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Morrissey CO, Kim HY, Garnham K, Dao A, Chakrabarti A, Perfect JR, Alastruey-Izquierdo A, Harrison TS, Bongomin F, Galas M, Siswanto S, Dagne DA, Roitberg F, Gigante V, Sati H, Alffenaar JW, Beardsley J. Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myad130. [PMID: 38935901 PMCID: PMC11210621 DOI: 10.1093/mmy/myad130] [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: 09/17/2023] [Revised: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 06/29/2024] Open
Abstract
The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal priority pathogens list (FPPL). This systematic review aimed to evaluate the epidemiology and impact of invasive fungal disease due to Mucorales. PubMed and Web of Science were searched to identify studies published between January 1, 2011 and February 23, 2021. Studies reporting on mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence during the study time frames were selected. Overall, 24 studies were included. Mortality rates of up to 80% were reported. Antifungal susceptibility varied across agents and species, with the minimum inhibitory concentrations lowest for amphotericin B and posaconazole. Diabetes mellitus was a common risk factor, detected in 65%-85% of patients with mucormycosis, particularly in those with rhino-orbital disease (86.9%). Break-through infection was detected in 13.6%-100% on azole or echinocandin antifungal prophylaxis. The reported prevalence rates were variable, with some studies reporting stable rates in the USA of 0.094-0.117/10 000 discharges between 2011 and 2014, whereas others reported an increase in Iran from 16.8% to 24% between 2011 and 2015. Carefully designed global surveillance studies, linking laboratory and clinical data, are required to develop clinical breakpoints to guide antifungal therapy and determine accurate estimates of complications and sequelae, annual incidence, trends, and global distribution. These data will provide robust estimates of disease burden to refine interventions and better inform future FPPL.
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Affiliation(s)
- C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Hannah Yejin Kim
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Katherine Garnham
- Department of Infectious Diseases and Microbiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Aiken Dao
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Department of Infectious Diseases, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Orthopaedic Research and Biotechnology Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Thomas S Harrison
- Institute for Infection and Immunity, and Clinical Academic Group in Infection and Immunity, St. George’s, University of London, and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Siswanto Siswanto
- World Health Organization, South-East Asia Region Office, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Valeria Gigante
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Jan-Willem Alffenaar
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Justin Beardsley
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Chen X, Chen C, Wu M, Wang S, Jiang H, Li Z, Yu Y, Li B. Causal relationship between type 1 diabetes mellitus and mycoses: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1408297. [PMID: 38947239 PMCID: PMC11211379 DOI: 10.3389/fmed.2024.1408297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is frequently associated with various infections, including mycoses; however, the direct link between T1DM and fungal infections remains under-researched. This study utilizes a Mendelian randomization (MR) approach to investigate the potential causal relationship between T1DM and mycoses. Methods Genetic variants associated with T1DM were sourced from the European Bioinformatics Institute database, while those related to fungal infections such as candidiasis, pneumocystosis, and aspergillosis were obtained from the Finngen database, focusing on European populations. The primary analysis was conducted using the inverse variance weighted (IVW) method, with additional insight from Mendelian randomization Egger regression (MR-Egger). Extensive sensitivity analyses assessed the robustness, diversity, and potential horizontal pleiotropy of our findings. Multivariable Mendelian randomization (MVMR) was employed to adjust for confounders, using both MVMR-IVW and MVMR-Egger to evaluate heterogeneity and pleiotropy. Results Genetically, the odds of developing candidiasis increased by 5% in individuals with T1DM, as determined by the IVW method (OR = 1.05; 95% CI 1.02-1.07, p = 0.0001), with a Bonferroni-adjusted p-value of 0.008. Sensitivity analyses indicated no significant issues with heterogeneity or pleiotropy. Adjustments for confounders such as body mass index, glycated hemoglobin levels, and white blood cell counts further supported these findings (OR = 1.08; 95% CI:1.03-1.13, p = 0.0006). Additional adjustments for immune cell counts, including CD4 and CD8 T cells and natural killer cells, also demonstrated significant results (OR = 1.04; 95% CI: 1.02-1.06, p = 0.0002). No causal associations were found between T1DM and other fungal infections like aspergillosis or pneumocystosis. Conclusion This MR study suggests a genetic predisposition for increased susceptibility to candidiasis in individuals with T1DM. However, no causal links were established between T1DM and other mycoses, including aspergillosis and pneumocystosis.
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Affiliation(s)
- Xiaolan Chen
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Chen
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingyan Wu
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shanmei Wang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongbin Jiang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhe Li
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Panda S, Sahu MC, Turuk J, Pati S. Mucormycosis: A Rare disease to Notifiable Disease. Braz J Microbiol 2024; 55:1065-1081. [PMID: 38561499 PMCID: PMC11153412 DOI: 10.1007/s42770-024-01315-z] [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: 05/10/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is the third most frequent invasive mycosis, following candidiasis and aspergillosis. It is frequently neglected due to its rare occurrence; but recently attend the status of notifiable disease due to its higher incidence in both developed and developing nations. India has received global notice since its estimated instances were greater than the global estimated figures. Mucormycosis has several clinical manifestations, including rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and diffuse Mucormycosis. ROCM is the most frequent clinical manifestation in India, although pulmonary mucormycosis is prevalent worldwide. This review also discusses host defenses, pre disposing risk factors and fungal virulence factors that impair host's ability to prevent fungus invasion and disease establishment. The diagnosis of the disease depends on clinical interventions, histological or microbiological procedures along with molecular methods to obtain timely results. But there are still unmet challenges for rapid diagnosis of the disease. Treatment of the disease is achieved by multimodal approaches such as reversal of underlying predisposing factors, rapid administration of antifungals in optimal doses and surgical procedures to remove infected tissues. Liposomal Amphotericin B, Posaconazole and Isavuconazoles are preferred as the first line of treatment procedures. clinical trials. Different studies have improved the existing drug and under clinical trials while several studies predicted the new potential targets as CotH and Ftr1 as shown in infection and in vitro models. Therefore, current scenario demands a multidisciplinary approach is needed to investigate the prevalence, pathogenesis which is highly important for the advancement of rapid diagnosis and effective treatment.
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Affiliation(s)
- Sunita Panda
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | | | - Jyotirmayee Turuk
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India.
| | - Sanghamitra Pati
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India.
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Yiallouris A, Pana ZD, Marangos G, Tzyrka I, Karanasios S, Georgiou I, Kontopyrgia K, Triantafyllou E, Seidel D, Cornely OA, Johnson EO, Panagiotou S, Filippou C. Fungal diversity in the soil Mycobiome: Implications for ONE health. One Health 2024; 18:100720. [PMID: 38699438 PMCID: PMC11064618 DOI: 10.1016/j.onehlt.2024.100720] [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: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Today, over 300 million individuals worldwide are afflicted by severe fungal infections, many of whom will perish. Fungi, as a result of their plastic genomes have the ability to adapt to new environments and extreme conditions as a consequence of globalization, including urbanization, agricultural intensification, and, notably, climate change. Soils and the impact of these anthropogenic environmental factors can be the source of pathogenic and non-pathogenic fungi and subsequent fungal threats to public health. This underscores the growing understanding that not only is fungal diversity in the soil mycobiome a critical component of a functioning ecosystem, but also that soil microbial communities can significantly contribute to plant, animal, and human health, as underscored by the One Health concept. Collectively, this stresses the importance of investigating the soil microbiome in order to gain a deeper understanding of soil fungal ecology and its interplay with the rhizosphere microbiome, which carries significant implications for human health, animal health and environmental health.
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Affiliation(s)
- Andreas Yiallouris
- School of Medicine, European University, Cyprus
- Medical innovation center (MEDIC), School of Medicine, European University, Cyprus
| | - Zoi D. Pana
- School of Medicine, European University, Cyprus
- Medical innovation center (MEDIC), School of Medicine, European University, Cyprus
| | | | | | | | | | | | | | - Danila Seidel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Elizabeth O. Johnson
- School of Medicine, European University, Cyprus
- Medical innovation center (MEDIC), School of Medicine, European University, Cyprus
| | - Stavros Panagiotou
- School of Medicine, European University, Cyprus
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
| | - Charalampos Filippou
- School of Medicine, European University, Cyprus
- Medical innovation center (MEDIC), School of Medicine, European University, Cyprus
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Tiew TC, Md Ali NA, Ismail MI, Abdul Rahman MR, Ding CH, Tzar MN. Successful Treatment of Sternal Osteomyelitis and Mediastinitis Caused by Rhizopus Following Cardiac Surgery. Cureus 2024; 16:e62312. [PMID: 39006712 PMCID: PMC11246069 DOI: 10.7759/cureus.62312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Sternal osteomyelitis and mediastinitis are rare yet severe complications post-cardiac surgery, often associated with significant morbidity and mortality. Fungal etiologies, particularly those caused by Rhizopus spp., are infrequent but can lead to aggressive infections. Here, we present the case of a 68-year-old male who developed sternal osteomyelitis and mediastinitis caused by Rhizopus spp. two weeks following coronary artery bypass grafting surgery. Debridement and pectoralis flap reconstruction were performed following clinical identification and confirmation with microbiological examinations and a CT scan. Prompt recognition, aggressive surgical intervention, and targeted antifungal therapy were crucial for successful management. This case underscores the importance of considering fungal pathogens, such as Rhizopus, in the differential diagnosis of post-cardiac surgery infections, as well as aggressive treatment to improve outcomes for affected patients.
