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Pannu S, Exline MC, Bednash JS, Englert JA, Diaz P, Bartlett A, Brock G, Wu Q, Davis IC, Crouser ED. SCARLET (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial): study protocol for a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 trial of i.v. citicoline (CDP-choline) in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure. Trials 2024; 25:328. [PMID: 38760804 PMCID: PMC11102211 DOI: 10.1186/s13063-024-08155-0] [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: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior studies showed that post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline, which is an essential precursor for de novo phosphatidylcholine synthesis, improved gas exchange and reduced pulmonary inflammation without altering viral replication. In unpublished studies, we found that treatment of SARS CoV-2-infected K18-hACE2-transgenic mice with CDP-choline prevented development of hypoxemia. We hypothesize that administration of citicoline (the pharmaceutical form of CDP-choline) will be safe in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure (HARF) and that we will obtain preliminary evidence of clinical benefit to support a larger Phase 3 trial using one or more citicoline doses. METHODS We will conduct a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 dose-ranging and safety study of Somazina® citicoline solution for injection in consented adults of any sex, gender, age, or ethnicity hospitalized for SARS CoV-2-associated HARF. The trial is named "SCARLET" (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial). We hypothesize that SCARLET will show that i.v. citicoline is safe at one or more of three doses (0.5, 2.5, or 5 mg/kg, every 12 h for 5 days) in hospitalized SARS CoV-2-infected patients with HARF (20 per dose) and provide preliminary evidence that i.v. citicoline improves pulmonary outcomes in this population. The primary efficacy outcome will be the SpO2:FiO2 ratio on study day 3. Exploratory outcomes include Sequential Organ Failure Assessment (SOFA) scores, dead space ventilation index, and lung compliance. Citicoline effects on a panel of COVID-relevant lung and blood biomarkers will also be determined. DISCUSSION Citicoline has many characteristics that would be advantageous to any candidate COVID-19 therapeutic, including safety, low-cost, favorable chemical characteristics, and potentially pathogen-agnostic efficacy. Successful demonstration that citicoline is beneficial in severely ill patients with SARS CoV-2-induced HARF could transform management of severely ill COVID patients. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov on 5/31/2023 (NCT05881135). TRIAL STATUS Currently enrolling.
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Affiliation(s)
- Sonal Pannu
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Matthew C Exline
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph S Bednash
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joshua A Englert
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Philip Diaz
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy Bartlett
- Center for Clinical and Translational Sciences, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Qing Wu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Ian C Davis
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
| | - Elliott D Crouser
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Lax C, Nicolás FE, Navarro E, Garre V. Molecular mechanisms that govern infection and antifungal resistance in Mucorales. Microbiol Mol Biol Rev 2024; 88:e0018822. [PMID: 38445820 PMCID: PMC10966947 DOI: 10.1128/mmbr.00188-22] [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] [Indexed: 03/07/2024] Open
Abstract
SUMMARYThe World Health Organization has established a fungal priority pathogens list that includes species critical or highly important to human health. Among them is the order Mucorales, a fungal group comprising at least 39 species responsible for the life-threatening infection known as mucormycosis. Despite the continuous rise in cases and the poor prognosis due to innate resistance to most antifungal drugs used in the clinic, Mucorales has received limited attention, partly because of the difficulties in performing genetic manipulations. The COVID-19 pandemic has further escalated cases, with some patients experiencing the COVID-19-associated mucormycosis, highlighting the urgent need to increase knowledge about these fungi. This review addresses significant challenges in treating the disease, including delayed and poor diagnosis, the lack of accurate global incidence estimation, and the limited treatment options. Furthermore, it focuses on the most recent discoveries regarding the mechanisms and genes involved in the development of the disease, antifungal resistance, and the host defense response. Substantial advancements have been made in identifying key fungal genes responsible for invasion and tissue damage, host receptors exploited by the fungus to invade tissues, and mechanisms of antifungal resistance. This knowledge is expected to pave the way for the development of new antifungals to combat mucormycosis. In addition, we anticipate significant progress in characterizing Mucorales biology, particularly the mechanisms involved in pathogenesis and antifungal resistance, with the possibilities offered by CRISPR-Cas9 technology for genetic manipulation of the previously intractable Mucorales species.
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Affiliation(s)
- Carlos Lax
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Francisco E. Nicolás
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Eusebio Navarro
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Victoriano Garre
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
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Mojtahedi SS, Zarrinfar H, Bakhshaee M. Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2024; 36:399-405. [PMID: 38476561 PMCID: PMC10925964 DOI: 10.22038/ijorl.2024.75276.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/18/2024] [Indexed: 03/14/2024]
Abstract
Introduction Rhinosinusitis mucormycosis (RM) is an invasive opportunistic fungal infection, especially among COVID-19 patients. The current study aimed to assess the peripheral blood hematological disorders of COVID-19 patients-associated RM. Materials and Methods During ten month, in two COVID-19 centers in Mashhad, Iran, from June 2021 to March 2022, eighty-three patients suspected of COVID-19 with rhinosinusitis or rhino-orbital mucormycosis participated in this study. The hematological indices of these patients were measured by independent sample T-test or Mann-Whitney test for quantitative data, and the qualitative variables were analyzed using Chi-square or Fisher's exact test in SPSS version 20 at a significance level of 0.05. Results Of the COVID-19 patients, 40 (48.2%) were affected by RM, and leukocytosis due to neutrophilia was observed in 30% of them. Leukocyte counts were normal in 10 (25%) patients, but 1 (2.5%) and 3 (7.5%) had leukopenia and lymphopenia, respectively. Leukocytosis plus lymphopenia was observed in 7 (17.5%) patients. Also, the synchronicity of leukopenia and lymphopenia was seen in 5 (12.5%) patients. Leukopenia, lymphopenia, and neutropenia have occurred concurrently in 2 (5%) patients. The complete blood count (CBC) showed that RBCs, hemoglobin (Hb), hematocrit (HCT), MCH, MCHC, platelet (PLT), and lymphocytes decreased while neutrophils increased. Conclusion Among the hematological parameters, leukocytosis due to neutrophilia and reduction in Hb, HCT, and PLT are more dominant factors in COVID-19 patients-associated RM.
