized compounds and to provide a valuable structure-activity relationship. Phenylthiazole 4 m exhibited the most potent anti-MRSA activity with 8 μg/mL MIC value. Compounds 4 k and 4 m demonstrated potent activity against Clostridium difficile with MIC values of 2 μg/mL and moderate activity against Candida albicans with MIC value of 4 μg/mL. When analyzed for their anti-COVID-19 inhibitory effect, compound 4 b emerged with IC50 =1269 nM and the highest selectivity of 138.86 and this was supported by its binding score of -5.21 kcal mol-1 when docked against SARS-CoV-2 M pro . Two H-bonds were formed, one with His164 and the other with Met49 stabilizing phenylthiazole derivative 4 b, inside the binding pocket. Additionally, it created two arene-H bonds with Asn142 and Glu166, through the phenylthiazole scaffold and one arene-H bond with Leu141 via the phenyl ring of the lipophilic tail.
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Affiliation(s)
- Inas G Shahin
- Department of Organic Chemistry, Faculty of Pharmacy, October University for Modern Sciences and Arts, Giza, 11787, Egypt
| | - Khaled O Mohamed
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Azza T Taher
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Department of Pharmaceutical Organic Chemistry, College of Pharmacy, October 6 University, 6-October, Giza, Egypt
| | - Mohamed M Elsebaei
- Department of Pharmaceutical Organic Chemistry, College of Pharmacy, Al-Azhar University, Cairo, 11884, Egypt
| | - Abdelrahman S Mayhoub
- Department of Pharmaceutical Organic Chemistry, College of Pharmacy, Al-Azhar University, Cairo, 11884, Egypt
- University of Science and Technology, Nanoscience Program, Zewail, City of Science and Technology, October Gardens, 6th October, Giza, 12578, Egypt
| | - Asmaa E Kassab
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed Elshewy
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Galala University, Galala Plateau, Attaka, Suez, 43713, Egypt
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10
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Sharma C, Kadosh D. Post-transcriptional control of antifungal resistance in human fungal pathogens. Crit Rev Microbiol 2023; 49:469-484. [PMID: 35634915 PMCID: PMC9766424 DOI: 10.1080/1040841x.2022.2080527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
Global estimates suggest that over 300 million individuals of all ages are affected by serious fungal infections every year, culminating in about 1.7 million deaths. The societal and economic burden on the public health sector due to opportunistic fungal pathogens is quite significant, especially among immunocompromised patients. Despite the high clinical significance of these infectious agents, treatment options are limited with only three major classes of antifungal drugs approved for use. Clinical management of fungal diseases is further compromised by the emergence of antifungal resistant strains. Transcriptional and genetic mechanisms that control drug resistance in human fungal pathogens are well-studied and include drug target alteration, upregulation of drug efflux pumps as well as changes in drug affinity and abundance of target proteins. In this review, we highlight several recently discovered novel post-transcriptional mechanisms that control antifungal resistance, which involve regulation at the translational, post-translational, epigenetic, and mRNA stability levels. The discovery of many of these novel mechanisms has opened new avenues for the development of more effective antifungal treatment strategies and new insights, perspectives, and future directions that will facilitate this process are discussed.
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Affiliation(s)
- Cheshta Sharma
- Department of Microbiology, Immunology and Molecular Genetics University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David Kadosh
- Department of Microbiology, Immunology and Molecular Genetics University of Texas Health Science Center at San Antonio, San Antonio, TX
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11
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Liebl M, Huber L, Elsaman H, Merschak P, Wagener J, Gsaller F, Müller C. Quantifying Isoprenoids in the Ergosterol Biosynthesis by Gas Chromatography-Mass Spectrometry. J Fungi (Basel) 2023; 9:768. [PMID: 37504756 PMCID: PMC10381423 DOI: 10.3390/jof9070768] [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: 05/30/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
The ergosterol pathway is a promising target for the development of new antifungals since its enzymes are essential for fungal cell growth. Appropriate screening assays are therefore needed that allow the identification of potential inhibitors. We developed a whole-cell screening method, which can be used to identify compounds interacting with the enzymes of isoprenoid biosynthesis, an important part of the ergosterol biosynthesis pathway. The method was validated according to the EMEA guideline on bioanalytical method validation. Aspergillus fumigatus hyphae and Saccharomyces cerevisiae cells were lysed mechanically in an aqueous buffer optimized for the enzymatic deconjugation of isoprenoid pyrophosphates. The residual alcohols were extracted, silylated and analyzed by GC-MS. The obtained isoprenoid pattern provides an indication of the inhibited enzyme, due to the accumulation of specific substrates. By analyzing terbinafine-treated A. fumigatus and mutant strains containing tunable gene copies of erg9 or erg1, respectively, the method was verified. Downregulation of erg9 resulted in a high accumulation of intracellular farnesol as well as elevated levels of geranylgeraniol and isoprenol. The decreased expression of erg1 as well as terbinafine treatment led to an increased squalene content. Additional analysis of growth medium revealed high farnesyl pyrophosphate levels extruded during erg9 downregulation.
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Affiliation(s)
- Maximilian Liebl
- Department of Pharmacy, Center for Drug Research, Ludwig-Maximilians University, 81377 Munich, Germany; (M.L.); (L.H.)
| | - Ludwig Huber
- Department of Pharmacy, Center for Drug Research, Ludwig-Maximilians University, 81377 Munich, Germany; (M.L.); (L.H.)
| | - Hesham Elsaman
- Institute for Hygiene and Microbiology, Julius-Maximilians-University Wuerzburg, 97080 Wuerzburg, Germany; (H.E.); (J.W.)
| | - Petra Merschak
- Institute of Molecular Biology, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.M.); (F.G.)
| | - Johannes Wagener
- Institute for Hygiene and Microbiology, Julius-Maximilians-University Wuerzburg, 97080 Wuerzburg, Germany; (H.E.); (J.W.)
- Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, The University of Dublin, D08 RX0X Dublin, Ireland
| | - Fabio Gsaller
- Institute of Molecular Biology, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.M.); (F.G.)
| | - Christoph Müller
- Department of Pharmacy, Center for Drug Research, Ludwig-Maximilians University, 81377 Munich, Germany; (M.L.); (L.H.)