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Affiliation(s)
- Toot Chaw Tiew
- Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Nur Ayub Md Ali
- Cardiothoracic Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | | | | | - Chuan Hun Ding
- Medical Microbiology and Immunology, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Mohd Nizam Tzar
- Medical Microbiology and Immunology, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
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Pandey M, Xess I, Sachdev J, Sharad N, Gupta S, Singh G, Yadav RK, Rana B, Raj S, Ahmad MN, Nityadarshini N, Baitha U, Soneja M, Shalimar, Prakash B, Sikka K, Mathur P, Jyotsna VP, Kumar R, Wig N, Gourav S, Biswas A, Thakar A. Utility of an in-house real-time PCR in whole blood samples as a minimally invasive method for early and accurate diagnosis of invasive mould infections. J Infect 2024; 88:106147. [PMID: 38555035 DOI: 10.1016/j.jinf.2024.106147] [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: 09/20/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Invasive mould infections (IMIs) are a leading cause of death in patients with compromised immune systems. Proven invasive mould infection requires detection of a fungus by histopathological analysis of a biopsied specimen, sterile culture, or fungal DNA amplification by PCR in tissue. However, the clinical performance of a PCR assay on blood samples taken from patients suspected of invasive mould disease has not been fully evaluated, particularly for the differential diagnosis of invasive aspergillosis (IA) and invasive Mucormycosis (IM). OBJECTIVES To assess the diagnostic utility of our previously validated in-house real-time PCR in blood samples for diagnosis of invasive aspergillosis and mucormycosis in patients with suspected invasive mould infection. METHODS All patients with suspected invasive mould infection were prospectively enrolled from May 2021 to July 2021. Conventional fungal diagnosis was performed using tissue and respiratory samples. In-house PCR was performed on blood samples and its diagnostic performance evaluated. RESULTS A total of 158 cases of suspected invasive mould infection were enrolled in the study. The sensitivity and specificity of in-house PCR performed on blood samples was found to be 92.5% and 81.4% respectively for diagnosis of probable IA, and 65% and 84.62% respectively for diagnosis of proven and probable IM. It was also able to detect 3 out of 5 cases of possible IM where no other microbiological evidence of IM was obtained. CONCLUSIONS This assay could be helpful in minimally invasive diagnosis of IMIs for patients in whom invasive sampling is not feasible, especially as a preliminary or screening test. It can help in early diagnosis, anticipating conventional laboratory confirmation by days or weeks. Possible correlation between fungal load and mortality can help in initiating aggressive treatment for patients with high initial fungal load.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Sharad
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonakshi Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Renu Kumari Yadav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Rana
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Stephen Raj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M Nizam Ahmad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Nityadarshini
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudesh Gourav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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Cheng X, Li T, Wu F, Liu D. Clinical Manifestation, mNGS Based Diagnosis and Treatment of Pulmonary Mucormycosis with Rhizopus delemar in a Diabetic Patient. Infect Drug Resist 2024; 17:1379-1384. [PMID: 38618581 PMCID: PMC11011641 DOI: 10.2147/idr.s454029] [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: 12/13/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Pulmonary mucormycosis is a severe and often fatal disease that commonly affects patients with underlying conditions, such as diabetes. Early diagnosis and appropriate treatment are crucial for improving survival rates. However, clinical diagnosis remains challenging due to difficulty in obtaining etiological evidence. In this particular case, the patient presented with a cough-producing bloody sputum, and a chest CT revealed lesions in the right upper lobe of the lung. The patient was ultimately diagnosed with pulmonary mucormycosis caused by Rhizopus delemar through clinical bronchoscopy biopsy and metagenomic next-generation sequencing (mNGS) analysis of bronchoalveolar lavage fluid sample. Subsequently, antifungal therapy using the less toxic Amphotericin B cholesterol Organosulfate complex was initiated, improving the patient's condition. In conclusion, our findings underscore the potential of mNGS to provide an accurate and rapid etiological diagnosis of pulmonary mucormycosis, offering a foundation for treatment.
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Affiliation(s)
- Xuesong Cheng
- The Department of Pulmonary and Critical Care Medicine, Anhui No.2 Provincial People’s Hospital, Hefei, People’s Republic of China
| | - Tianyu Li
- Genoxor Medical Science and Technology Inc., Shanghai, People’s Republic of China
| | - Fengsheng Wu
- Genoxor Medical Science and Technology Inc., Shanghai, People’s Republic of China
| | - Dandan Liu
- The Department of Pulmonary and Critical Care Medicine, Anhui No.2 Provincial People’s Hospital, Hefei, People’s Republic of China
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Paavai TT, Vasanthi V, Rameshkumar A, Rajkumar K, Krishnakumar Raja VB, Muthusubramanian V. Maxillary Mucormycotic Osteonecrosis as a Manifestation of Post-COVID-19 Infection in Non-diabetic Patients: Report of Two Cases. J Microsc Ultrastruct 2024; 12:99-103. [PMID: 39006044 PMCID: PMC11245128 DOI: 10.4103/jmau.jmau_81_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 08/06/2023] [Indexed: 07/16/2024] Open
Abstract
Mucormycosis is a rare, opportunistic fungal infection prevalent in the elderly, especially in patients with uncontrolled diabetes or a compromised immune system. However, the outbreak of the pandemic declared by the World Health Organization in late 2019 increased the incidence of mucormycosis cases in COVID-19 patients due to increased steroid usage that resulted in an immunocompromised state. The current report presents two cases of oral mucormycotic osteomyelitis in patients who developed diabetes post-COVID infection, along with a review and relevant literature.
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Affiliation(s)
| | - V. Vasanthi
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Annasamy Rameshkumar
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Krishnan Rajkumar
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - V. B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
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Mathur A, Mishra P, Yadav A, Nigam N, Ghoshal UC. Colonic Mucormycosis in Fistulizing Crohn's Disease. J Emerg Trauma Shock 2024; 17:107-110. [PMID: 39070858 PMCID: PMC11279494 DOI: 10.4103/jets.jets_69_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 07/30/2024] Open
Abstract
Gastrointestinal mucormycosis, a rare fatal fungal infection in an immunocompromised host, affects mainly the stomach. Colonic mucormycosis is infrequent and is associated with high mortality. Perianal involvement is seen in almost one-third of patients with Crohn's disease. Perianal Crohn's disease is a particularly debilitating form of the disease, which requires multidisciplinary care. It may also require profound immunosuppression with biological agents to control disease activity. Opportunistic infections can complicate the disease course in these patients. We present a case of a middle-aged female with perianal Crohn's disease on adalimumab who developed colonic mucormycosis causing a flare in her disease activity. This patient highlights the need to increase awareness about fungal infections as a cause of disease flare in inflammatory bowel disease.
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Affiliation(s)
- Akash Mathur
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Piyush Mishra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Yadav
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kusumesh R, Singh V, Sinha S, Ali MS, Mishra SK, Ambasta A, Prakash V, Sinha P, Sinha BP, Priyadarshi RN. Risk factors and clinical presentation of rhino-orbital mucormycosis: Lesson learnt during Covid pandemic. J Family Med Prim Care 2024; 13:1354-1361. [PMID: 38827672 PMCID: PMC11142005 DOI: 10.4103/jfmpc.jfmpc_1259_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 06/04/2024] Open
Abstract
Aim To analyze the potential predisposing factors and clinical presentation of mucormycosis in patients with COVID-19. Material and Methods Medical records of 141 patients with COVID-19-associated mucormycosis (CAM) treated at a tertiary care center in Bihar were reviewed. The predisposing factors, clinical features, and imaging findings of mucormycosis were analyzed. Results The median age was 48 years (IQR, 43-60). A total of 58 patients developed concurrent CAM and 83 post-CAM. The median interval between COVID-19 and onset of CAM symptoms was 15 days (IQR, 9-16). A total of 80 patients received at-home treatment for COVID-19, and 73 had mild-to-moderate disease. While 61 patients received in-hospital treatment, 57 had severe disease. At presentation, 131 patients had hyperglycemia: 64 type 2 diabetes mellitus (DM) and 67 new-onset DM. The history of glucocorticoid use for COVID-19 was present in 125 patients; 47% were administered at home without monitoring plasma glucose. The common presenting features were toothache, periocular or facial pain, and edema. Rhino-orbital mucormycosis was the most common. Imaging revealed rhinosinusitis in all patients, including pansinusitis (68%), pterygopalatine fossa involvement (21%), cavernous sinus thrombosis (38%), brain abscess (8%), and infarct (4%). All patients received intravenous liposomal amphotericin B, and surgical debridement was performed in 113. Conclusion COVID-19 patients with hyperglycemia are at risk of developing CAM, irrespective of the severity. Timely recognition of symptoms and prompt initiation of therapy by primary healthcare physicians are imperative for enhancing outcomes. Additionally, glucocorticoid overuse should be avoided, and close monitoring for hyperglycemia development is warranted.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vivek Singh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shivani Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mobashir S. Ali
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sarita K. Mishra
- Department of Otolaryngology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ved Prakash
- Department of Endocrinology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Pravek Sinha
- Northern Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Bibhuti P. Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rajeev N. Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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11
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Velasco JC, Vargas LJ, García L, Torres IJ, González IC. Oral mucormycosis associated with COVID-19 and diabetes mellitus: Case report and literature review. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:10-15. [PMID: 38648346 PMCID: PMC11186624 DOI: 10.7705/biomedica.6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/04/2024] [Indexed: 04/25/2024]
Abstract
Mucormycosis is an invasive opportunistic fungal infection with high mortality, mainly detected in people with COVID-19, especially those with underlying diseases such as diabetes mellitus. Mucormycosis prevalence is 0.005 to 1.7 cases per million inhabitants, and it has been increasing in countries like India and Pakistan. This mycosis can affect different organs, and clinical manifestations reflect the transmission mechanism. Frequent forms are rhino-orbital-cerebral and pulmonary. This disease should be suspected in patients with necrotic injuries on mucous membranes or skin. We present a case of a patient with diabetes mellitus and diagnosed with oral mucormycosis associated with COVID-19.