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Affiliation(s)
- Seyedeh Sabereh Mojtahedi
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences Mashhad Iran.
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Zhou Y. Survival of a Rhino-Orbital-Cerebral Mucormycosis Patient after Localized Combination Liposomal Amphotericin B Medications: A Case Report. Case Rep Ophthalmol 2024; 15:122-128. [PMID: 38322311 PMCID: PMC10846874 DOI: 10.1159/000536185] [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: 07/13/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction The aim of this study was to report a case of ROCM related to nasogastric intubation who was survived by liposomal amphotericin B (LAmB) combination therapy in situ without orbital exenteration. Case Presentation A 44-year-old woman presented with a 1-week history of rapidly enlarging swelling on the right nose, cheek, and lower eyelid after underwent gastrointestinal decompression. The lesions were derived from the nasal area where the nasogastric tube had been placed. Based on the biopsy results and clinical manifestations, ROCM was diagnosed. Immediate combination therapy with intravenous LAmB and micafungin and multisection debridement of the right facial region were applied. Postoperative treatment included cleaning, irrigating, and local dressing of the wound area using LAmB. LAmB was also used daily as binocular eye drops against deep infection on the eyeballs. The patient recovered well 4 months later and remained free of disease after 40 months of follow-up. Conclusion This case adds to our knowledge on the potential risk of nasogastric intubation for mucormycosis infection. Nasogastric tube may be the source of infection associated with ROCM. This report evaluates the beneficial effect of LAmB combination therapy in situ for cleaning, irrigating, local wound dressing, and eye drops on lesion areas. The combination of LAmB as cleaning, irrigating, local dressing solution, and eye drops to control intraocular and intraorbital ROCM infection has not been previously reported to our knowledge. These methods provide multiple choices to substitute for orbital exenteration on the survival of ROCM patients.
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Affiliation(s)
- Yang Zhou
- Department of Ophthalmology, Qingdao Qingda Zhengda Guangming Eye Hospital, Zhengda Guangming Eye Group, Qingdao, China
- Zhengda Guangming International Eye Research Center, Qingdao University, Qingdao, China
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Smirnov AV, Ermilov VV, Sasin AN, Grigor'eva NV, Poplavskiy AE, Chernetsky OA, Blokhina SV, Grableva VS, Barkanova ON, Gurov DY, Ermilova IV, Poplavskaya AA. [Fatal case of rhinocerebral mucormycosis on the background of type II diabetes mellitus]. Arkh Patol 2024; 86:52-58. [PMID: 38881006 DOI: 10.17116/patol20248603152] [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: 06/18/2024]
Abstract
Mucormycosis is a disease caused by fungi of the Mucorales family, widespread in the environment, with pronounced angiotropism and the ability to angioinvasion, leading to thrombosis with surrounding necrosis. The main triggers for the development of mucormycosis are: immunodeficiency states, use of glucocorticosteroid drugs, decompensation of diabetes mellitus, concomitant diseases, age > 65 years. We present a clinical case of rhinocerebral mucormycosis in a 79-year-old patient against the background of uncontrolled type 2 diabetes mellitus with ketoacidosis, a condition after previous glucocorticosteroid therapy for COVID-19 (according to the severity of the disease). After suffering a new coronavirus infection caused by the SARS-CoV-2 virus, she was admitted to the hospital with complaints characteristic of mucormycosis. On the 5th day of hospital stay, the patient's condition worsened significantly, despite the correction of the therapy, and on the 12th day the patient died. According to the results of the autopsy, it was established that the rhinocerebral mucormycosis was complicated by thrombosis of the anterior and posterior left cerebral arteries with subsequent infarctions in the frontal lobe and parieto-occipital region of the brain left hemisphere, cerebral edema, which was the immediate cause of death.
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Affiliation(s)
- A V Smirnov
- Volgograd State Medical University, Volgograd, Russia
- Volgograd Medical Research Center, Volgograd, Russia
| | - V V Ermilov
- Volgograd State Medical University, Volgograd, Russia
| | - A N Sasin
- Volgograd State Medical University, Volgograd, Russia
| | | | - A E Poplavskiy
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - O A Chernetsky
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - S V Blokhina
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - V S Grableva
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - O N Barkanova
- Volgograd State Medical University, Volgograd, Russia
| | - D Yu Gurov
- Volgograd State Medical University, Volgograd, Russia
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Juyal D, Pal S, Negi N, Singh M, Kumar M, Singhal S. Coronavirus disease (COVID-19)-associated mucormycosis (CAM): The unholy triad of COVID-19, diabetes mellitus, and corticosteroid therapy. J Family Med Prim Care 2023; 12:2538-2541. [PMID: 38186842 PMCID: PMC10771147 DOI: 10.4103/jfmpc.jfmpc_1130_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/05/2023] [Accepted: 09/02/2023] [Indexed: 01/09/2024] Open
Abstract
The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.