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12
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Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SCA. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel) 2023; 9:659. [PMID: 37367595 DOI: 10.3390/jof9060659] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is an uncommon, yet deadly invasive fungal infection caused by the Mucorales moulds. These pathogens are a WHO-assigned high-priority pathogen group, as mucormycosis incidence is increasing, and there is unacceptably high mortality with current antifungal therapies. Current diagnostic methods have inadequate sensitivity and specificity and may have issues with accessibility or turnaround time. Patients with diabetes mellitus and immune compromise are predisposed to infection with these environmental fungi, but COVID-19 has established itself as a new risk factor. Mucorales also cause healthcare-associated outbreaks, and clusters associated with natural disasters have also been identified. Robust epidemiological surveillance into burden of disease, at-risk populations, and emerging pathogens is required. Emerging serological and molecular techniques may offer a faster route to diagnosis, while newly developed antifungal agents show promise in preliminary studies. Equitable access to these emerging diagnostic techniques and antifungal therapies will be key in identifying and treating mucormycosis, as delayed initiation of therapy is associated with higher mortality.
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Affiliation(s)
- David Pham
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Annaleise R Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Sparks
- Douglass Hanly Moir Pathology, Sydney, NSW 2113, Australia
| | - Maurizio Stefani
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Varsha Sivalingam
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Justin Beardsley
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
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13
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Parsons MG, Diekema DJ. What Is New in Fungal Infections? Mod Pathol 2023; 36:100187. [PMID: 37059227 DOI: 10.1016/j.modpat.2023.100187] [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: 12/01/2022] [Revised: 03/11/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Invasive fungal infections are an increasingly important cause of morbidity and mortality. We provide a summary of important changes in the epidemiology of invasive fungal infections, citing examples of new emerging pathogens, expanding populations who are at-risk, and increasing antifungal resistance. We review how human activity and climate change may play a role in some of these changes. Finally, we discuss how these changes create the need for advances in fungal diagnostics. The limitations of existing fungal diagnostic testing emphasize the critically important role of histopathology in the early recognition of fungal disease.
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Affiliation(s)
- Meredith G Parsons
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel J Diekema
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department and Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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14
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Spencer AC, Brubaker KR, Garneau-Tsodikova S. Systemic fungal infections: A pharmacist/researcher perspective. FUNGAL BIOL REV 2023. [DOI: 10.1016/j.fbr.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Losier A, Gupta G, Caldararo M, Dela Cruz CS. The Impact of Coronavirus Disease 2019 on Viral, Bacterial, and Fungal Respiratory Infections. Clin Chest Med 2023; 44:407-423. [PMID: 37085229 PMCID: PMC9968485 DOI: 10.1016/j.ccm.2022.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Although coronavirus disease 2019 (COVID-19) remains an ongoing threat, concerns regarding other respiratory infections remain. Throughout the COVID-19 pandemic various epidemiologic trends have been observed in other respiratory viruses including a reduction in influenza and respiratory syncytial virus infections following onset of the COVID-19 pandemic. Observations suggest that infections with other respiratory viruses were reduced with social distancing, mask wearing, eye protection, and hand hygiene practices. Coinfections with COVID-19 exist not only with other respiratory viruses but also with bacterial pneumonias and other nosocomial and opportunistic infections. Coinfections have been associated with increased severity of illness and other adverse outcomes.
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Affiliation(s)
- Ashley Losier
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA.
| | - Gayatri Gupta
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Mario Caldararo
- Veteran's Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Charles S Dela Cruz
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA
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Kumari A, Ranjan A, Nishant P, Sinha S, Sinha RK. Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India. Indian J Ophthalmol 2023; 71:2193-2198. [PMID: 37202947 PMCID: PMC10391476 DOI: 10.4103/ijo.ijo_2507_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: 05/20/2023] Open
Abstract
Purpose The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome. Results There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.
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Affiliation(s)
- Abhilasha Kumari
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Alok Ranjan
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Prateek Nishant
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Sony Sinha
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Ranjeet K Sinha
- Department of Community Medicine, Patna Medical College, Patna, India
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Duong TN, Le M, Beardsley J, Denning DW, Le N, Nguyen BT. Updated estimation of the burden of fungal disease in Vietnam. Mycoses 2023; 66:346-353. [PMID: 36564981 PMCID: PMC10953305 DOI: 10.1111/myc.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anecdotally, the burden of fungal diseases in Vietnam is rapidly rising, but there has been no updated estimate on this issue since a previous report in 2015. OBJECTIVES In this study, we aimed at estimating the incidence and prevalence of serious fungal infections for the year 2020. METHODS We made estimates with a previously described methodology, using reports on the incidence and prevalence of various established risk factors for fungal infections from local, regional or global sources. RESULTS We estimated 2,389,661 cases of serious fungal infection occurred in Vietnam in 2020. The most common condition was recurrent vaginal candidiasis (4047/100,000 women annually). Among people living with HIV, we estimated 451 cases of cryptococcal meningitis, 1030 of pneumocystis pneumonia, 166 of histoplasmosis and 1612 of talaromycosis annually. Candidaemia incidence was estimated at 12/100,000 population each year. Owing to its high burden of tuberculosis and respiratory diseases, Vietnam had high rates of severe infections caused by Aspergillus species. Incidence of invasive aspergillosis is 24/100,000 population, allergic bronchopulmonary aspergillosis 78/100,000 and severe asthma with fungal sensitisation 102/100,000. Five-year period prevalence of chronic pulmonary aspergillosis is 120/100,000 population /5-year period. Mucormycosis, fungal keratitis and tinea capitis were estimated at 192, 14,431 and 201 episodes each year, respectively. CONCLUSIONS The number of patients with mycoses in Vietnam is likely underestimated due to a lack of local data and limited diagnostic capacity, but at least 2.5% of the population might have some form of serious fungal disease.