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Affiliation(s)
- Julio César Velasco
- Departamento de Investigación, Hospital Regional de la Orinoquía, Yopal, ColombiaHospital Regional de la OrinoquíaDepartamento de InvestigaciónHospital Regional de la OrinoquíaYopalColombia
| | - Ledmar Jovanny Vargas
- Departamento de Investigación, Hospital Regional de la Orinoquía, Yopal, ColombiaHospital Regional de la OrinoquíaDepartamento de InvestigaciónHospital Regional de la OrinoquíaYopalColombia
| | - Lorena García
- Departamento de Investigación, Hospital Regional de la Orinoquía, Yopal, ColombiaHospital Regional de la OrinoquíaDepartamento de InvestigaciónHospital Regional de la OrinoquíaYopalColombia
| | - Iván José Torres
- Cirugía Maxilofacial, Hospital Regional de la Orinoquía, Yopal, ColombiaHospital Regional de la OrinoquíaHospital Regional de la OrinoquíaYopalColombia
| | - Iván Camilo González
- Medicina de Urgencias, Hospital Regional de la Orinoquía, Yopal, ColombiaHospital Regional de la OrinoquíaHospital Regional de la OrinoquíaYopalColombia
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12
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Veisi A, Aletaha M, Abolhosseini M, Ownagh V, Fekri S, Feizi M, Amoushahi Khouzani S, Najafi M. Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report. J Fr Ophtalmol 2024; 47:104139. [PMID: 38696866 DOI: 10.1016/j.jfo.2024.104139] [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: 10/21/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To investigate the long-term outcomes of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM) patients. METHODS Retrospective, observational study including all COVID-19 patients who developed ROCM and were referred to our oculoplastic clinic. RESULTS Twenty-one patients with COVID-19-associated ROCM were included in this study. Twelve (57.1%) individuals were female with a mean age of 50.7±7.6 years (range 33-59), and nine (38.1%) were male with a mean age of 58.7±14.4 years (range 37-82). Corticosteroids were used in 85.7% of patients, and three patients received no systemic corticosteroids; 76.2% were diabetic and two of these developed new-onset diabetes mellitus (DM) after receiving corticosteroids during their treatment course. The average interval between COVID-19 and the development of ROCM in our subjects was 18.6 days (range 8-46 days). In our series of patients, decreasing vision, proptosis, and periorbital edema constituted the most prevalent presentation, seen in 52.4% of subjects. Endoscopic paranasal sinus debridement was performed a mean of 3.4 times in 95.2%, abscess drainage in one, and orbital exenteration in three (14.2%) patients. Orbital apex and bilateral paranasal sinus involvement were significantly associated with higher mortality, and the overall 18-month survival rate was 52.3%. CONCLUSION Based upon common factors among the COVID-19-associated ROCM patients, we presume that DM and drug-induced immunosuppression are two main factors, which may lead to a higher rate of ROCM infection in areas where fungal spores are more likely to be present, such as hospitals.
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Affiliation(s)
- A Veisi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Abolhosseini
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - V Ownagh
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - S Fekri
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Feizi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amoushahi Khouzani
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Najafi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Singh R, Mittal G, Kakati B, Koul N. An Observational Study of Fungal Infections in COVID-19: Highlighting the Role of Mucormycosis in Tertiary Healthcare Settings. Cureus 2024; 16:e57295. [PMID: 38690487 PMCID: PMC11059081 DOI: 10.7759/cureus.57295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Background Fungal infections, especially mucormycosis, have remarkably surged during the coronavirus disease 2019 (COVID-19) era, especially during the second wave peak of the pandemic raising the concern of the clinicians for the admitted patients. Steroid therapy, diabetes, and other immunocompromised states are more commonly associated with COVID-19-associated mucormycosis (CAM). Aim and objective The aim of this study is to ascertain the prevalence of fungal infections amidst the second wave of the COVID-19 pandemic and discern the associated risk factors. Materials and methods During the second peak of COVID-19, samples were received in the microbiology laboratory from all clinically suspected mucormycosis patients. These samples underwent processing for potassium hydroxide (KOH) wet mount, fungal culture on Sabouraud's dextrose agar (SDA) medium, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) testing. All relevant clinical and associated risk factors were tabulated and analyzed. Results Among the 107 suspected cases of mucormycosis, 39 (36.4%) were confirmed positive for COVID-19 via RT-PCR, while 68 (63.6%) tested negative. Males exhibited a predominant infection rate, with the rhinocerebral system being the most commonly affected site. Significantly higher mortality rates were observed in COVID-19-associated mucormycosis (CAM) patients (33.4%) compared to those without COVID-19 (5.9%), with a notable p-value of 0.0005. CAM patients also demonstrated a higher frequency of ICU admissions (77%) compared to non-COVID-19-associated mucormycosis patients (21.4%), a statistically significant finding (p-value of 0.007). Additionally, immunocompromised states, diabetes, and the administration of oxygen therapy were identified as significant risk factors in CAM (p < 0.05). Notably, mucormycosis accounted for the majority of fungal isolates (48.27%) among COVID-19 patients. Conclusion Mucormycosis infection is more commonly seen in COVID-19-infected patients as compared to non-COVID-19 patients, especially with comorbidities such as diabetes mellitus, steroid usage, and other immunocompromised states.
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Affiliation(s)
- Rajender Singh
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Garima Mittal
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Barnali Kakati
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Nupur Koul
- Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
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14
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Bhambhani D, Bhambhani G, Thomas S, Bhambhani S, Parlani S, Tandon R. Comparison Between Pre-COVID and Post-COVID Mucormycosis: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2024; 23:135-144. [PMID: 38312959 PMCID: PMC10831006 DOI: 10.1007/s12663-023-02028-w] [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: 05/16/2023] [Accepted: 09/22/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Mucormycosis has emerged as one of the most fatal complications arising due to COVID-19, though it has to be mentioned that the disease is capable of causing serious illness even on its own. Objectives Through this investigation, we would review the threat that mucormycosis poses, in terms of its prevalence and degree of severity both in the pre- and post-COVID world. Materials and Methods A comprehensive examination of the studies published in online databases turned up 207 papers, 103 of which had undergone in-depth analysis, using both inclusion and exclusion criteria, shortlisting 15 studies that were appropriate for reviewing. Results The incidence of mucormycosis was linked to coronavirus in 7 of the 15 studies that were chosen. The remaining eight studies had sufferers of various systemic diseases, like HIV/AIDS and diabetes. Discussion All the cases suffered diabetes mellitus. Regardless of the time period of the chosen article, corticosteroids and antifungal medications were administered to all patients. There were noticeable differences in terms of mortality, predisposing factors, and virulence between pre-COVID and post-COVID mucormycosis. Summary and Conclusion The prevalence of systemic conditions such as diabetes in cases of mucormycosis has remained the same even after the incidence of this pandemic, showing that the basic treatment modalities continue to remain the same irrespective of the damage that corona virus has caused to the sufferer, although mucormycosis arising due to COVID-19 differs from mucormycosis that was incident before the advent of the pandemic.
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Affiliation(s)
| | - Garima Bhambhani
- Department of Public Health Dentistry, People’s College of Dental Sciences and Research Centre, Bhopal, 462037 India
| | - Shaji Thomas
- Department of Oral and Maxillofacial Surgery, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh 462037 India
| | - Suresh Bhambhani
- Department of General Medicine, Chirayu Medical College, Bhopal, Madhya Pradesh 462037 India
| | - Swapnil Parlani
- Department of Prosthodontics, Crown and Bridge, Bhopal, Madhya Pradesh 462037 India
| | - Riddhi Tandon
- Mahavir Institute of Medical Sciences and Research, Bhopal, India
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15
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Erami M, Raiesi O, Momen-Heravi M, Mirhendi H, Aboutalebian S, Getso MI, Matini AH, Ahsaniarani AH, Ganjizadeh M, Hassani Josheghani H, Amiri S, Pakzad R, Hashemi SJ. COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes. Infect Dis (Lond) 2024; 56:81-90. [PMID: 37816067 DOI: 10.1080/23744235.2023.2267669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran. METHODS A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination. RESULTS We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40-79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O2 required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO2 were also significantly higher in survivors than non-survivors. CONCLUSION Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Raiesi
- Department of Parasitology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Head and Neck Surgery, Department, Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Ganjizadeh
- Kashan Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Sasan Amiri
- Roozbeh hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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16
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Mohammadi K, Mohiyuddin SMA, Prasad KC, Rajan A, Indu Varsha G, Natrajan A, Sakalecha AK, Jose DA. Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause? Indian J Otolaryngol Head Neck Surg 2024; 76:55-63. [PMID: 38440575 PMCID: PMC10908983 DOI: 10.1007/s12070-023-04077-6] [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: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 03/06/2024] Open
Abstract
The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.
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Affiliation(s)
- Kouser Mohammadi
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - K. C. Prasad
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Akshaya Rajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - Arvind Natrajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Anil k. Sakalecha
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Diana Ann Jose
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
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17
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Ji R. Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report. BMC Infect Dis 2024; 24:136. [PMID: 38287258 PMCID: PMC10823596 DOI: 10.1186/s12879-023-08220-0] [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: 11/20/2022] [Accepted: 04/04/2023] [Indexed: 01/31/2024] Open
Abstract
Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
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Affiliation(s)
- Ran Ji
- Department of the Surgical Intensive Care Unit (SICU), The Second Affiliated Hospital Zhejiang, University School of Medicine, NO. 88 Jiefang Road,Shangcheng District Hangzhou, 310009, Zhejiang, China.
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18
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Abdulkader RS, Ponnaiah M, Bhatnagar T, S D, Rozario AG, K G, Mohan M, E M, Saravanakumar D, Moorthy A, Tyagi AK, Parmar BD, Devaraja K, Medikeri G, Ojah J, Srivastava K, K K, Das N, B N, Sharma P, Kumar Parida P, Kumar Saravanam P, Kulkarni P, S P, Patil S P, Kumar Bagla R, D R, S Melkundi R, S Satpute S, Narayanan S, Jahagirdar S, Dube S, Kumar Panigrahi S, Babu D S, Saini V, Singh Saxena R, Srivastava A, Chandra Baishya A, Garg A, Kumar Mishra A, Jyoti Talukdar A, Kankaria A, Karat A, Sundaresh Kumar A, Chug A, Vankundre A, Ramaswamy B, MB B, R Jadav B, Dhiwakar M, Ghate G, Shah HV, Saha I, Sivapuram K, J Joshi K, Singh M, Chand Bairwa M, K D, K K, E M, Samagh N, Dinakaran N, Gupta N, Gupta N, M Nagarkar N, Solanki N, Kumar Panda P, Bachalli P, Shanbag R, Patil R, Kumar A R, Narayan Patil R, Thookkanaickenpalayam Vijayaraghavan R, Hanumantappa R, A R, Mandal SK, Kishve SP, Varghese Thomas S, Sarkar S, Thakur S, Patil S, Lakshmanan S, D Rao S, V S, Nayak T, Dixit UR, B U, Backiavathy V, Shenoy V, Hallur VK, Bhatnagar A, Murhekar MV. Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India. Mycology 2024; 15:70-84. [PMID: 38558844 PMCID: PMC10976993 DOI: 10.1080/21501203.2023.2271928] [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: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.