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Affiliation(s)
- Deepak Juyal
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
| | - Shekhar Pal
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
- Viral Research and Diagnostic Laboratory, Departments of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
| | - Nidhi Negi
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
| | - Minakshi Singh
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
| | - Manish Kumar
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
| | - Shweta Singhal
- Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, Uttarakhand, India
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Tran E, Phu V, Xu R, Teoderascu A, Aly M, Shah N, Malvankar-Mehta MS. Ocular manifestations of COVID-19: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00248-X. [PMID: 37683691 DOI: 10.1016/j.jcjo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Our study aims to build on our understanding of COVID-19 by detailing a comprehensive look at the prevalence of different ocular manifestations related to COVID-19 infection. DESIGN Systematic review and meta-analysis. METHODS Eligible studies published between June 20, 2021, and May 11, 2023, were retrieved from the MEDLINE, EMBASE, and CINAHL databases as well as grey literature. Covidence was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, a risk-of-bias assessment was carried out. Data were extracted, and a meta-analysis was performed using STATA 14.0. Fixed-effects and random-effects models were computed based on heterogeneity. RESULTS Our meta-analysis included 43 articles with a total of 10,572 subjects. The results showed that COVID-19 patients had a significantly higher prevalence of conjunctivitis (effect size [ES] = 0.11; 95% CI, 0.07-0.15), ptosis (ES = 0.22; 95% CI, 0.15-0.30), and ophthalmoplegia (ES = 0.40; 95% CI, 0.06-0.74). Our results also indicate that COVID-19 patients have higher prevalence of cotton wool spots (ES = 0.06; 95% CI, 0.03-0.09), retinal hemorrhages (ES = 0.12; 95% CI, 0.06-0.18), and retinal vein tortuosity (ES = 0.19; 95% CI, 0.09-0.35). CONCLUSION COVID-19 can exhibit extrapulmonary manifestations, affecting both the anterior and posterior segments of the eye. Common anterior-segment findings include conjunctivitis, whereas posterior-segment findings may include cotton wool spots, retinal hemorrhages, and retinal vein tortuosity. Improving our understanding of the ocular manifestations of COVID-19 has the potential to facilitate quicker diagnosis and subsequent treatment.
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Affiliation(s)
- Edward Tran
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Vivian Phu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Riley Xu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Angela Teoderascu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Mohamed Aly
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Nirmit Shah
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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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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Arora P, Kaur G, Tyagi N, Nair MK. Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus. Proc AMIA Symp 2023; 36:389-391. [PMID: 37091750 PMCID: PMC10120457 DOI: 10.1080/08998280.2023.2177081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained much attention in the post-COVID era. The elucidation of invasive fungal sinusitis with osteomyelitis as a rare aggressive infection that requires prompt diagnosis and treatment to prevent fatal consequences has been noteworthy. Cone-beam computed tomography findings in those patients are central to early diagnosis and management. Here we report a case of post-COVID mucormycosis with osteomyelitis of the maxilla in a 72-year-old woman with a history of recently diagnosed diabetes mellitus.
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Affiliation(s)
- Pallak Arora
- Department of Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, Texas A&M University College of Dentistry, Dallas, Texas
| | - Geetpriya Kaur
- Department of Oral Pathology, Institute of Dental Studies and Technology (IDST), Ghaziabad, India
| | - Nutan Tyagi
- Department of Oral Pathology, Institute of Dental Studies and Technology (IDST), Ghaziabad, India
| | - Madhu K. Nair
- Department of Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, Texas A&M University College of Dentistry, Dallas, Texas
- Baylor University Medical Center, Dallas, Texas
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Vasanthapuram VH, Gupta R, Adulkar N, Nair AG, Bradoo RA, Hegde R, Singh U, Tadepalli S, Mukherjee B, Kamal S, Alam MS, Rao R, Ananthakrishna S, Backiavathy V, Murthy AK, D'Cunha L, Dudeja G, Joji A, Kiran A, Koka K, Goswami Mukhopadhyay M, Nisar SP, Rao PR, Shinde CA. A fungal epidemic amidst a viral pandemic: Risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis in India. Orbit 2023; 42:30-41. [PMID: 35192435 DOI: 10.1080/01676830.2021.2020851] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. METHODS Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. RESULTS There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. CONCLUSION Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.