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Affiliation(s)
- Tra‐My N. Duong
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Woolcock Institute of Medical ResearchHanoiVietnam
| | - Minh‐Hang Le
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Woolcock Institute of Medical ResearchHanoiVietnam
| | - Justin Beardsley
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Westmead Institute for Medical ResearchWestmeadNew South WalesAustralia
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and HealthUniversity of Manchester and Manchester Academic Health Science CentreManchesterUK
- Global Action for Fungal InfectionsManchesterSwitzerland
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18
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DP I, Yadhav ML K, GS C. Is Serum Ferritin an Early Marker for COVID-19-Associated Mucormycosis? Cureus 2023; 15:e36734. [PMID: 37123703 PMCID: PMC10131487 DOI: 10.7759/cureus.36734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a hyperinflammatory disease caused by severe acute respiratory syndrome coronavirus 2, which makes critically ill patients susceptible to invasive fungal infections. Invasive fungal infections such as mucormycosis are associated with high morbidity and mortality. This study aimed to determine the serum ferritin levels in COVID-19-associated mucormycosis (CAM) patients and isolate and identify the fungi causing secondary fungal infections in patients with suspected CAM. Methodology This cross-sectional study was conducted from June to September 2021 among CAM patients admitted to Bowring and Lady Curzon Hospital. After obtaining approval from the institutional ethics committee and valid consent, data regarding demographic details, past medical history, and serum ferritin levels, along with other blood investigations, were carefully collected from patients presenting with clinical features of mucormycosis and a history of COVID-19. Samples were examined under a bright field microscope using wet mounts of samples in KOH, cultured on Sabouraud's dextrose agar, and examined under a microscope after staining with lactophenol cotton blue for the isolation and correct identification of fungi. Statistical analysis was done using Microsoft Excel (Microsoft Corp., Seattle, WA, USA) and SPSS version 26.0 (IBM Corp., Armonk, NY, USA). A p-value less than <0.05 was considered statistically significant. Results A total of 95 patients with CAM were included in this study, comprising 70 males and 25 females. The mean age of presentation was 49.83 ± 12.41 years, with 73% males and 26% females. Type 2 diabetes mellitus was noted in 69% of patients, hypertension in 29%, and steroid use in 42%. The mean serum ferritin level was 537.38 ± 468.88 ng/mL. We found a significant association between increased serum ferritin and a history of diabetes. Serum ferritin levels had a statistically significant correlation with samples of patients who were positive for Mucorales under KOH microscopy. The fungal culture showed the growth of Aspergillus, Mucor, Rhizopus, and Candida. The mean value of serum ferritin in patients who showed mucor growth was 842.09 ng/mL. Conclusions We found a significant increase in serum ferritin levels in CAM patients. Ferritin can be used as an early marker for screening mucormycosis in COVID-19 patients. Monitoring patients with elevated serum ferritin levels in severe COVID-19, glycemic control, judicious use of corticosteroids, early diagnosis, and appropriate treatment can aid in better management of the disease.
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19
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Huamani-Córdova JM, Hueda-Zavaleta M, Vargas-Bellina V, Simbron-Ribbeck L, Chong-Chinchay KDR, Gómez de la Torre JC, Benítes-Zapata VA. Cerebral Cryptococcosis Associated with CD4+ T-lymphocytopenia in Non-HIV Patients after SARS-CoV-2 Infection: Case Series in a Specialized Institute in Lima, Peru. Trop Med Infect Dis 2023; 8:tropicalmed8030182. [PMID: 36977183 PMCID: PMC10056744 DOI: 10.3390/tropicalmed8030182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Cases of cryptococcosis have been reported in patients with COVID-19. The majority are in patients with severe symptoms or who received immunosuppressants. However, there is still no clear association between COVID-19 and cryptococcosis. We report eight cases of cerebral cryptococcosis associated with CD4+ T lymphocytopenia in non-HIV patients after SARS-CoV-2 infection. The median age was 57 years and 5/8 were male. In addition, 2/8 of patients had diabetes, and 8/8 had a history of mild COVID-19, with a median of 75 days before diagnosis of cerebral cryptococcosis. All patients denied having received prior immunosuppressive therapy. The most frequent symptoms were confusion (8/8), headache (7/8), vomiting (6/8), and nausea (6/8) All patients were diagnosed by isolating Cryptococcus in cerebrospinal fluid. The median CD4+ and CD8+ T lymphocytes were 247 and 173.5, respectively. Other causes of immunosuppression, such as HIV or HTLV infection, were excluded in all patients. Finally, three patients died, and one presented long-term visual and auditory sequelae. The CD4+/CD8+ T lymphocyte count normalized during follow-up in those patients who survived. We hypothesize that CD4+ T lymphocytopenia in the patients in this case series could increase the risk of cryptococcosis after SARS-CoV-2 infection.
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Affiliation(s)
| | - Miguel Hueda-Zavaleta
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru;
- Hospital III Daniel Alcides Carrión—Essalud, Tacna 23000, Peru
| | | | | | | | | | - Vicente A. Benítes-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence:
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Kottarathil M, Thayanidhi P, P S, Jyoti Kindo A. Rise of mucormycosis during the COVID-19 pandemic and the challenges faced. Curr Med Mycol 2023; 9:44-55. [PMID: 37867589 PMCID: PMC10590187 DOI: 10.18502/cmm.2023.345032.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 10/24/2023] Open
Abstract
Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk factors for the development of mucormycosis are diabetic ketoacidosis, deferoxamine treatment, cancer, solid organ or bone marrow transplantations, prolonged steroid use, extreme malnutrition, and neutropenia. The common clinical forms of mucormycosis are rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal. During the second wave of COVID-19, there was a rapid increase in mucormycosis with more severity than before. Amphotericin B is currently found to be an effective drug as it is found to have a broad-spectrum activity and posaconazole is used as a salvage therapy. Newer triazole isavuconazole is also found effective against mucormycosis. This study aimed to review various studies on the laboratory diagnosis and treatment of mucormycosis.
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Affiliation(s)
- Malavika Kottarathil
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Premamalini Thayanidhi
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sathyamurthy P
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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21
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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22
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Franklin A, Wurster S, Axell-House DB, Jiang Y, Kontoyiannis DP. Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies-Complex and Intriguing Associations. J Fungi (Basel) 2022; 9:jof9010045. [PMID: 36675866 PMCID: PMC9860539 DOI: 10.3390/jof9010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Mucormycosis (MCR) is frequently associated with diabetic ketoacidosis and hyperglycemia, as well as hematologic malignancies (HMs) and hematopoietic stem cell transplantation (HSCT). However, little is known about the effect of hyperglycemia on MCR outcomes in patients with HMs. We therefore conducted a retrospective cohort study of adult patients hospitalized with MCR and HM or HSCT (n = 103) at MD Anderson Cancer Center from April 2000 through to April 2020. Twenty-three patients (22%) had documented episodes of severe hyperglycemia. Sixty patients had >5 serum glucose measurements within 28 days prior to MCR symptom onset; of those, 14 (23%) met the criteria for persistent hyperglycemia. Sixteen patients (16%) received insulin prior to admission. The crude mortality 42 days from the onset of MCR symptoms in our cohort was 31%. Neither severe nor persistent hyperglycemia were associated with excess mortality. Insulin use prior to index admission was associated with decreased 42-day mortality on univariate analysis (p = 0.031). In conclusion, in a setting of high crude mortality, severe and/or persistent hyperglycemia do not appear to be associated with excess mortality in patients with HM or HSCT developing MCR. Insulin use prior to MCR diagnosis may be associated with decreased mortality, although further research is needed to validate this effect and to study its mechanistic underpinnings.