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Affiliation(s)
| | | | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Devika S
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Gayathri K
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malu Mohan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Michaelraj E
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhagirathsinh D Parmar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - K Devaraja
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gaurav Medikeri
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Kajal Srivastava
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Niharika B
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Parul Sharma
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Prasanna Kumar Saravanam
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Priya S
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Pushpa Patil S
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rahul Kumar Bagla
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Ramesh D
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Renuka S Melkundi
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Satish S Satpute
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shubhashri Jahagirdar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Panigrahi
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Surendra Babu D
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
| | - Vaibhav Saini
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rita Singh Saxena
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Abhinav Srivastava
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | | | - Ajai Garg
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Amit Kumar Mishra
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Anjan Jyoti Talukdar
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Ankita Kankaria
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Arathi Karat
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
| | - Arul Sundaresh Kumar
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Ashi Chug
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Vankundre
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharathi MB
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Bhargav R Jadav
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - Muthuswamy Dhiwakar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Girija Ghate
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Hardik V Shah
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Ipsita Saha
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavya Sivapuram
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Krupal J Joshi
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Mahendra Singh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Chand Bairwa
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Muthurajesh E
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Navneh Samagh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Nethra Dinakaran
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Nikhil Gupta
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Nitin Gupta
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Nitin Solanki
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Prasan Kumar Panda
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prithvi Bachalli
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Raghunath Shanbag
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajashri Patil
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Rajesh Kumar A
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Rakesh Narayan Patil
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | | | - Ramesh Hanumantappa
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Rathinavel A
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saleel Kumar Mandal
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Sara Varghese Thomas
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Shalini Thakur
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Siddaram Patil
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Somu Lakshmanan
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Srinivas D Rao
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Sumathi V
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Umesh R Dixit
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Backiavathy
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Vijendra Shenoy
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kumar Hallur
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
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19
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Wang W, Yao Y, Li X, Zhang S, Zeng Z, Zhou H, Yang Q. Clinical impact of metagenomic next-generation sequencing of peripheral blood for the diagnosis of invasive mucormycosis: a single-center retrospective study. Microbiol Spectr 2024; 12:e0355323. [PMID: 38095467 PMCID: PMC10782995 DOI: 10.1128/spectrum.03553-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Given the high fatality rates, prompt and accurate identification of the fungal culprit is crucial, emphasizing the need for invasive mucormycosis. Unfortunately, mucormycosis lacks definitive biomarkers, depending primarily on smears, cultures, or pathology, all necessitating invasive specimen collection from the infection site. However, obtaining valid specimens early in critically ill patients poses substantial risks and challenges. Whether peripheral blood metagenomic next-generation sequencing (mNGS) can enhance early mucormycosis diagnosis, especially when direct specimen collection from the infection site is challenging, is warranted. This is a large-scale clinical study conducted to evaluate the utility and clinical impact of mNGS of peripheral blood for the diagnosis of invasive mucormycosis. We believe our study provided both novelty in translational medicine and a great value for the medical community to understand the strengths and limitations of mNGS of peripheral blood as a new diagnostic tool for the diagnosis and management of invasive mucormycosis.
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Affiliation(s)
- Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Respiratory and Critical Care Medicine, Shaoxing Central Hospital, Shaoxing, China
| | - Yake Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xi Li
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shanshan Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Respiratory and Critical Care Medicine, Beilun People’s Hospital, Ningbo, China
| | - Zhu Zeng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Yang
- Department of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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20
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Sachdeva A, Targhotra M, Chauhan MK, Chopra M. Role of Amphotericin B in the Treatment of Mucormycosis. Curr Pharm Des 2024; 30:1-9. [PMID: 38178658 DOI: 10.2174/0113816128272443231221101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Regardless of the most recent inclusion of mold-active agents (isavuconazole and posaconazole) to antifungal agents against mucormycosis, in conjunction with amphotericin B (AMB) items, numerous uncertainties still exist regarding the treatment of this rare infection. The order Mucorales contains a variety of fungi that cause the serious but uncommon fungal illness known as mucormycosis. The moulds are prevalent in nature and typically do not pose significant risks to people. Immunocompromised people are affected by it. OBJECTIVE This article's primary goal is to highlight the integral role that AMB plays in this condition. METHODS Like sinusitis (including pansinusitis, rhino-orbital, or rhino-cerebral sinusitis) is one of the many signs and symptoms of mucormycosis. The National Center for Biotechnology Information (NCBI) produces a variety of online information resources for review articles on the topic-based mucormycosis, AMB, diagnosis of mucormycosis and the PubMed® database of citations and abstracts published in life science journals. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov. RESULTS The article provides a summary of the pharmacological attributes of the various AMB compositions accessible for systemic use. CONCLUSION The article demonstrates the traits of the drug associated with its chemical, pharmacokinetics, stability, and other features, and illustrates their most useful characteristics for clinical application.
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Affiliation(s)
- Alisha Sachdeva
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Monika Targhotra
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Meenakshi Kanwar Chauhan
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Monica Chopra
- Department of Pharmaceutical Chemistry, Centre for Healthcare, Allied Medical and Paramedical Sciences, Delhi Skill and Entrepreneurship University, (CHAMPS-DSEU Okhla-II Campus), Maa Anandmayi Marg, Okhla Industrial Area Phase II, New Delhi 110020, India
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21
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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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Verma V, Sarkar D, Moharana B, Singh P, Noyadu R, Sharma B. Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India. Indian J Ophthalmol 2023; 71:3669-3676. [PMID: 37991302 PMCID: PMC10788766 DOI: 10.4103/ijo.ijo_356_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. METHODS A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. RESULTS ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. CONCLUSION Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM.
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Affiliation(s)
- Vidhya Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bruttendu Moharana
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Richa Noyadu
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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23
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Thakur (Rai) N, Misra M, Misra S, Misra S, Shukla DK, Singh AK, Dheer Y, Jaiswal V, Rai N. Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India. J Diabetes Metab Disord 2023; 22:1459-1469. [PMID: 37975119 PMCID: PMC10638341 DOI: 10.1007/s40200-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Introduction Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and methods An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.
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Affiliation(s)
- Neha Thakur (Rai)
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Maitreyi Misra
- Intern, Department Of Surgery, TSM Medical College, Lucknow, Uttar Pradesh India
| | - Samir Misra
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | | | - Devesh Kumar Shukla
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Arvind Kumar Singh
- Department of Social and Preventive Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Yadvendra Dheer
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Vaibhav Jaiswal
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Narendra Rai
- Department of Paediatrics, Chandan Hospital, Lucknow, Uttar Pradesh India
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24
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Somkuwar S, Vijayabharathi P, Galhotra V, Rao S, Nagarkar NM, Raghani M, Pathak VK, Mehta R. Clinical, Demographic, and Oral Presentations of COVID-19 Associated Mucormycosis from a Tertiary Care Hospital in India: A Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:1130-1138. [PMID: 38105823 PMCID: PMC10719169 DOI: 10.1007/s12663-023-01970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/26/2023] [Indexed: 12/19/2023] Open
Abstract
Background The black fungus, mucormycosis, is on the list of lethal complications reported in recent times in COVID patients. Methodology This cross-sectional study included all cases of post-COVID-19 mucormycosis. Patients' demographics, clinical presentations, and general health information were collected using a pre-designed form. Results The study included 171 participants with the mean (SD) age as 49 (10) years with the sex distribution as 71% (122/171) male and 29% (49/122) females. About half of the admitted patients (47%) were known cases of Diabetes Mellitus type II with a median (IQR) Glycosylated Haemoglobin (HbA1c) of 9.1% (7-11.1%). Only 28% (48/171) had received the first COVID vaccination, and 2.9% (5/171) were fully vaccinated with two doses. During COVID-19, 76% (130/171) required hospitalisation for a mean (SD) stay of 11 (6.4) days. Eighty percent of the patients (136/171) received steroids during therapy, while 87% (150/171) and 51% (88/171) received antibiotics and antivirals, respectively. Oxygen was administered to 71% of hospitalised patients (120/171), with 39.1% (47/120) receiving it for more than 7 days. About the development of the first symptoms of mucormycosis (headache, nasal congestion, black crusts in the nose, facial pain, swelling in cheeks and eyes, and loss of vision) after being diagnosed with COVID-19, 16% (28/171) reported it within 7 days, 75% (127/171) between 8 and 30th days and 9% (16/171) after a month. On examination, 20% of mucor patients had hard palate findings, eschars, fistulas, and perforations, 38% had periodontal abscesses, and 5% reported tenderness to percussion. Conclusion Generally, oral manifestations involved the palate and included varying degrees of mucosal discolouration, swelling, ulcers, superficial necrotic areas, and bone exposure and necrosis with dark eschars.
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Affiliation(s)
- Surabhi Somkuwar
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - P. Vijayabharathi
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - Virat Galhotra
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
- Department of Dentistry—Pediatric and Preventive Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Santhosh Rao
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Nitin M. Nagarkar
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Manish Raghani
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | | | - Rupa Mehta
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
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25
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Jain A, Jain A, Purohit S. COVID-19, Diabetes Mellitus, Corticosteroids: A Recipe for Disaster. EAR, NOSE & THROAT JOURNAL 2023; 102:757-758. [PMID: 34281417 DOI: 10.1177/01455613211033687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Avani Jain
- Department of ENT, ESIC Medical College and Hospital, Faridabad, India
| | | | - Sandeep Purohit
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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George SP, Bhalot L, Verma J, Godha S, Gupta Y, Mundra RK. Mucormycosis Epidemic in Covid Era: A Sinister Superinfection. Indian J Otolaryngol Head Neck Surg 2023; 75:3501-3506. [PMID: 37974856 PMCID: PMC10646106 DOI: 10.1007/s12070-023-04014-7] [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: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 11/19/2023] Open
Abstract
In this study, we attempt to look at the various presentations, comorbidities and association of the recent epidemic of rhino-orbital cerebral mucormycosis with Covid-19 in central India. A prospective study of 612 patients diagnosed with mucormycosis from April to July 2021. Detailed history was taken and thorough clinical examination was done. The relation of mucormycosis with Covid-19 and other morbidities was studied. Nasal endoscopy, imaging and management findings were tabulated and analyzed. Male predominance of the disease was noted. The most common age group affected was found to be 41-50 years group having 33.1% of all patients. 83.2% patients had history of Covid-19 infection. Majority of the patients (41.6%) had mucormycosis symptoms within 1 month of Covid-19 symptom onset. Nasal symptoms predominated with 61.1% patients having one or more of the several nasal symptoms. Most common comorbidity was diabetes mellitus (75.8% cases). Nasal and sinus debridement was performed in 584 patients (95.4%). Mucormycosis turned into a widespread epidemic during the second wave of Covid-19 in India. Diabetes mellitus was the most common associated comorbidity that increased the risk of mucormycosis in patients with history of Covid-19 infection. A high index of suspicion in patients presenting with early symptoms in the context of Covid-19, along with prompt diagnosis using radiological, endoscopic and microbiological tools will help reduce mortality to a great extent. Mainstay of treatment is aggressive surgical and medical management, controlling comorbidities and adequate post-operative care.