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Affiliation(s)
| | - Roshmi Gupta
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Namrata Adulkar
- Orbit & Oculoplasty Services, Sunayan Eye Care and Aesthetic Clinic, Pune, India
| | - Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital & institute, Advanced Eye Hospital & Institute, Navi Mumbai India.,Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Renuka A Bradoo
- Department of ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Raghuraj Hegde
- Orbit, Ophthalmic Plastic Surgery & Ophthalmic Oncology Service, Department of Ophthalmology, Manipal Hospital, Bangalore, India
| | - Usha Singh
- Department of Ophthalmic Plastic Surgery, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Sameeksha Tadepalli
- Department of Ophthalmic Plastic Surgery, Advanced Eye Centre, PGIMER, Chandigarh, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Saurabh Kamal
- Orbit & Oculoplasty Services, EYEHUB, Faridabad, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Raksha Rao
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | | | - Varsha Backiavathy
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | | | - Lynn D'Cunha
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Gagan Dudeja
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Annie Joji
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Anjali Kiran
- Ophthalmic Plastic Surgery Services, Narayana Nethralaya, Bangalore, India
| | - Kirti Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | | | - Sonam Poonam Nisar
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Priyanka R Rao
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
| | - Chhaya A Shinde
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
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Pei YC, Huang GH, Liu GL, Xiang Y, Yang L, Lv SQ, Liu J. Case Report: An Intracranial Aspergillus Infection with Cyst Formation. Brain Sci 2023; 13:brainsci13020239. [PMID: 36831782 PMCID: PMC9953761 DOI: 10.3390/brainsci13020239] [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: 11/24/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Intracranial fungal infection is a rare condition that often requires surgical intervention. In this study, we present a case of intracranial fungal infection with a space-occupying effect and a long medical history of five years. We comprehensively evaluated the medical history, symptoms, imaging manifestations, and pathological examinations of the patient to confirm this rare case of fungal infection with cyst formation. Moreover, we reviewed the literature on intracranial fungal infection, hoping to draw awareness and attention to this rare disease.
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Affiliation(s)
| | | | | | | | | | | | - Jun Liu
- Correspondence: ; Tel.: +86-23-6877-4910
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12
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Nahaei M, Motazedian G, Mohammadi AA, Davarpanah MA, Yazdanpanahi P, Ayareh N, Salari F, Keshtkar A. Evaluation of Clinical Manifestations, Pattern of Involvement, and Surgical Outcomes in Patients with Post Covid-19 Head and Neck Mucormycosis Infection among Patients Admitted To Namazi Hospital, Shiraz, Iran (2021-2022). World J Plast Surg 2023; 12:64-72. [PMID: 38226199 PMCID: PMC10788107 DOI: 10.61186/wjps.12.3.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background COVID-19, caused by SARS-CoV-2, is a global pandemic that particularly affects immunocompromised individuals, leading to secondary bacterial and fungal infections. Mucormycosis, caused by Mucorales fungi, is a severe infection primarily affecting immunocompromised individuals. The COVID-19 pandemic has seen a surge in mucormycosis cases worldwide, with India experiencing a significant increase. Various factors, including diabetes mellitus, contribute to the risk of mucormycosis. This study investigated head and neck mucormycosis in patients with prior COVID-19 infection. Methods Data from 45 patients were analyzed, with diabetes being the most common risk factor. Visual symptoms, ethmoid bone involvement, and orbital bone involvement were also identified as significant factors. Results The COVID-19 pandemic has led to an increase in mucormycosis cases, particularly in the head and neck region, with high mortality. Successful management involves addressing underlying factors, surgical debridement, and antifungal therapy. Conclusion Timely debridement reduces morbidity and mortality.
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Affiliation(s)
- Mehryar Nahaei
- Department of Plastic and Reconstructive Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Motazedian
- Burn and Wound Healing Research Centre, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Akbar Mohammadi
- Burn and Wound Healing Research Centre, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Parsa Yazdanpanahi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Ayareh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Salari
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz Univ-ersity of Medical Sciences, Shiraz, Iran
| | - Alireza Keshtkar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Samir A, Abdel-Gawad MS, Elabd AM, Abed WM, Mahmoud A, Gaweesh TY, Youssef A. Early CT and MRI signs of invasive fungal sinusitis complicating COVID-19 infection: case report. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC8800432 DOI: 10.1186/s43163-022-00206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Corticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19). Despite their importance to decrease patients’ mortality, they can cause serious side effects like fulminant fungal infection that can damage lungs or invade the sinuses then rapidly spread to the orbit and even intra-cranially. Unless early diagnosed and properly managed, patients can lose their vision or die from cavernous sinus thrombosis or other intracranial complications. Case presentation A 71-year-old diabetic male patient presented with dry cough, fever, and dyspnea for 6 days. PCR test for COVID-19 was ordered and declared positive. The oxygen saturation on day 7 started to decline to reach 90%. Eight ampules of intra-muscular dexamethasone were prescribed. The patient’s dyspnea improved, and the oxygen saturation reached 94% by day 13. Oral prednisone was prescribed in a withdrawal protocol. Unfortunately, on day 15, the patient complained of mild left-sided cheek swelling and noticeably dropped left angle of mouth. Neurological consultation suspected facial palsy and asked for brain MRI examination. Limited lower cuts of the MRI study that covered the left maxillary antrum revealed mild fullness of the pre-maxillary fat planes with mucosal thickening. Complimentary dedicated MRI and CT cuts over the left maxillary sinus showed localized signs of invasive fungal sinusitis without orbital or intracranial complications. The patient received antifungal therapy even before evident endoscopic findings appeared. He underwent endoscopic debridement few days after and he had an excellent outcome without any progression or significant morbidities. Conclusion Early CT/MRI radiological signs of invasive fungal sinusitis that complicated COVID-19 infection aid in the diagnosis and proper timely management of this fatal disease.