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Affiliation(s)
- Alexander Franklin
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dierdre B. Axell-House
- Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Is the production of reactive oxygen and nitrogen species by macrophages associated with better infectious control in female mice with experimentally disseminated and pulmonary mucormycosis? PLoS One 2022; 17:e0270071. [PMID: 36520787 PMCID: PMC9754262 DOI: 10.1371/journal.pone.0270071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Different levels of resistance against Rhizopus oryzae infection have been observed between inbred (BALB/c) and outbred (Swiss) mice and are associated with the genetic background of each mouse strain. Considering that macrophages play an important role in host resistance to Rhizopus species, we used different infectious outcomes observed in experimental mucormycosis to identify the most efficient macrophage response pattern against R. oryzae in vitro and in vivo. For this, we compared BALB/c and Swiss macrophage activity before and after intravenous or intratracheal R. oryzae infections. The production of hydrogen peroxide (H2O2) and nitric oxide (NO) was determined in cultures of peritoneal (PMΦ) or alveolar macrophages (AMΦ) challenged with heat-killed spores of R. oryzae. The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) were measured to confirm our findings. Naïve PMΦ from female BALB/c mice showed increased production of H2O2, TNF-α, and IL-10 in the presence of heat-killed spores of R. oryzae. Naïve PMΦ from female Swiss mice were less responsive. Naïve AMΦ from the two strains of female mice were less reactive to heat-killed spores of R. oryzae than PMΦ. After 30 days of R. oryzae intravenous infection, lower fungal load in spleen from BALB/c mice was accompanied by higher production of H2O2 by PMΦ compared with Swiss mice. In contrast, AMΦ from BALB/c mice showed higher production of NO, TNF-α, and IL-10 after 7 days of intratracheal infection. The collective findings reveal that, independent of the female mouse strain, PMΦ is more reactive against R. oryzae upon first contact than AMΦ. In addition, increased PMΦ production of H2O2 at the end of disseminated infection is accompanied by better fungal clearance in resistant (BALB/c) mice. Our findings further the understanding of the parasite-host relationship in mucormycosis.
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Factors Associated with Mortality in Coronavirus-Associated Mucormycosis: Results from Mycotic Infections in COVID-19 (MUNCO) Online Registry. J Clin Med 2022; 11:jcm11237015. [PMID: 36498589 PMCID: PMC9738048 DOI: 10.3390/jcm11237015] [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: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND COVID-19-associated mucormycosis (CAM) is associated with high morbidity and mortality. MUNCO is an international database used to collect clinical data on cases of CAM in real time. Preliminary data from the Mycotic Infections in COVID-19 (MUNCO) online registry yielded 728 cases from May to September 2021 in four South Asian countries and the United States. A majority of the cases (694; 97.6%) consisted of a mucormycosis infection. The dataset allowed for the analysis of the risk factors for adverse outcomes from CAM and this analysis is presented in this paper. METHODS The submission of cases was aided by a direct solicitation and social media online. The primary endpoints were full recovery or death measured on day 42 of the diagnosis. All patients had histopathologically confirmed CAM. The groups were compared to determine the contribution of each patient characteristic to the outcome. Multivariable logistic regression models were used to model the probability of death after a CAM diagnosis. RESULTS The registry captured 694 cases of CAM. Within this, 341 could be analyzed as the study excluded patients with an unknown CAM recovery status due to either an interruption or a lack of follow up. The 341 viable cases consisted of 258 patients who survived after the completion of treatment and 83 patients who died during the period of observation. In a multivariable logistic regression model, the factors associated with an increased risk of mortality include old age (OR = 1.04, 95% CI 1.02-1.07, p = 0.001), history of diabetes mellitus (OR 3.5, 95% CI 1.01-11.9, p = 0.02) and a lower BMI (OR 0.9, 95% CI 0.82-0.98, p = 0.03). Mucor localized to sinus disease was associated with 77% reduced odds of death (OR = 0.23, 95% CI 0.09-0.57, p = 0.001), while cerebral mucor was associated with an increased odds of death (OR = 10.96, 95% CI 4.93-24.36, p = ≤0.0001). CONCLUSION In patients with CAM, older age, a history of diabetes and a lower body mass index is associated with increased mortality. Disease limited to the sinuses without a cerebral extension is associated with a lower risk of mortality. Interestingly, the use of zinc and azithromycin were not associated with increased mortality in our study.
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Gurunathan S, Lee AR, Kim JH. Antifungal Effect of Nanoparticles against COVID-19 Linked Black Fungus: A Perspective on Biomedical Applications. Int J Mol Sci 2022; 23:12526. [PMID: 36293381 PMCID: PMC9604067 DOI: 10.3390/ijms232012526] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 08/21/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus that has caused a 'coronavirus disease 2019' (COVID-19) pandemic in multiple waves, which threatens human health and public safety. During this pandemic, some patients with COVID-19 acquired secondary infections, such as mucormycosis, also known as black fungus disease. Mucormycosis is a serious, acute, and deadly fungal infection caused by Mucorales-related fungal species, and it spreads rapidly. Hence, prompt diagnosis and treatment are necessary to avoid high mortality and morbidity rates. Major risk factors for this disease include uncontrolled diabetes mellitus and immunosuppression that can also facilitate increases in mucormycosis infections. The extensive use of steroids to prevent the worsening of COVID-19 can lead to black fungus infection. Generally, antifungal agents dedicated to medical applications must be biocompatible, non-toxic, easily soluble, efficient, and hypoallergenic. They should also provide long-term protection against fungal growth. COVID-19-related black fungus infection causes a severe increase in fatalities. Therefore, there is a strong need for the development of novel and efficient antimicrobial agents. Recently, nanoparticle-containing products available in the market have been used as antimicrobial agents to prevent bacterial growth, but little is known about their efficacy with respect to preventing fungal growth, especially black fungus. The present review focuses on the effect of various types of metal nanoparticles, specifically those containing silver, zinc oxide, gold, copper, titanium, magnetic, iron, and carbon, on the growth of various types of fungi. We particularly focused on how these nanoparticles can impact the growth of black fungus. We also discussed black fungus co-infection in the context of the global COVID-19 outbreak, and management and guidelines to help control COVID-19-associated black fungus infection. Finally, this review aimed to elucidate the relationship between COVID-19 and mucormycosis.