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Affiliation(s)
- Sonith Peter George
- Department of Otorhinolaryngology, M.G.M Medical College, 301-A, Elite Anmol, Shree Mangal Nagar, Near Bengali Square, Indore, M.P. 452016 India
| | - Lokesh Bhalot
- Department of Otorhinolaryngology Medical College, Ratlam, M.P India
| | - Jagram Verma
- Department of Otorhinolaryngology, M.G.M Medical College, 301-A, Elite Anmol, Shree Mangal Nagar, Near Bengali Square, Indore, M.P. 452016 India
| | - Surbhi Godha
- Department of Otorhinolaryngology, M.G.M Medical College, 301-A, Elite Anmol, Shree Mangal Nagar, Near Bengali Square, Indore, M.P. 452016 India
| | - Yamini Gupta
- Department of Otorhinolaryngology, M.G.M Medical College, 301-A, Elite Anmol, Shree Mangal Nagar, Near Bengali Square, Indore, M.P. 452016 India
| | - R. K. Mundra
- Department of Otorhinolaryngology, M.G.M Medical College, 301-A, Elite Anmol, Shree Mangal Nagar, Near Bengali Square, Indore, M.P. 452016 India
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Shen M, Wang J, Lei M, Wang Z. The outcome and the risk factors of mucormycosis among patients with hematological diseases: a systematic and meta-analysis. Front Med (Lausanne) 2023; 10:1268840. [PMID: 38098845 PMCID: PMC10720036 DOI: 10.3389/fmed.2023.1268840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives Mucorale has come into a significant pathogen over recent decades. Nonetheless, mucormycosis-related mortality rates among patients with hematological disorders remain unascertained. Thus, we conducted a meta-analysis to determine mortality rates of mucormycosis in patients with hematology-related conditions. Methods We scoured PubMed, Embase, and Web of Science for original papers exploring the intersection of Mucormycosis and Hematological Diseases (from 2000 to 2022). We scrutinized the overall mortality across three distinct periods, as well as differentiating between high-income and middle-income nations. We further evaluated the pooled mortality and the risk differential (RD) across several subgroups. Results The overall mortality rate for hematology patients with mucormycosis was 61%, within a 95% confidence interval (CI) of 0.54-0.68. A significant observation was that mortality rates were somewhat lower in high-income countries compared to middle-income countries (0.60 versus 0.64, p = 0.45). Importantly, we discovered that a combination of surgical and medical treatment significantly improved survival rates compared to medical treatment alone [mortality 0.49 versus 0.67, RD -0.19 (95%CI -0.38-0.00, I2 63.7%)]. As might be expected, disseminated mucormycosis posed a significantly higher risk of death compared to isolated mucormycosis [0.60 versus 0.57, RD death 0.16 (95%CI 0.03-0.28)]. Additionally, our analysis showed no discernible differences in survival rates between genders, between patients with and without breakthrough infection, between those who received mucor-active or mucor-inactive drugs prior to mucor infection, or between those on a multi-drug regimen and those on a single drug treatment. Conclusion Despite the high mortality rates associated with mucormycosis in patients with hematological disorders, those receiving both medical and surgical interventions, as well as those with isolated infection sites, exhibited improved survival outcomes. Conversely, factors such as gender, the presence of breakthrough infection, the use of mucor-active drugs before mucor infection, and multi-drug administration did not significantly influence patient outcomes.
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Affiliation(s)
| | | | | | - Zhiming Wang
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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Fatima N, Ahmed S, Shameem M, Ahmed A, Hasan W, Khan PA. Rhino-orbito-cerebral mucormycosis during Covid-19 pandemic- a prospective observational study. Indian J Med Microbiol 2023; 46:100467. [PMID: 37651764 DOI: 10.1016/j.ijmmb.2023.100467] [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: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE An unprecedented rise in mucormycosis cases; apparently called 'an epidemic within a pandemic' was seen worldwide. Therefore, the following study was conducted to know the epidemiology, underlying risk factors, diagnostic approach, and possible outcome of mucormycosis during the Covid-19 pandemic. METHODS A prospective observational study was conducted on patients with a high index of clinical suspicion of mucormycosis Data about demographics, co-morbidities, laboratory investigations, radiology, management, and outcomes were collected. RESULTS We got 45 cases of proven Rhino-orbital-cerebral-mucormycosis (ROCM) from clinically suspected cases. Covid-19 was the most common underlying risk factor (n = 41, 91.11%) followed by Diabetes mellitus (DM) (n = 39; 86.67%). Steroids and oxygen usage were noted in 53.66% (n = 22) and 41.46% (n = 17) respectively. Among the 51 suspected cases of mucormycosis, 47 were supported by radiodiagnosis. Histopathology diagnosed the highest number of mucormycosis cases (n = 44; 97.78%), followed by KOH examination (n = 36; 80%) and Culture (n = 28; 62.22%). The most common species isolated from the tissue samples was Rhizopus species (n = 17; 60.71%), followed by Mucor species (n = 7; 25%). The mortality rate was 17.14%. CONCLUSION DM, Covid-19, and corticosteroids are the chief underlying risk factor for ROCM. Rhizopus spp. was the most dominant etiological agent. Early diagnosis and management with combined medical & surgical intervention have a better survival rate.
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Affiliation(s)
- Nazish Fatima
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Shariq Ahmed
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India.
| | - Mohammad Shameem
- Department of TB and Respiratory Disease, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Aftab Ahmed
- Department of Oto-Rhino-Laryngology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Wasil Hasan
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Parvez A Khan
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
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Coste A, Conrad A, Porcher R, Poirée S, Peterlin P, Defrance C, Letscher-Bru V, Morio F, Gastinne T, Bougnoux ME, Suarez F, Nevez G, Dupont D, Ader F, Halfon-Domenech C, Ducastelle-Leprêtre S, Botterel F, Millon L, Guillerm G, Ansart S, Boutoille D, Ledoux MP, Herbrecht JE, Robin C, Melica G, Danion F, Blanchard E, Paccoud O, Garcia-Hermoso D, Lortholary O, Herbrecht R, Lanternier F. Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases. Chest 2023; 164:1097-1107. [PMID: 37419276 DOI: 10.1016/j.chest.2023.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality. RESEARCH QUESTION Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient's underlying condition? STUDY DESIGN AND METHODS All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycologic evidence. Thoracic CT scans were reviewed centrally. RESULTS A total of 114 cases of PM were recorded, including 40% with disseminated forms. Main underlying conditions were hematologic malignancy (49%), allogeneic hematopoietic stem cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiologic presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum quantitative polymerase chain reaction (qPCR) was positive in 42 (79%) of 53 patients and BAL in 46 (50%) of 96 patients. Results of transthoracic lung biopsy were diagnostic in 8 (73%) of 11 patients with noncontributive BAL. Overall 90-day mortality was 59%. Patients with neutropenia more frequently displayed an angioinvasive presentation, including reversed halo sign and disseminated disease (P < .05). Serum qPCR was more contributive in patients with neutropenia (91% vs 62%; P = .02), and BAL was more contributive in patients without neutropenia (69% vs 41%; P = .02). Serum qPCR was more frequently positive in patients with a > 3 cm main lesion (91% vs 62%; P = .02). Overall, positive qPCR was associated with an early diagnosis (P = .03) and treatment onset (P = .01). INTERPRETATION Neutropenia and radiologic findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in patients with neutropenia and BAL examination in patients without neutropenia. Results of lung biopsies are highly contributive in cases of noncontributive BAL.
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Affiliation(s)
- Anne Coste
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - Anne Conrad
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Raphaël Porcher
- Centre d'Epidémiologie Clinique, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Sylvain Poirée
- Radiology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Pierre Peterlin
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Claire Defrance
- Radiology Department, Nantes University Hospital, Nantes, France
| | - Valérie Letscher-Bru
- Parasitology and Medical Mycology Laboratory, Strasbourg University Hospital, Strasbourg, France; Institut de Parasitologie et Pathologie Tropicale, UR 7292, Strasbourg University, Strasbourg, France
| | - Florent Morio
- Parasitology and Mycology Laboratory, Nantes University Hospital, Nantes, France; UR 1155 IICiMed, Nantes University, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie-Elisabeth Bougnoux
- Mycology and Parasitology Laboratory, Necker-Enfants Malades Hospital, AP-HP, Paris, France; Unité Biologie et Pathogénicité Fongiques, Institut Pasteur, Paris, France
| | - Felipe Suarez
- Hematology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Gilles Nevez
- Mycology and Parasitology Department, La Cavale Blanche University Hospital, Brest, France
| | - Damien Dupont
- Medical Mycology and Parasitology Department, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | | | | | - Françoise Botterel
- Mycology and Parasitology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA DYNAMYC 1380, Université Paris-Est Créteil, Créteil, France
| | - Laurence Millon
- Mycology and Parasitology Laboratory, Besançon University Hospital, Besançon, France; UMR 6249, CNRS Chrono-Environnement, Université de Bourgonne Franche-Comté, Besançon, France
| | - Gaelle Guillerm
- Hematology Department, Morvan Hospital, Brest University Hospital, Brest, France
| | - Séverine Ansart
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - David Boutoille
- Infectious Diseases Department, Nantes University Hospital, Nantes, France; Centre d'Investigation Clinique, INSERM 1413, Nantes University Hospital, Nantes, France
| | - Marie-Pierre Ledoux
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | | | - Christine Robin
- Hematology Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Giovanna Melica
- Infectious Diseases Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - François Danion
- Infectious Diseases Department, Strasbourg University Hospital, Strasbourg, France; UMR_S 1109, INSERM, ImmunoRhumatologie Moléculaire, Strasbourg University, Strasbourg, France
| | - Elodie Blanchard
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Paccoud
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Olivier Lortholary
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Raoul Herbrecht
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | - Fanny Lanternier
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.