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14
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Ripa M, Motta L, Schipa C, Rizzo S, Sollazzi L, Aceto P. “Vision Loss” and COVID-19 Infection: A Systematic Review and Meta-Analysis. Vision (Basel) 2022; 6:vision6040060. [PMID: 36278672 PMCID: PMC9589937 DOI: 10.3390/vision6040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Visual impairment in terms of reduced visual acuity and “visual loss” has been reported as an atypical symptom in patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This systematic review and meta-analysis aims to assess the cumulative incidence of “visual loss” during coronavirus disease 2019 (COVID-19) and review the current evidence regarding “visual loss” caused by SARS-CoV-2 infection. Methods: We performed a systematic review and meta-analysis of studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched the PubMed, Embase, and Scopus databases for relevant studies published that clearly described “vision loss” and SARS-CoV-2 infection. All studies reporting concomitant “vision loss” and laboratory-confirmed SARS-CoV-2 infection were included. Meta-analyses were conducted using the measurement of risk and a 95% confidence interval for each study. Results: Our search identified 1143 manuscripts published in the English language. After study screening, twenty-nine articles were selected: two cross-sectional studies, twenty-four case reports, and three case series. A random-effect meta-analysis demonstrated that the pooled “visual loss” cumulative incidence in COVID-19 patients was 0.16 (95% CI 0.12–0.21). The quality rating of the cross-sectional studies averaged four out of the maximum score on the Newcastle–Ottawa scale. Conclusions: COVID-19 infection might cause “visual loss”. Even if the current evidence is limited, ophthalmological assessment should be promptly provided to all patients experiencing visual impairment symptoms during SARS-CoV-2 infection.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, 56127 Pisa, Italy
| | - Liliana Sollazzi
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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15
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Alkhamiss AS, Ahmed AA, Rasheed Z, Alghsham R, Shariq A, Alsaeed T, Althwab SA, Alsagaby S, Aljohani ASM, Alhumaydhi FA, Alduraibi SK, Alduraibi AK, Alhomaidan HT, Allemailem KS, Alharbi RA, Alamro SA, Alqusayer AM, Alharbi SA, Alharby TA, Almujaydil MS, Mousa AM, Alghaniam SA, Alghunaim AA, Alghamdi R, Fernández N, Al Abdulmonem W. Mucormycosis co-infection in COVID-19 patients: An update. Open Life Sci 2022; 17:917-937. [PMID: 36045713 PMCID: PMC9372758 DOI: 10.1515/biol-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.
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Affiliation(s)
- Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmed A Ahmed
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ruqaih Alghsham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Departments of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thamir Alsaeed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sami A Althwab
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Suliman Alsagaby
- Department of Medical Laboratories Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Raya A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Samar A Alamro
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Arwa M Alqusayer
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sahim A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thekra A Alharby
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Mona S Almujaydil
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ayman M Mousa
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sultan A Alghaniam
- Department of Clinical Nutrition, Qassim Health Affairs, Ministry of Health, Buraidah, Saudi Arabia
| | | | - Rana Alghamdi
- Department of Chemistry, Science and Arts College, Rabigh Campus, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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16
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Baral PK, Aziz MA, Islam MS. Comparative risk assessment of COVID‐19 associated mucormycosis and aspergillosis: A systematic review. Health Sci Rep 2022; 5:e789. [PMID: 36000078 PMCID: PMC9387898 DOI: 10.1002/hsr2.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID‐19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID‐19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA‐associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South‐European and West‐European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre‐existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one‐fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.
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Affiliation(s)
- Prodip Kumar Baral
- Department of Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
| | - Md. Abdul Aziz
- Department of Pharmacy State University of Bangladesh Dhaka Bangladesh
| | - Mohammad Safiqul Islam
- Department of Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
- Laboratory of Pharmacogenomics and Molecular Biology Noakhali Science and Technology University Noakhali Bangladesh
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17
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Ghasemi S, Dashti M, Fahimipour A, Daryakenari G, Mirzaei F, Akbari F, Khurshid Z. Onset of Mucormycosis in Patients with COVID-19: A Systematic Review on Patients' Characteristics. Eur J Dent 2022; 17:24-38. [PMID: 36049777 PMCID: PMC9949939 DOI: 10.1055/s-0042-1751003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Mucormycosis has a significant impact on patients' standard of living and, therefore, a high clinical suspicion, prediagnosis, and rapid treatment are critical in easing patients' suffering and fast recovery. Our focus is to conduct an organized review based on various variables on the patients' characteristics having mucormycosis in severe novel coronavirus disease 2019 (COVID-19). We examined Embase, PubMed-Medline, LitCovid, Web of Science, Scopus, and the reference lists of included case reports up to September 20, 2021, using the Medical Subject Heading (MeSH) phrases and other keywords related to this topic. Subsequently, we investigated associated comorbidities, patient characteristics, position of mucormycosis, steroids use, body involvements, and outcomes. Overall, 77 studies were conducted and among these, 72 studies mentioned that the patients' age to be 48.13±14.33 (mean±standard deviation [SD]) years. Diabetes mellitus (DM) was reported in 77.9% (n=60) of cases. Studies showed that central nervous system (CNS) and bone involvement were reported in 62.3 (n=48) and 53.2% (n=41), respectively. More fatalities were observed in patients with mucormycosis with the active form of COVID-19. Also, men infected with mucormycosis significantly affected by COVID-19. In the end, mortality was higher in males with mucormycosis. As a result, a solid investigation into the root cause of mucormycosis, especially in COVID-19, should be included in the study plan. If the patient is COVID-19-positive and immunosuppressed, this opportunistic pathogen diagnostic test should not be overlooked.