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Affiliation(s)
- Sangiliyandi Gurunathan
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Seoul 05029, Korea
| | - Ah Reum Lee
- CHA Advanced Research Institute, CHA Medical Center, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Korea
| | - Jin Hoi Kim
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Seoul 05029, Korea
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Pathogenesis and Pathology of COVID-Associated Mucormycosis: What Is New and Why. CURRENT FUNGAL INFECTION REPORTS 2022; 16:206-220. [PMID: 36193101 PMCID: PMC9520103 DOI: 10.1007/s12281-022-00443-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review There is global increase in the incidence of mucormycosis. However, a sudden increase in the COVID-associated mucormycosis (CAM) was noted, particularly in India, during the second wave of the COVID-19 pandemic. The interplay of factors involved in the pathogenesis is complex. In this review, the influence of pre-existing disease, exaggerated risk factors, altered milieu due to COVID-19 itself and the consequences of its treatment on the host pathogen interactions leading to the disease and morphology of the fungus will be highlighted. Recent Findings Hyperglycemia, acidosis, available free iron, lowered host defenses, and the fungal virulence factors promote the growth of Mucorales. There is a high background prevalence of diabetes mellitus (DM) in India. Uncontrolled or undiagnosed DM, COVID-19 itself, and inappropriate administration of corticosteroids in high doses and for prolonged periods result in hyperglycemia. Diabetic ketoacidosis (DKA) and metabolic acidosis due to hypoxia or renal failure contribute to acidic pH and dissociate bound iron from serum proteins. The host defenses are lowered due to COVID-19-induced immune dysregulation, hyperglycemia itself, and administration of corticosteroids and immune suppressants for the treatment of COVID-19. The altered metabolic milieu in the local microenvironment of nose and paranasal sinuses (PNS) promotes specific interaction of glucose-regulated protein-78 (GRP-78) on host cells with spore coat protein homologue (CotH 3) on Mucorales resulting in rhino-orbito-cerebral mucormycosis (ROCM) as the predominant clinical form in CAM. The pathology is extensive soft tissue involvement with angioinvasion and perineural invasion. Melanized hyphae and sporangia were seen on histopathology, which is unique to CAM. While many factors favor the growth of Mucorales in CAM, hyperglycemia, hyperferritinemia, and administration of hyperbaric oxygen result in reactive oxygen species (ROS) and inadequate humidification results in dehydration. Melanization is possibly the adaptive and protective mechanism of Mucorales to escape the unfavorable conditions due to the treatment of COVID-19. Summary High background prevalence of DM, inappropriate administration of corticosteroids and immune dysregulation due to COVID-19 favor the growth of Mucorales in CAM. Melanization of Mucorales hyphae and sporangia on histopathology probably represent adaptive and protective mechanism due to the treatment with hyperbaric oxygen with inadequate humidification as well as the metabolic alterations.
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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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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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Karat S, Lobo AC, Satish D, Devaraj R, Manjooran RR, Nithyanandam S. Uncontrolled diabetes mellitus exacerbated by COVID-19-induced inflammation is the risk factor for COVID-19-associated rhino-orbito-cerebral mucormycosis: A matched pair case-control study. Indian J Ophthalmol 2022; 70:3096-3101. [PMID: 35918980 DOI: 10.4103/ijo.ijo_448_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: 12/15/2022] Open
Abstract
Purpose Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19-associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM. Methods This case-control study included all COVID-19-associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients. Results The study included 69 patients with COVID-19-associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19-associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03-1.78), blood glucose (OR = 1.008, 95% CI: 1.003-1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02-1.17) were associated with increased odds of developing COVID-19-associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30-9.02) and blood glucose (OR = 1.02, 95% CI: 1.005-1.03) (P = 0.02) had a higher probability of developing COVID-19-associated ROCM than patients with established DM. Conclusion Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19-induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19-associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
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Affiliation(s)
- Shubashree Karat
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Aaron C Lobo
- Department of Internal Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Deepthi Satish
- Department of Otorhinolaryngology, St. John's Medical College, Bangalore, Karnataka, India
| | - Rincy Devaraj
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Riya R Manjooran
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Suneetha Nithyanandam
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
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COVID-19-Associated Pulmonary Mucormycosis. J Fungi (Basel) 2022; 8:jof8070711. [PMID: 35887466 PMCID: PMC9315775 DOI: 10.3390/jof8070711] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 12/21/2022] Open
Abstract
COVID-19-associated mucormycosis (CAM) emerged as an epidemic in certain parts of the world amidst the global COVID-19 pandemic. While rhino–orbital mucormycosis was well reported during the pandemic, in the absence of routine diagnostic facilities including lower airway sampling, pulmonary mucormycosis was probably under-recognized. In this review, we have focused on the epidemiology and management of COVID-19-associated pulmonary mucormycosis (CAPM). CAPM is a deadly disease and mortality can be as high as 80% in the absence of early clinical suspicion and treatment. While histopathological examination of tissue for angio-invasion and cultures have remained gold standard for diagnosis, there is an increasing interest in molecular and serological methods to facilitate diagnosis in critically ill patients and often, immune-suppressed hosts who cannot readily undergo invasive sampling. Combined medical and surgical treatment offers more promise than standalone medical therapy. Maintaining adequate glycemic control and prudent use of steroids which can be a double-edged sword in COVID-19 patients are the key preventative measures. We would like to emphasize the urgent need for the development and validation of reliable biomarkers and molecular diagnostics to facilitate early diagnosis.
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31
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Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives. J Clin Med 2022; 11:jcm11133620. [PMID: 35806905 PMCID: PMC9267579 DOI: 10.3390/jcm11133620] [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: 03/11/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.