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Rani Singh G, Azad S, Kumari M, Kumari S, Kumar S, Ahmed A. A Retrospective Observational Study on the Comparison of Different Diagnostic Modalities of Post-COVID Mucormycosis. Cureus 2023; 15:e48925. [PMID: 38106762 PMCID: PMC10725520 DOI: 10.7759/cureus.48925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Background Mucormycosis, attributed to a group of molds known as mucormycosis, is a rare yet life-threatening fungal infection often colloquially referred to as black fungus. While its incidence notably surged during the second wave of COVID-19 infections in India, it's essential to recognize that mucormycosis was a significant concern even before the advent of the pandemic. Understanding the prevalence and characteristics of this infection in the pre-COVID era provides a crucial context for evaluating its impact and dynamics during the pandemic. Multiple diagnostic methods, such as potassium hydroxide (KOH) mount, culture, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and histopathological examination (HPE), are available for identifying this lethal infection. The primary objective of this study is to ascertain the sensitivity of various diagnostic methods for mucormycosis and to analyze the comparative effectiveness of microbiological versus histopathological diagnoses. Methods We conducted a retrospective observational study spanning six months, from May 2021 to October 2021, encompassing all mucormycosis cases meeting the inclusion criteria and diagnosed via histopathological examination (HPE) in the departments of pathology and microbiology. Microbiological tests were performed prior to the histopathological examinations. Sensitivity was assessed through statistical analysis, and the relationship between microbiological and histopathological diagnoses was evaluated using the chi-square test. Results Biopsy samples of 77 patients were collected, comprising 56 male and 21 female patients. Regarding age distribution, most patients fell within the 41-60 age bracket, while the smallest proportion was over 60 years old. The sensitivity and specificity of histopathological diagnosis, confirmed with periodic acid-Schiff (PAS) and Grocott-Gomori's methenamine silver (GMS) staining, both recorded a flawless 100%. KOH mount sensitivity stood at 88.3%, while fungal culture and MALDI-TOF exhibited sensitivities of 75.3%. Histopathological analysis revealed that 17% of cases displayed minimal fungal hyphae alongside necrotic tissue, whereas 58% exhibited abundant fungal hyphae accompanied by inflammatory cells. Additionally, absolute neutrophilia was observed in 55% of cases. Conclusions In our study, histopathology and KOH mount emerged as not only compassionate but also cost-effective diagnostic tools for identifying mucormycosis. The economic aspect of these diagnostic methods is highlighted in the results section to provide a comprehensive understanding of their cost-effectiveness. Additionally, we utilized MALDI-TOF MS as a straightforward, economically viable, and expeditious method specifically for confirming the fungal subtype in mucormycosis cases. The rationale behind choosing either MALDI-TOF MS or KOH for the diagnosis is elucidated, contributing to a clearer interpretation of our diagnostic approach. Furthermore, our findings indicate that absolute neutrophilia consistently manifests in 55% of mucormycosis cases.
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Affiliation(s)
- Guddi Rani Singh
- Pathology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Shabana Azad
- Pathology, Homi Bhabha Cancer Hospital, Varanasi, IND
| | - Mamta Kumari
- Pathology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sweta Kumari
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sanjiv Kumar
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Ausaf Ahmed
- Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Singh A, Goel G, Khan M, Kanodia A, Sikka K, Thakar A. Factors affecting clinical outcome in COVID-associated rhino-orbito-cerebral mucormycosis (CAROM) patients-An ambispective, single-arm, observational study. Am J Otolaryngol 2023; 44:103975. [PMID: 37478538 DOI: 10.1016/j.amjoto.2023.103975] [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: 05/23/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND COVID-associated Rhino-Orbito-Cerebral Mucormycosis (CAROM) appeared as an epidemic in India during the second wave of the COVID-19 pandemic during the months of March to May 2021. Though many reports have highlighted cross sectional and short-term attributes related to CAROM, long term follow up data is sparse. OBJECTIVE This report aims to analyze the follow-up outcomes in consecutive patients presenting to us during the epidemic. PATIENTS AND METHODS This was an ambispective observational analytical study, recruiting the consecutive patients admitted to our tertiary care centre during the period of the CAROM epidemic. The mortality rate during the follow-up and various factors affecting survival were studied using univariable and multivariable statistics with the Stata 14.0 software. RESULTS Of the 189 patients studied, eight were lost to follow-up. The outcome analysis was performed for the 181 patients. 93.6 % (162/173) of the patients had diabetes. The All-cause mortality was 45 % (81/181), while the ROCM-specific mortality was found to be 24 % (46/181) at a median follow-up of 176 days (IQR: 21-217 days). With univariable analysis, increasing age, higher serum IL-6 levels, presence of additional comorbidities (in addition to Diabetes and hypertension), bilateral disease, skin necrosis, palatal involvement, infratemporal fossa involvement, and impaired vision/ocular movements were found to be associated with increased mortality. However, on multivariable analysis, only 1) increasing age, 2) raised serum IL-6 levels, and 3) bilateral disease were predictive of increased mortality. Surgical debridement (endoscopic, palatal removal, orbital exenteration, neurosurgical intervention) was associated with significantly reduced mortality on both univariable and multivariable analysis. CONCLUSION Our intermediate-term follow-up data showed advanced age at presentation, raised IL-6 levels, and bilateral sinonasal involvement to be predictive of increased mortality, while surgical debridement is significantly protective from mortality in CAROM patients.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Goel
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kanodia
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Thakar
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Wadhawan S, Kerai S, Husain F, Labani P, Agarwal M, Saxena KN. Post-COVID-19 mucormycosis: A prospective, observational study in patients undergoing surgical treatment. J Anaesthesiol Clin Pharmacol 2023; 39:587-595. [PMID: 38269161 PMCID: PMC10805215 DOI: 10.4103/joacp.joacp_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/22/2022] [Accepted: 05/28/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aims Post the second wave of COVID-19 in India, our institute became a dedicated center for managing COVID-19-associated mucormycosis (CAM), but there was a paucity of data regarding perioperative considerations in these patients. The objectives of present study was to describe the preoperative clinical profile, the perioperative complications and outcome of CAM patients undergoing urgent surgical debridement. Material and Methods This prospective observational study was conducted on CAM patients presenting for surgical debridement from July to September 2021. During preoperative visits, evaluation of extent of disease, any side effects of ongoing medical management and post-COVID-19 systemic sequalae were done. The details of anaesthetic management of these patients including airway management, intraoperative haemodynamic complications and need for perioperative blood transfusion were noted. Results One hundred twenty patients underwent surgical debridement; functional endoscopic sinus surgery (FESS) was carried out in 63% of patients, FESS with orbital exenteration in 17.5%, and maxillectomy in 12.5%. Diabetes mellitus was found in 70.8% and post-COVID new onset hyperglycemia in 29.1% of patients. Moderate-to-severe decline in post-COVID functional status (PCFS) scale was observed in 73.2% of patients, but with optimization, only 5.8% required ICU management. The concern during airway management was primarily difficulty in mask ventilation (17.5%). Intraoperatively, hemodynamic adverse events responded to conventional treatment for hypotension, judicious use of fluids and blood transfusion. Perioperatively, 10.8% of patients required blood transfusion and 4.2% of patients did not survive. Non-surviving patients were older, with a more aggressive involvement of CAM, and had comorbidities and a greater decline in functional capacity. Conclusion A majority of patients reported a moderate-to-severe decline in PCFS that required a preoperative multisystem optimization and a tailored anesthetic approach for a successful perioperative outcome.
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Affiliation(s)
- Sonia Wadhawan
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Farah Husain
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Preeti Labani
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Munisha Agarwal
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Kirti N. Saxena
- Department of Anaesthesiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Kumari K, Rathod D, Meshram T, Mohammed S, Raju S, Sharma A, Chaudhary B, Bhatia P. Perioperative anesthesia challenges and outcomes of patients with Rhino-Orbito-Cerebral Mucormycosis during the second wave of COVID-19 pandemic: An observational study. J Anaesthesiol Clin Pharmacol 2023; 39:615-621. [PMID: 38269163 PMCID: PMC10805186 DOI: 10.4103/joacp.joacp_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aims A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients. Material and Methods This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted. Results The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%). Conclusion Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality.
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Affiliation(s)
- Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Darshana Rathod
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Tanvi Meshram
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sachith Raju
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bikram Chaudhary
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Saud B, Chand K, Amatya N, Paudel G, Adhikari S, Shrestha V. Factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. Access Microbiol 2023; 5:000495.v4. [PMID: 37841102 PMCID: PMC10569662 DOI: 10.1099/acmi.0.000495.v4] [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: 09/13/2022] [Accepted: 08/11/2023] [Indexed: 10/17/2023] Open
Abstract
This study was conducted to assess factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. A total of 800 swab samples from 200 participants including 100 diabetics and 100 non-diabetics were collected from four different body sites: (1) the forehead, (2) nasal cavity, (3) hands and (4) feet. Fungal isolation, fungal identification and antibiotic sensitivity tests were performed on the isolates. Overall, 12.0 % of the participants showed Mucormycetes colonization while the commonest fungal isolates were Mucor Species (Spp.). followed by Rhizopus spp. Diabetics had a 11 times higher odds of colonization compared to non-diabetics. The majority of the isolates were resistant to itraconazole; however, all isolates were sensitive to amphotericin B. A significant association was observed between profession and Mucormycetes (P=0.03) with significantly higher colonization in retired people compared to business people. Higher odds of colonization were demonstrated among older ages, lower class status and individuals with prolonged contact time with soil.