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Affiliation(s)
- Shohreh Ghasemi
- Department of Oral and Maxillofacial Surgery, The Dental College of Georgia at Augusta University, Augusta, GA, USA,Department of Craniofacial Reconstruction and Trauma Queen Marry, University of London, London, UK
| | - Mahmood Dashti
- Department of Orthodontics, Georgia School of Orthodontics, Atlanta, Georgia, USA,Address for correspondence Mahmood Dashti, DDS Department of Orthodontics, Georgia School of OrthodonticsAtlanta, GeorgiaUSA
| | - Amir Fahimipour
- Department of Oral Surgery, Medicine and Diagnostics, School of Dentistry, Faculty of Medicine and Health, Westmead Centre for Oral Health, The University of Sydney, Sydney, Australia
| | - Ghazaleh Daryakenari
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Mirzaei
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Akbari
- Department of Dentistry, Mazandaran University of Medical Science, Mazandaran, Iran
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
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18
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Saadi MHG, Hosseini SA, Khodamoradi Z, Mokhtaryan M, Omidifar N, Moghadami M. Comparison of mucormycosis infection between patients with and without a history of COVID-19 infection: a retrospective cohort study. Trans R Soc Trop Med Hyg 2022; 117:174-178. [PMID: 36001888 PMCID: PMC9452119 DOI: 10.1093/trstmh/trac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/30/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mucormycosis infection is a complication seen in some coronavirus disease 2019 (COVID-19) patients. This study compares the characteristics of mucormycosis infection between COVID-19 and non-COVID-19 patients. METHODS This retrospective cohort comprised 87 patients with mucormycosis divided into two groups. The first included 44 patients who had COVID-19 recently before hospitalization due to mucormycosis at Namazi Hospital, Shiraz, Iran, between February 2019 and August 2021. The second group included all 43 patients hospitalized at the same hospital due to mucormycosis between 2010 and 2019 (pre-pandemic). RESULTS Mucormycosis patients with a history of recent COVID-19 infection had a higher rate of diabetes mellitus, fewer malignancies and higher blood glucose, erythrocyte sedimentation rate and C-reactive protein levels (p<0.05). Glucocorticoid use was common (77%) in the COVID-19 group. CONCLUSIONS In the pre-COVID-19 era, mucormycosis mainly affected immunodeficient patients like those receiving chemotherapy due to malignancy but now seems to affect COVID-19 patients with uncontrolled blood glucose and glucocorticoids use. Special care must be taken in prescribing glucocorticoids and controlling the blood glucose levels of COVID-19 patients.
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Affiliation(s)
| | | | - Zohre Khodamoradi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Mokhtaryan
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Omidifar
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Mortality-Related Risk Factors for Coronavirus Disease (COVID-19)-Associated Mucormycosis: a systematic review and meta-analysis. CURRENT FUNGAL INFECTION REPORTS 2022; 16:143-153. [PMID: 35971380 PMCID: PMC9366801 DOI: 10.1007/s12281-022-00440-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 12/12/2022]
Abstract
Purpose of Review Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a serious public health concern, particularly in developing countries. This meta-analysis aims to identify the risk factors that affect the mortality rate of patients with CAM. Recent Findings We systematically searched PubMed, Google Scholar, Scopus, Cochrane library, and preprint databases using pertinent keywords and the reference lists of the included relevant articles from inception till October 27, 2021. In order to reduce the effects of small-scale studies, we only selected cross-sectional, case–control, and cohort studies and case series with at least four patients. We identified 26 articles that included 821 patients with CAM. The effect size (ES) of mortality rate was 28% (95% confidence interval (CI) 20%–38%; I2 =82.28%; p for Cochran Q<0.001). The CAM patients with a history of comorbidities other than diabetes (malignancies, transplant, or renal failure), mechanical ventilation due to COVID-19, pulmonary and cerebral mucormycosis, and those who only received medical treatment for mucormycosis had the highest mortality rate. Summary Coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a major public health problem, particularly in developing countries. Severe COVID-19 infection, history of mechanical ventilation, early CAM, comorbidities other than diabetes (malignancies, transplant, or renal failure), pulmonary and rhino-orbito-cerebral mucormycosis, and delivering only medical treatment for mucormycosis were the worst prognostic factors in CAM patients. Identifying the mortality-related risk factors in CAM patients may help reduce the mortality rate by implementing optimized treatment approaches. Supplementary Information The online version contains supplementary material available at 10.1007/s12281-022-00440-2.
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20
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COVID-19-Associated Mucormycosis: A Matter of Concern Amid the SARS-CoV-2 Pandemic. Vaccines (Basel) 2022; 10:vaccines10081266. [PMID: 36016154 PMCID: PMC9415927 DOI: 10.3390/vaccines10081266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/16/2022] Open
Abstract
Mucormycosis is an invasive fungal infection caused by fungi belonging to order Mucorales. Recently, with the increase in COVID-19 infections, mucormycosis infections have become a matter of concern globally, because of the high morbidity and mortality rates associated with them. Due to the association of mucormycosis with COVID-19 disease, it has been termed COVID-19-associated mucormycosis (CAM). In the present review, we focus on mucormycosis incidence, pathophysiology, risk factors, immune dysfunction, interactions of Mucorales with endothelial cells, and the possible role of iron in Mucorales growth. We review the limitations associated with current diagnostic procedures and the requirement for more specific, cost-effective, convenient, and sensitive assays, such as PCR-based assays and monoclonal antibody-based assays for the effective diagnosis of mucormycosis. We discuss the current treatment options involving antifungal drug therapies, adjunctive therapy, surgical treatment, and their limitations. We also review the importance of nutraceuticals-based therapy for the prevention as well as treatment of mucormycosis. Our review also highlights the need to explore the potential of novel immunotherapeutics, which include antibody-based therapy, cytokine-based therapy, and combination/synergistic antifungal therapy, as treatment options for mucormycosis. In summary, this review provides a complete overview of COVID-19-associated mucormycosis, addressing the current research gaps and future developments required in the field.