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Gold JAW, Ahmad FB, Cisewski JA, Rossen LM, Montero AJ, Benedict K, Jackson BR, Toda M. Increased Deaths From Fungal Infections During the Coronavirus Disease 2019 Pandemic-National Vital Statistics System, United States, January 2020-December 2021. Clin Infect Dis 2022; 76:e255-e262. [PMID: 35717660 PMCID: PMC9214147 DOI: 10.1093/cid/ciac489] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying of fungal infections during the COVID-19 pandemic. METHODS Using NVSS's January 2018-December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100 000 population) of deaths due to fungal infection by fungal pathogen, COVID-19 association, demographic characteristics, and year. RESULTS Numbers and age-adjusted rates of deaths due to fungal infection increased from 2019 (n = 4833; rate, 1.2 [95% confidence interval, 1.2-1.3]) to 2021 (n = 7199; rate, 1.8 [1.8-1.8] per 100 000); of 13 121 such deaths during 2020-2021, 2868 (21.9%) were COVID-19 associated. Compared with non-COVID-19-associated deaths (n = 10 253), COVID-19-associated deaths more frequently involved Candida (n = 776 [27.1%] vs n = 2432 [23.7%], respectively) and Aspergillus (n = 668 [23.3%] vs n = 1486 [14.5%]) and less frequently involved other specific fungal pathogens. Rates of death due to fungal infection were generally highest in nonwhite and non-Asian populations. Death rates from Aspergillus infections were approximately 2 times higher in the Pacific US census division compared with most other divisions. CONCLUSIONS Deaths from fungal infection increased during 2020-2021 compared with previous years, primarily driven by COVID-19-associated deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in patients with COVID-19, especially in certain racial/ethnic groups and geographic areas.
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Affiliation(s)
- Jeremy A W Gold
- Corresponding author: Jeremy A. W. Gold, MD, MS, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop H24-10, Atlanta, GA 30329, USA,
| | - Farida B Ahmad
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Jodi A Cisewski
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Lauren M Rossen
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Alejandro J Montero
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kontoghiorghes GJ. Deferiprone: A Forty-Year-Old Multi-Targeting Drug with Possible Activity against COVID-19 and Diseases of Similar Symptomatology. Int J Mol Sci 2022; 23:ijms23126735. [PMID: 35743183 PMCID: PMC9223898 DOI: 10.3390/ijms23126735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
The need for preparing new strategies for the design of emergency drug therapies against COVID-19 and similar diseases in the future is rather urgent, considering the high rate of morbidity and especially mortality associated with COVID-19, which so far has exceeded 18 million lives. Such strategies could be conceived by targeting the causes and also the serious toxic side effects of the diseases, as well as associated biochemical and physiological pathways. Deferiprone (L1) is an EMA- and FDA-approved drug used worldwide for the treatment of iron overload and also other conditions where there are no effective treatments. The multi-potent effects and high safety record of L1 in iron loaded and non-iron loaded categories of patients suggests that L1 could be developed as a “magic bullet” drug against COVID-19 and diseases of similar symptomatology. The mode of action of L1 includes antiviral, antimicrobial, antioxidant, anti-hypoxic and anti-ferroptotic effects, iron buffering interactions with transferrin, iron mobilizing effects from ferritin, macrophages and other cells involved in the immune response and hyperinflammation, as well as many other therapeutic interventions. Similarly, several pharmacological and other characteristics of L1, including extensive tissue distribution and low cost of production, increase the prospect of worldwide availability, as well as many other therapeutic approach strategies involving drug combinations, adjuvant therapies and disease prevention.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol 3021, Cyprus
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Lampejo T, Curtis C, Ijaz S, Haywood B, Flores A, Sudhanva M, El Bouzidi K, Patel S, Dowling M, Zuckerman M. Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19. J Clin Virol 2022; 148:105083. [PMID: 35086023 PMCID: PMC8785262 DOI: 10.1016/j.jcv.2022.105083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 12/16/2022]
Abstract
Background Transmission of hepatitis E virus (HEV) within the healthcare setting is extremely rare. Additionally, the development of chronic HEV infection in association with severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection and/or its immunomodulatory therapy has not been reported previously. Aims To describe the investigation and management of a nosocomial HEV transmission incident during the coronavirus disease 2019 (COVID-19) pandemic. Methods Epidemiological and molecular investigation of two individuals hospitalised with COVID-19 who were both diagnosed with HEV infection. Results Findings from our investigation were consistent with transmission of HEV from one patient with a community-acquired HEV infection to another individual (identical HEV sequences were identified in the two patients), most likely due to a breach in infection control practices whilst both patients shared a bed space on the intensive care unit (ICU). Chronic HEV infection requiring treatment with ribavirin developed in one patient with prolonged lymphopaenia attributable to COVID-19 and/or the immunomodulators received for its treatment. Further investigation did not identify transmission of HEV to any other patients or to healthcare workers. Conclusions The extraordinary demands that the COVID-19 pandemic has placed on all aspects of healthcare, particularly within ICU settings, has greatly challenged the ability to consistently maintain optimal infection prevention and control practices. Under the significant pressures of the COVID-19 pandemic a highly unusual nosocomial HEV transmission incident occurred complicated further by progression to a chronic HEV infection in one patient.
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Affiliation(s)
- Temi Lampejo
- Department of Infection Sciences, King's College Hospital, London, United Kingdom.
| | - Carmel Curtis
- Department of Infection Sciences, King's College Hospital, London, United Kingdom
| | - Samreen Ijaz
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | - Becky Haywood
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | - Ashley Flores
- Department of Infection Prevention and Control, King's College Hospital, London, United Kingdom
| | - Malur Sudhanva
- Department of Infection Sciences, King's College Hospital, London, United Kingdom
| | - Kate El Bouzidi
- Department of Infection Sciences, King's College Hospital, London, United Kingdom
| | - Sameer Patel
- Department of Critical Care Medicine, King's College Hospital, London, United Kingdom
| | - Mick Dowling
- Department of Critical Care Medicine, King's College Hospital, London, United Kingdom
| | - Mark Zuckerman
- Department of Infection Sciences, King's College Hospital, London, United Kingdom
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Dravid A, Kashiva R, Khan Z, Bande B, Memon D, Kodre A, Mane M, Pawar V, Patil D, Kalyani S, Raut P, Bapte M, Saldanha C, Chandak D, Patil T, Reddy MS, Bhayani K, Laxmi SS, Vishnu PD, Srivastava S, Khandelwal S, More S, Shakeel A, Pawar M, Nande P, Harshe A, Kadam S, Hallikar S, Kamal N, Andrabi D, Bodhale S, Raut A, Chandrashekhar S, Raman C, Mahajan U, Joshi G, Mane D. Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single center experience from Pune, Western India. Mycoses 2022; 65:526-540. [PMID: 35212032 PMCID: PMC9115310 DOI: 10.1111/myc.13435] [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: 09/16/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Background The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM). Methods This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM. Results 59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. Conclusions CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.