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Affiliation(s)
- Bhuvan Saud
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Kajal Chand
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Neetu Amatya
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Govinda Paudel
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Saroj Adhikari
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Vikram Shrestha
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
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Cumpa-Quiroz R, Elguera-Falcón F, Guevara-Lazo DR. Emergence of Rhino-Orbito-Cerebral Mucormycosis in Peru: Impact of the COVID-19 Pandemic. Cureus 2023; 15:e45240. [PMID: 37842460 PMCID: PMC10576593 DOI: 10.7759/cureus.45240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Mucormycosis is an invasive fungal infection caused by Mucorales that has been increasingly recognized over the years, particularly during the COVID-19 pandemic. Nevertheless, in Peru, there has been limited research on this disease. This study seeks to provide insights into the demographics, clinical presentations, treatment, and outcomes of patients with mucormycosis, before and during the COVID-19 pandemic. Materials and methods We conducted a retrospective case series by reviewing the medical records of Peruvian patients hospitalized at a referral medical center between 2017 and 2021. The selection criteria included patients aged 18 years or older with clinical features of rhino-orbito-cerebral mucormycosis supported by radiological imaging. We extracted data related to risk factors for mucormycosis infection, clinical presentation, management, and hospitalization. Data analysis was performed using Stata software (StataCorp LLC, College Station, Texas, USA) to compare patient groups before and during the COVID-19 pandemic. Results Nineteen cases met our selection criteria: 11 men and eight women with an average age of 57.6 ± 10.6 years. All 19 patients had type 2 diabetes mellitus as comorbidity, with 13 cases exhibiting uncontrolled diabetes. Six patients presented before the COVID-19 pandemic, while 13 during its course. Within the group of patients diagnosed during the pandemic, nine were diagnosed with SARS-CoV-2 infection. Regarding the site of mucormycosis infection, the paranasal sinuses were predominantly involved. Survival analysis indicated that patients who developed mucormycosis during the COVID-19 pandemic, those with uncontrolled diabetes, or those who did not undergo surgery had lower probabilities of survival. Conclusion Mucormycosis is a rare infection associated with high mortality and morbidity with increased frequency during the COVID-19 pandemic. Early diagnosis, timely administration of antifungal treatment, surgery, and effective management of comorbidities can have life-saving implications. Unfortunately, despite the availability of various diagnostic tests and less toxic antifungal options such as liposomal amphotericin-B, such resources are not accessible in Peru's national hospitals.
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Affiliation(s)
- Robert Cumpa-Quiroz
- Department of Internal Medicine, Hospital Nacional Arzobispo Loayza, Lima, PER
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Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
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G V, T R, A R, A SP. Traumatic mucormycosis caused by Apophysomyces species - A case series. J Orthop 2023; 42:13-16. [PMID: 37408564 PMCID: PMC10318445 DOI: 10.1016/j.jor.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Background Apophysomyces species are emerging as the second most common agent of mucormycosis in India. It is worrisome as it affects predominantly immunocompetent host unlike other Mucorales. Unfortunately, the most common presentation is necrotising fasciitis which can be overlooked as bacterial infection. Results Seven cases of mucormycosis due to Apophysomyces species were detected in our hospital between January 2019 and September 2022. Mean age was 55 years and all were males. Six patients presented with necrotising soft tissue infection following accidental or iatrogenic trauma. In four cases, multiple fractures over the body were observed. Median days between admission to laboratory diagnosis was 9 days. All isolates were phenotypically identified as Apophysomyces variabilis. Multiple wound debridements, on an average two, was performed in all the cases and amputation performed in two patients. Three patients recovered, two could not be treated due to financial constraints and lost to followup and two patients died. Conclusion Through this series, we anticipate to upheave awareness among the orthopedician community about this emerging infection and contemplate it in appropriate case settings. All patients with necrotising soft tissue infection following trauma and significant degree of wound contamination with soil should be suspected for traumatic mucormycosis at the time of wound assessment.
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Affiliation(s)
- Vithiya G
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Rajendran T
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Ramesh A
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Sathesini Priya A
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India
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Pandya HB, Bhad KM, Patel VR, Diwan SR, Dave HM. Rehabilitation of Acquired Maxillary and Mandibular Defects Secondary to Mucormycosis - A Case Series. Ann Maxillofac Surg 2023; 13:228-231. [PMID: 38405574 PMCID: PMC10883218 DOI: 10.4103/ams.ams_79_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale To suggest a directing algorithm for rehabilitative management of complex soft and hard tissue defects due to mucormycosis. Patient Concerns An utmost need for surgical, reconstructive and rehabilitative options; functional, aesthetic, acceptable to the patient and enduring rehabilitation. Diagnosis Different cases of rhinomaxillary mucormycosis pertaining to the facial skeleton, diagnosed with the help of radiographic as well as fungal cultures. Treatment Thorough medical assessment, and antifungal prescription; followed by surgical resection of the affected areas, rigorous follow-up scheme and later rehabilitation with the help of implants and immediate loading. Outcomes Regular follow-ups for at least one year and successful rehabilitation providing acceptable functional outcomes. Take-away Lessons Unconventional pathologies like rhinomaxillary mucormycosis infecting the jaws require novel, unprecedented and elaborate procedures both surgical and reconstructive based on sound scientific principles. There must be a vision for the rehabilitation of such cases right from the commencement of the surgical treatment.
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Affiliation(s)
- Haren B. Pandya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Kaustubh M. Bhad
- Department of Oral and Maxillofacial Surgery, AMC Dental College, Ahmedabad, Gujarat, India
| | - Vimesh R. Patel
- Department of Oral and Maxillofacial Surgery, Karnavati School of Dentistry, Ahmedabad, Gujarat, India
| | - Shaswat R. Diwan
- Department of Oral and Maxillofacial Surgery, Sparshh and Diwasha Maxillofacial Centre, Ahmedabad, Gujarat, India
| | - Harsh Manoj Dave
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India
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Yong JY, Chong KL, Gan WF, Zaidan NZ. Mucormycosis: A Case Series. Cureus 2023; 15:e41375. [PMID: 37546065 PMCID: PMC10400303 DOI: 10.7759/cureus.41375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Mucormycosis is a potentially life-threatening invasive fungal infection caused by diverse fungal organisms in the order Mucorales. Traditional risk factors of mucormycosis include poorly controlled diabetes, hematological malignancies such as leukemia and lymphoma, and post-transplant patients, with rhino-orbito-cerebral and pulmonary mucormycosis as common manifestations. We report four cases of mucormycosis precipitated by classical as well as atypical risk factors, with common sites of infection such as pulmonary and rhino-orbital to rare manifestations such as peritoneal mucormycosis. Diagnoses were confirmed by either a histopathological sample or a positive culture. Only one patient had concomitant positive culture and histopathology results. Low culture positivity rate has delayed the diagnosis of two cases. First-line antifungal therapy was limited to amphotericin B deoxycholate in three cases due to financial cost, but all patients responded to the treatment. There were two mortalities, but both were unrelated to disease progression. All cases had source control done, except for the patient with pulmonary mucormycosis, due to poor lung reserve which refrained him from surgery. With emerging evidence of local therapies for endobronchial lesions, they potentially serve as an alternative for patients who are not suitable for operation. This case series also aims to contribute to the local epidemiology of mucormycosis, highlights the importance of early diagnosis, and draws attention from stakeholders to the challenges faced in managing this life-threatening infection.
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Affiliation(s)
- Jo Yen Yong
- Infectious Diseases, Hospital Melaka, Melaka, MYS
| | | | - Wee Fu Gan
- Infectious Diseases, Hospital Melaka, Melaka, MYS
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Rudramurthy SM, Singh S, Kanaujia R, Chaudhary H, Muthu V, Panda N, Pandey A, Thakur S, Kaur H, Ghosh A, Agarwal R, Chakrabarti A. Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus. Emerg Infect Dis 2023; 29:1313-1322. [PMID: 37347535 PMCID: PMC10310386 DOI: 10.3201/eid2907.221491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02-0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03-16], itraconazole [0.03-16], posaconazole [0.03-8], and isavuconazole [0.03-16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus.
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Affiliation(s)
| | | | - Rimjhim Kanaujia
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Valliappan Muthu
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Pandey
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetal Thakur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimran Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Ghosh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kumari R, Talawar P, Tripaty DK, Singla D, Kaushal A, Sharma S, Malhotra M, Boruah P, Sangadala P, Kumar KS. A Retrospective Study to Evaluate the Perioperative Clinical Characteristics and Outcomes of Rhino-Orbital Cerebral Mucormycosis in COVID-19 Patients at a Tertiary Care Hospital in India. Cureus 2023; 15:e41613. [PMID: 37565105 PMCID: PMC10410089 DOI: 10.7759/cureus.41613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background and aims A descriptive analysis of patients who underwent surgical debridement for coronavirus disease 2019 (COVID-19) related mucormycosis was described, which aimed at the evaluation of perioperative clinical characteristics, perioperative complications, and outcomes. Methods We conducted a retrospective study on patients who underwent surgical intervention for mucormycosis during the COVID-19 pandemic at a tertiary care institute in India from March 1, 2021, to June 30, 2021. The medical records of 92 patients were reviewed and analyzed. Results There was a male predominance with a mean age of 50.86 years. The most common comorbidity was diabetes mellitus (DM) (98.9%). Intra-operative complications included hypotension, hyperglycemia, and hypokalemia. Most of the patients (88%) were extubated inside the operation theater, and 48% of patients had mortality. Serum ferritin levels, computed tomography severity score (CTSS), and D-dimers were significantly high in the patient who had mortality. Conclusion The perioperative mortality in patients with COVID-19 associated mucormycosis was very high. DM was the most common comorbidity followed by hypertension. Pre-operative elevated serum ferritin, D-dimer, and high CTSS were associated with higher mortality; hypokalemia, followed by hypocalcemia, was the most common perioperative and post-operative electrolyte imbalance. Thorough pre-operative optimization, multidisciplinary involvement, and perioperative care are of the utmost importance to decrease mortality and improve outcomes.