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21
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Sengupta I, Nayak T. Coincidence or reality behind Mucormycosis, diabetes mellitus and Covid-19 association: A systematic review. J Mycol Med 2022; 32:101257. [PMID: 35219907 PMCID: PMC8855615 DOI: 10.1016/j.mycmed.2022.101257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
Abstract
Mucormycosis is a rare but life-threatening disease with high morbidity and mortality and is difficult to diagnose. Mucormycosis, is a severe but rare fungal infection caused by a group of molds called mucormycetes. Diabetes, use of corticosteroids, metabolic/diabetic acidosis and Covid-19 mediated immunosuppression are reported in more than 70% of cases in mucormycosis patients. Coexisting mucormycosis, Covid-19 along with diabetes mellitus increase the likelihood of mortality. Despite its occurrence since the beginning of the pandemic, there are still unanswered concerns regarding the origin of this fungal infection and mortality rate and/or relation with diabetic patients. In this review, we describe the detailed view of causative pathogens responsible for mucormycosis, diabetes mellitus and Covid-19 association along with the morbidity cases during the latest Covid-19 crisis. In the case of mucormycosis diagnosis, imaging, histopathological confirmation, fungal culture and molecular identification methods should be considered. Once mucormycosis is diagnosed, a combined treating method consisting of antifungals administration like amphotericin B, surgical intervention is needed for the reversal of the underlying condition. Early detection of this potentially life-threatening infection and timely care is needed in lowering mortality rates.
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Affiliation(s)
- Indraneel Sengupta
- Department of Life Science and Biotechnology, Jadavpur University, Kolkata 700032, India
| | - Tilak Nayak
- Department of Life Science and Biotechnology, Jadavpur University, Kolkata 700032, India.
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22
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Seyedjavadi SS, Bagheri P, Nasiri MJ, Razzaghi-Abyaneh M, Goudarzi M. Fungal Infection in Co-infected Patients With COVID-19: An Overview of Case Reports/Case Series and Systematic Review. Front Microbiol 2022; 13:888452. [PMID: 35875562 PMCID: PMC9298665 DOI: 10.3389/fmicb.2022.888452] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Fungal co-infections are frequent in patients with coronavirus disease 2019 (COVID-19) and can affect patient outcomes and hamper therapeutic efforts. Nonetheless, few studies have investigated fungal co-infections in this population. This study was performed to assess the rate of fungal co-infection in patients with COVID-19 as a systematic review. EMBASE, MEDLINE, and Web of Science were searched considering broad-based search criteria associated with COVID-19 and fungal co-infection. We included case reports and case series studies, published in the English language from January 1, 2020 to November 30, 2021, that reported clinical features, diagnosis, and outcomes of fungal co-infection in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Totally, 54 case reports and 17 case series were identified, and 181 patients (132 men, 47 women, and 2 not mentioned) co-infected with COVID-19 and fungal infection enrolled. The frequency of fungal co-infection among patients with COVID-19 was 49.7, 23.2, 19.8, 6.6, and 0.5% in Asia, America, Europe, Africa, and Australia, respectively. Diabetes (59.6%) and hypertension (35.9%) were found as the most considered comorbidities in COVID-19 patients with fungal infections. These patients mainly suffered from fever (40.8%), cough (30.3%), and dyspnea (23.7%). The most frequent findings in the laboratory results of patients and increase in C-reactive protein (CRP) (33.1%) and ferritin (18.2%), and lymphopenia (16%) were reported. The most common etiological agents of fungal infections were Aspergillus spp., Mucor spp., Rhizopus spp., and Candida spp. reported in study patients. The mortality rate was 54.6%, and the rate of discharged patients was 45.3%. Remdesivir and voriconazole were the most commonly used antiviral and antifungal agents for the treatment of patients. The global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 54.6% of COVID-19 patients with fungal co-infections died. Thus, this study indicated that fungal co-infection and COVID-19 could increase mortality. Targeted policies should be considered to address this raised risk in the current pandemic. In addition, fungal infections are sometimes diagnosed late in patients with COVID-19, and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with fungal infections should be screened regularly during the COVID-19 pandemic to prevent the spread of the COVID-19 patients with fungal co-infection.
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Affiliation(s)
| | - Parmida Bagheri
- Department of Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives. J Clin Med 2022; 11:jcm11133620. [PMID: 35806905 PMCID: PMC9267579 DOI: 10.3390/jcm11133620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.