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Affiliation(s)
- Ameet Dravid
- Department of Infectious diseases and HIV/AIDS, Noble hospitals and Research Centre, Pune, Maharashtra, India
| | - Reema Kashiva
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Zafer Khan
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Balasaheb Bande
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Danish Memon
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Aparna Kodre
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Milind Mane
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Vishal Pawar
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Dattatraya Patil
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Suraj Kalyani
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Prathamesh Raut
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Madhura Bapte
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Charlotte Saldanha
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Dinesh Chandak
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Teerthagouda Patil
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - M Sateesh Reddy
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Krushnadas Bhayani
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - S S Laxmi
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - P D Vishnu
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shipra Srivastava
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shubham Khandelwal
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sailee More
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Atif Shakeel
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Mohit Pawar
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Pranava Nande
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Amol Harshe
- Department of Pathology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sagar Kadam
- Department of Radiology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sudhir Hallikar
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Nudrat Kamal
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Danish Andrabi
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sachin Bodhale
- Department of Ophthalmology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Akshay Raut
- Department of Maxillo-facial surgery, Noble hospital and Research Centre, Pune, Maharashtra, India
| | | | - Chandrashekhar Raman
- Department of Neurosurgery, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Uma Mahajan
- Statistician, VMK Diagnostics private limited, Pune, Maharashtra, India
| | - Gaurav Joshi
- Independent statistical consultant, Chicago, USA
| | - Dilip Mane
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
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Rizvi SG, Ahammad SZ. COVID-19 and antimicrobial resistance: A cross-study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 807:150873. [PMID: 34634340 PMCID: PMC8500695 DOI: 10.1016/j.scitotenv.2021.150873] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 05/03/2023]
Abstract
Antimicrobial resistance (AMR) is emerging as a severe concern due to the escalating instances of resistant human pathogens encountered by health workers. Consequently, there is a shortage of antibiotics to treat Multidrug Resistance (MDR) and Extensively Drug Resistance (XDR) patients. The primary cause of AMR is the vast array of anthropogenic disturbances in natural microfauna brought about by the extensive use of antibiotics. Coronavirus Disease of 2019 (COVID-19) has crashed antibiotic stewardship and single-handedly increased the global usage of antibiotics, Personal Protective Equipment (PPE), and biocide, causing a ripple effect in the existing global AMR problem. This surge in antibiotic usage has escalated the residual antibiotics reaching Wastewater Treatment Plants (WWTPs) from pharmaceutical companies, health care centers, and domestic settings. Ultimately the natural water bodies receiving their effluents will have higher concentrations of emerging contaminants as the WWTPs cannot remove the Pharmaceuticals and Personal Care Products (PPCPs) completely. Furthermore, increased biocides usage will increase AMR by co-resistance, and increasing plastics will turn into microplastics and get converted to plastisphere, which will further enhance its propagation. Therefore, it is crucial to curb antibiotic usage, implement antibiotic stewardship dynamically; and, ameliorate the present condition of WWTPs to remove residual PPCPs efficiently. The need of the hour is to address the grave threat of AMR, which is loitering silently; if not the mankind will endure more affliction hereafter.
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Affiliation(s)
| | - Shaikh Ziauddin Ahammad
- Block I, Room # 135, Department of Biochemical Engineering & Biotechnology, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
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Salazar F, Bignell E, Brown GD, Cook PC, Warris A. Pathogenesis of Respiratory Viral and Fungal Coinfections. Clin Microbiol Rev 2022; 35:e0009421. [PMID: 34788127 PMCID: PMC8597983 DOI: 10.1128/cmr.00094-21] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Individuals suffering from severe viral respiratory tract infections have recently emerged as "at risk" groups for developing invasive fungal infections. Influenza virus is one of the most common causes of acute lower respiratory tract infections worldwide. Fungal infections complicating influenza pneumonia are associated with increased disease severity and mortality, with invasive pulmonary aspergillosis being the most common manifestation. Strikingly, similar observations have been made during the current coronavirus disease 2019 (COVID-19) pandemic. The copathogenesis of respiratory viral and fungal coinfections is complex and involves a dynamic interplay between the host immune defenses and the virulence of the microbes involved that often results in failure to return to homeostasis. In this review, we discuss the main mechanisms underlying susceptibility to invasive fungal disease following respiratory viral infections. A comprehensive understanding of these interactions will aid the development of therapeutic modalities against newly identified targets to prevent and treat these emerging coinfections.
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Affiliation(s)
- Fabián Salazar
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Elaine Bignell
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Gordon D. Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Peter C. Cook
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
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Fouad YA, Bakre HM, Nassar MA, Gad MOA, Shaat AAK. Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave. Clin Ophthalmol 2022; 15:4795-4800. [PMID: 34992339 PMCID: PMC8711239 DOI: 10.2147/opth.s344937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose To report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021). Methods A multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included. Results Of the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died. Conclusion CAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.
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Affiliation(s)
- Yousef A Fouad
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.,Oculoplastic Service, Al Mashreq Eye Center, Cairo, Egypt
| | | | | | | | - Ashraf Abdelsalam Kandeel Shaat
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.,Oculoplastic Service, Al Mashreq Eye Center, Cairo, Egypt
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Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients. J Fungi (Basel) 2022; 8:jof8010058. [PMID: 35049999 PMCID: PMC8779574 DOI: 10.3390/jof8010058] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.