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Affiliation(s)
- Rekha Kumari
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Praveen Talawar
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Debendra K Tripaty
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Deepak Singla
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ashutosh Kaushal
- Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sameer Sharma
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Manu Malhotra
- Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Priyanka Boruah
- Anaesthesiology, State Cancer Institute, Guwahati, Guwahati, IND
| | - Priyanka Sangadala
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Karthikeyan S Kumar
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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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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Farooq S, Khan NA, Singh A, Khan A, Sharma P, Meena R, Jakhar A, Kumar M, Kochar A. Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe. Cureus 2023; 15:e41010. [PMID: 37519583 PMCID: PMC10372466 DOI: 10.7759/cureus.41010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.
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Affiliation(s)
- Shaheen Farooq
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Nabab A Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ajeet Singh
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Arif Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Preeti Sharma
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ritu Meena
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ankita Jakhar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Mukesh Kumar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Anju Kochar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
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Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
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Sahni D, Singh P, kaur R, Aggarwal S, kaur A. Rising Incidence of Post Covid Rhinocerebral Mucormycosis: An Otolaryngologists Prospective. Indian J Otolaryngol Head Neck Surg 2023:1-9. [PMID: 37362131 PMCID: PMC10226435 DOI: 10.1007/s12070-023-03886-z] [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: 11/06/2021] [Accepted: 11/28/2021] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis or grimmer popular name, "black fungus" has evolved public concern in context of covid-19 pandemic, Covid Associated Mucormycosis (CAM) seen in Covid-19 pandemic and as a post covid sequelae. The present study was conducted to find out the incidence of the Mucormycosis, and to study its association with post-covid status and co-morbidities. A retrospective study conducted at tertiary care centre over a period of four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease. 59 patients had CAM, 47 patients had rhino-orbital Mucormycosis, followed by nasal and paranasal Mucormycosis in 8 patients, 3 patients with rhino-orbital-cerebral Mucormycosis, and one patient with pulmonary Mucormycosis. Diabetes mellitus was present in all 59 patients, 60.41% who had HbA1c > 10 (range 7-15), and 39.58% had HbA1c < 10 with range 6-13. Only 8.33% had controlled diabetes status, uncontroled hypertension and diabetes was seen in 34.02%. All patients were started with IV amphotericin B anti-fungal drug, and followed by oral posaconazole. Depending upon the extent of the disease surgical debridement was done in 52 patients. All patients had history of steroid intake. 7 mortality was there. Uncontrolled diabetes, over-zealous use of steroids, uncontrolled underlying primary disease or co-morbidities, prolonged hospitalization in intensive care unit or normal wards, and hyperventilation all these factors together aggravated the CAM. So it's proper management based on, prompt diagnosis, reversal of predisposing condition with proper medical and aggressive surgical debridement remain the corner stone for this deadly CAM.
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Affiliation(s)
- Dimple Sahni
- Department of Otorhinolaryngology, Government Medical College and Hospital Patiala, Government Flat-13, Opposite Medical College, New Lal Bhagh, Patiala, Punjab 147001 India
| | - Parvinder Singh
- Department of Otorhinolaryngology, Government Medical College and Hospital Patiala, Government Flat-13, Opposite Medical College, New Lal Bhagh, Patiala, Punjab 147001 India
| | - Rajwant kaur
- Department of Otorhinolaryngology, Government Medical College and Hospital Patiala, Government Flat-13, Opposite Medical College, New Lal Bhagh, Patiala, Punjab 147001 India
| | - Sangeeta Aggarwal
- Department of Otorhinolaryngology, Government Medical College and Hospital Patiala, Government Flat-13, Opposite Medical College, New Lal Bhagh, Patiala, Punjab 147001 India
| | - Amandeep kaur
- Department of Otorhinolaryngology, Government Medical College and Hospital Patiala, Government Flat-13, Opposite Medical College, New Lal Bhagh, Patiala, Punjab 147001 India
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Singh SI, Shah AK, Singh MK, Sonnahalli NK. Simplified Zygomatic Implant Perforated (Zip) Flap for Rehabilitation in Low Level Maxillary Defects. J Maxillofac Oral Surg 2023:1-8. [PMID: 37362872 PMCID: PMC10221744 DOI: 10.1007/s12663-023-01935-2] [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: 10/22/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Rehabilitation in Low level maxillectomy cases has plethora of options right from local flaps to microvascular flaps. Subsequent to flap surgery, a maxillary dental rehabilitation can be demanding and a fixed or removable prosthesis is obligatory to provide them with near-normal function and aesthetics. Unlike the original ZIP flaps which were dedicated to microvascular flaps, we present here our unique experience with ZIP-Temporalis flap specifically for rehabilitation for patients of CAM (covid associated mucormycosis), its methods, advantages and limitations.
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Affiliation(s)
- Swathi Iyengar Singh
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Anjan Kumar Shah
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Manish Kumar Singh
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Nithin Kumar Sonnahalli
- Manaswa Facial Surgery & Dental Implant Center, 16, Shambala, 8th Main, 9th Cross, Malleshwaram, Bangalore, 560003 India
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Tayabali K, Pothiwalla H, Narayanan S. Epidemiology of COVID-19-Associated Mucormycosis. CURRENT FUNGAL INFECTION REPORTS 2023; 17:1-20. [PMID: 37360859 PMCID: PMC10155162 DOI: 10.1007/s12281-023-00464-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
Purpose of the Review To describe the epidemiology and risk factors for Coronavirus disease-19 (COVID-19)-associated mucormycosis (CAM) based on current published literature. Recent Findings COVID-19 is associated with an increased risk of secondary infections. Mucormycosis is an uncommon invasive fungal infection that typically affects people with immunocompromising conditions and uncontrolled diabetes. Treatment of mucormycosis is challenging and is associated with high mortality even with standard care. During the second wave of the COVID 19 pandemic, an abnormally high number of CAM cases were seen particularly in India. Several case series have attempted to describe the risk factors for CAM. Summary A common risk profile identified for CAM includes uncontrolled diabetes and treatment with steroids. COVID-19-induced immune dysregulation as well as some unique pandemic specific risk factors may have played a role.
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Affiliation(s)
- Khadija Tayabali
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
| | | | - Shivakumar Narayanan
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
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Goel K, Dhillon J, Yadav V, Bhagat S, Aggarwal A. Post-Covid Isolated Mandibular Mucormycosis in a Patient with Chronic Kidney Disease: A Case Report. Indian J Otolaryngol Head Neck Surg 2023:1-6. [PMID: 37362119 PMCID: PMC10148609 DOI: 10.1007/s12070-023-03838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is an opportunistic fungal infection which was earlier seen only in immunocompromised patients. With the recent covid pandemic, there had been a drastic surge in cases of mucormycosis worldwide and especially in India. Here, we present an unusual case of biopsy proven invasive mandibular mucormycosis in a patient with chronic kidney disease and a history of COVID-19 infection. The patient was given low-dose amphotericin B and underwent surgical debridement with a successful outcome.
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Affiliation(s)
- Khushboo Goel
- Department of Otorhinolaryngology and Head & Neck Surgery, Government Medical College, Patiala, Punjab India
| | | | - Vishav Yadav
- Department of Otorhinolaryngology and Head & Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Sanjeev Bhagat
- Department of Otorhinolaryngology and Head & Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Ankita Aggarwal
- Department of Otorhinolaryngology and Head & Neck Surgery, Government Medical College, Patiala, Punjab India
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Singh S, Kanaujia R, Kumar MB, Naga Santhosh Irrinki RN, Satish SN, Choudhary H, Kaur H, Rudramurthy SM. Saksenaea vasiformis infection: Extensive abdominal wall necrotizing fasciitis with systematic review and analysis of 65 cases. Mycoses 2023. [PMID: 37095628 DOI: 10.1111/myc.13592] [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: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Saksenaea vasiformis is a rarely reported Mucorales causing mucormycosis in both immunocompromised and immunocompetent individuals. Due to few reported cases, the clinical characteristics and optimal management strategy for this rare agent are not clearly described. METHODS We systematically reviewed Medline, EmBase and CINHAL for studies on S. vasiformis infections reported until 1 January 2022 and 57 studies (63 patients) were retrieved. Additionally, one more case of extensive abdominal wall necrotizing fasciitis managed by our team was also included. The clinical and demographic characteristics and outcomes were extracted and analysed. RESULTS Out of the 65 included cases, the majority were reported from India (26.6%). The most common risk factors for infection were accidental trauma wounds (31.3%), health-care-related wounds (14.1%) and animal/insect bites (12.5%). Most common clinical presentation was subcutaneous mucormycosis (60.9%) followed by rhino-orbito cerebral mucormycosis (14%), necrotizing fasciitis (10%), disseminated infection (9.3%), pulmonary mucormycosis (3.2%) and osteomyelitis (1.6%). Mortality was observed in 24 (37.5%) patients and health care related injuries were significantly associated with higher mortality (p = .001). The use of posaconazole (p = .019) and the use of surgical management (p = .032) was associated with significantly better survival. DISCUSSION In this study, we describe the largest compendium of mucormycosis due to S. vasiformis, which can be useful in increasing awareness regarding this rare Mucorales and guiding patient management.
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Affiliation(s)
- Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mani Bhushan Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R N Naga Santhosh Irrinki
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S N Satish
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Taneja J, Chatterjee K, Sachdeva RA, Abbas SZ, Sen M. Rhizopus homothallicus, an emerging pathogen causing cavitary lung lesions. Access Microbiol 2023; 5:000526.v3. [PMID: 37223060 PMCID: PMC10202401 DOI: 10.1099/acmi.0.000526.v3] [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: 11/28/2022] [Accepted: 02/21/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Rhizopus homothallicus is an emerging pathogen that causes pulmonary mucormycosis. Case Presentation We report a case of pneumonia caused by R. homothallicus in a 54-year-old type 2 diabetic patient. The organism was isolated from bronchoalveolar lavage fluid and preliminarily identified by fungal morphology and finally by sequencing of the internal transcribed spacer region. Conclusion Mucormycosis may be associated with cavitary lung lesions against a backdrop of poorly controlled diabetes or other immunosuppressed states. Pulmonary mucormycosis may have variable clinical and radiological presentations. Therefore, strong clinical suspicion and prompt management can address the high fatality associated with the disease.
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Affiliation(s)
- Juhi Taneja
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Kuhu Chatterjee
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ruchi Arora Sachdeva
- Department of Respiratory Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - S. Zafar Abbas
- Department of Radiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - M.K. Sen
- Department of Respiratory Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
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