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40
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Vijapur MM, Kattimani V, Varsha VK, Girish HC, Kamat M, Ram B. COVID-19 Associated Mucormycosis (CAM): A Single Hospital-Based Study. J Oral Maxillofac Pathol 2022; 26:147-155. [PMID: 35968169 PMCID: PMC9364634 DOI: 10.4103/jomfp.jomfp_152_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Opportunistic fungal infections like Mucormycosis in Coronavirus Disease 2019 (COVID-19) patients have posed a great challenge to health care professionals, especially in developing countries like India. Hence, there is a need to understand the biological behaviour of COVID-19 associated Mucormycosis (CAM) to establish standard treatment Protocols and to reduce mortality. AIMS This study aims is to assess the type of Mucormycosis among COVID-19 patients in study population and compare the findings with clinical, radiological and haematological parameters along with treatment and surgical management. METHODS AND MATERIAL This retrospective, observational study included 60 cases of CAM reported to the Department of Oral and Maxillofacial Surgery at the tertiary care centre, Karnataka Institute of Medical Sciences, Hubli. Data about various parameters were tabulated and analysed statistically. STATISTICAL ANALYSIS USED Bivariate analysis was done using the Chi-Square test to assess the relationship between the type of Mucormycosis and other variables. Spearman's Correlation test was used to assess the correlation between types of Mucormycosis with the other variables. Linear regression analysis was performed to assess the response variable related to the type of Mucormycosis. RESULTS About 50% of subjects presented with "Rhino orbital" type of Mucormycosis. Palatal discoloration and palatal erosion was the most common oral manifestation among "only Sinus" and "Rhino orbital" types of Mucormycosis (P = 0.00). Significant association (P = 0.29) was found between the type of Diabetes mellitus and Mucormycosis. CONCLUSIONS The study indicates that DM is the most commonly associated comorbidity in CAM patients. Hence, a thorough understanding of the underlying comorbidity and its close monitoring during and after COVID-19 infection is mandatory for successful treatment outcomes.
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Affiliation(s)
- Manjunath M. Vijapur
- Department of Oral and Maxillofacial Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Vasanth Kattimani
- Department of Oral and Maxillofacial Surgery, District Health and Family Welfare Services, Dharwad, Karnataka, India
| | - VK Varsha
- Department of Oral and Maxillofacial Pathology, Rajarajeswari Dental College and Hospital Bengaluru, Karnataka, India,Address for correspondence: Dr. Varsha VK, Department of Oral and Maxillofacial Pathology, Rajarajeshwari Dental College and Hospital #14, Ramohalli Cross, Kumbalgodu, Mysore Road, Bengaluru - 560 074, Karnataka, India. E-mail:
| | - HC Girish
- Department of Oral and Maxillofacial Pathology, Rajarajeswari Dental College and Hospital Bengaluru, Karnataka, India
| | - Mamata Kamat
- Department of Oral and Maxillofacial Pathology, BV (DU) Dental College and Hospital, Sangli, Maharashtra, India
| | - Bhargav Ram
- Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia, Karnataka, India
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Swain S, Sharma K, Ray A, Vyas S, Singh G, Joshi M, Jain D, Xess I, Sinha S, Wig N. Post-COVID-19-Invasive Pulmonary Mycosis. LIBYAN INTERNATIONAL MEDICAL UNIVERSITY JOURNAL 2022. [DOI: 10.1055/s-0042-1750711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
COVID-19 has been associated with myriad manifestations as well as adverse outcomes. One of the less commonly reported consequences of COVID-19 is the occurrence of secondary infections in patients suffering acutely from COVID-19 or in those recuperating. Secondary invasive fungal infections (IFIs) have also been observed earlier in other viral infections such as influenza, parainfluenza, and respiratory syncytial virus infections. Severe lung damage and immunologic derangement resulting from SARS-CoV-2 infection predispose to superinfections. Risk factors for secondary IFI includes immunologic derangement and immunoparalysis resulting from SARS-CoV-2 infection, neutropenia, or lymphopenia, poorly controlled diabetes, structural lung disease fungal colonization, and drugs such as corticosteroids or immunomodulators given as therapies for COVID-19. Invasive aspergillosis following COVID-19 is most commonly described fungal infection but other non-Aspergillus fungal infections (including mucormycosis) has also been reported. Herein we describe two interesting cases of secondary infections developing in patients beyond the acute phase of COVID-19 who had similar presentations but with different diagnoses and requiring different management strategies. Patient in case 1 developed COVID-19-associated subacute invasive pulmonary aspergillosis (SAIA) and patient in case 2 had COVID-19 associated pulmonary mucormycosis (CAPM). We have also described the various postulated immune-pathogenesis of the super-added fungal infections in COVID-19 patients.
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Affiliation(s)
- Satish Swain
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kunal Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Joshi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Dulski TM, DeLong M, Garner K, Patil N, Cima MJ, Rothfeldt L, Gulley T, Porter A, Vyas KS, Liverett HK, Toda M, Gold JA, Kothari A. Notes from the Field: COVID-19-Associated Mucormycosis - Arkansas, July-September 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1750-1751. [PMID: 34914674 PMCID: PMC8675658 DOI: 10.15585/mmwr.mm7050a3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mejía-Santos H, Montoya S, Chacón-Fuentes R, Zielinski-Gutierrez E, Lopez B, Ning MF, Farach N, García-Coto F, Rodríguez-Araujo DS, Rosales-Pavón K, Urbina G, Rivera AC, Peña R, Tovar A, Paz MC, Lopez R, Pardo-Cruz F, Mendez C, Flores A, Varela M, Chiller T, Jackson BR, Jordan A, Lyman M, Toda M, Caceres DH, Gold JAW. Notes from the Field: Mucormycosis Cases During the COVID-19 Pandemic - Honduras, May-September 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1747-1749. [PMID: 34914675 PMCID: PMC8675660 DOI: 10.15585/mmwr.mm7050a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Aranjani JM, Manuel A, Abdul Razack HI, Mathew ST. COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic's second wave in India. PLoS Negl Trop Dis 2021; 15:e0009921. [PMID: 34793455 PMCID: PMC8601521 DOI: 10.1371/journal.pntd.0009921] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19-induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19-associated mucormycosis in India.
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Affiliation(s)
- Jesil Mathew Aranjani
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Atulya Manuel
- CCS National Institute of Animal Health, Baghpat, Uttar Pradesh, India
| | - Habeeb Ibrahim Abdul Razack
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia,* E-mail:
| | - Sam T. Mathew
- Researcher & Medical Communications Expert, Bengaluru, Karnataka, India
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Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:jof7110921. [PMID: 34829210 PMCID: PMC8620819 DOI: 10.3390/jof7110921] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.
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Larcher R, Klouche K. COVID-19-associated mucormycosis: Looking for the culprit! JOURNAL OF LIVER TRANSPLANTATION 2021; 4:100045. [PMID: 38620967 PMCID: PMC8487086 DOI: 10.1016/j.liver.2021.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Romaric Larcher
- Department of Intensive Care Medicine Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, INSERM U 1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, INSERM U 1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
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