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24
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Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha) 2022; 67:363-387. [PMID: 35220559 PMCID: PMC8881997 DOI: 10.1007/s12223-021-00934-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
Mucormycosis is a deadly opportunistic disease caused by a group of fungus named mucormycetes. Fungal spores are normally present in the environment and the immune system of the body prevents them from causing disease in a healthy immunocompetent individual. But when the defense mechanism of the body is compromised such as in the patients of diabetes mellites, neustropenia, organ transplantation recipients, and other immune-compromised states, these fungal spores invade our defense mechanism easily causing a severe systemic infection with approximately 45-80% of case fatality. In the present scenario, during the COVID-19 pandemic, patients are on immunosuppressive drugs, glucocorticoids, thus are at high risk of mucormycosis. Patients with diabetes mellitus are further getting a high chance of infection. Usually, the spores gain entry through our respiratory tract affecting the lungs and paranasal sinuses. Besides, they can also enter through damage into the skin or through the gastrointestinal route. This review article presents the current statistics, the causes of this infection in the human body, and its diagnosis with available recent therapies through recent databases collected from several clinics and agencies. The diagnosis and identification of the infection were made possible through various latest medical techniques such as computed tomography scans, direct microscopic observations, MALDI-TOF mass spectrometry, serology, molecular assay, and histopathology. Mucormycosis is so uncommon, no randomized controlled treatment studies have been conducted. The newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate) may be beneficial in patients who are refractory to or intolerant of Liposomal Amphotericin B. but due to lack of early diagnosis and aggressive surgical debridement or excision, the mortality rate remains high. In the course of COVID-19 treatments, there must be more vigilance and alertness are required from clinicians to evaluate these invasive fungal infections.
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Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India
| | - Anjana Goel
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India.
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25
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García-Carnero LC, Mora-Montes HM. Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis. J Fungi (Basel) 2022; 8:jof8050445. [PMID: 35628701 PMCID: PMC9144279 DOI: 10.3390/jof8050445] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
The ongoing COVID-19 pandemic has quickly become a health threat worldwide, with high mortality and morbidity among patients with comorbidities. This viral infection promotes the perfect setting in patients for the development of opportunistic infections, such as those caused by fungi. Mucormycosis, a rare but deadly fungal infection, has recently increased its incidence, especially in endemic areas, since the onset of the pandemic. COVID-19-associated mucormycosis is an important complication of the pandemic because it is a mycosis hard to diagnose and treat, causing concern among COVID-19-infected patients and even in the already recovered population. The risk factors for the development of mucormycosis in these patients are related to the damage caused by the SARS-CoV-2 itself, the patient’s overstimulated immune response, and the therapy used to treat COVID-19, causing alterations such as hyperglycemia, acidosis, endothelial and lung damage, and immunosuppression. In this review, the molecular aspects of mucormycosis and the main risk factors for the development of COVID-19-associated mucormycosis are explained to understand this virus–fungi–host interaction and highlight the importance of this neglected mycosis.
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Affiliation(s)
| | - Héctor M. Mora-Montes
- Correspondence: (L.C.G.-C.); (H.M.M.-M.); Tel.: +52-473-7320006 (ext. 8193) (H.M.M.-M.)
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26
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Molaei H, Shojaeefar E, Nemati E, Khedmat L, Mojtahedi SY, Jonaidi Jafari N, Izadi M, Einollahi B. Iranian patients co-infected with COVID-19 and mucormycosis: the most common predisposing factor, clinical outcomes, laboratory markers and diagnosis, and drug therapies. Infect Dis (Lond) 2022; 54:600-613. [PMID: 35389322 DOI: 10.1080/23744235.2022.2058604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The newly emerged pandemic of coronavirus disease-2019 (COVID-19) is the world's main health challenge because infected patients become vulnerable to a variety of opportunistic diseases. OBJECTIVE This study aimed to assess clinical outcomes, diagnosis, utilized drug therapies, and ongoing COVID-19 practices in Iranian cases co-infected with COVID-19 and mucormycosis. PARTICIPANTS AND METHODS A case-series analysis was conducted in the presence of 10 patients with COVID-19 and mucormycosis co-infection (two men and eight women; mean age of 48.8 years) from March to October 2020. Demographic variables, signs/symptoms, and comorbidities of all patients were recorded. COVID-19 was confirmed with reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab tests and high-resolution computed tomography (HR-CT)_ scans. RESULTS All patients had a positive RT-PCR for SARS-CoV-2. Eight patients had a history of diabetes, while three of them exhibited a hypertension history. Remarkable laboratory findings were elevated fasting blood sugar in 6 cases and anaemia in four patients. A rhino-orbital-cerebral of mucormycosis in all patients was detected based on HR-CT scans and otorhinolaryngological or ophthalmological examinations. Neurological disorders including facial, trigeminal, optic, and oculomotor nerve involvement resulted in paraesthesia, pain, ptosis, no light perception, blurred vision, and papilledema in five cases. Maxillary and ethmoid sinuses were the most common sites of involvement. CONCLUSION Vulnerable COVID-19 patients with comorbidities, any facial involvements, or treated by excessive doses of glucocorticoids and antibiotics should undergo precise examinations during the appearance of early signs and hospitalization to diagnose and treat mucormycosis using the standard care and antifungal treatments.
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Affiliation(s)
- Hamideh Molaei
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ehsan Shojaeefar
- Immunology Board for Transplantation and Advanced Cellular Therapeutics (ImmunoTACT), Universal Scientific and Education Network (USERN), Tehran, Iran
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nematollah Jonaidi Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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27
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Genetic Manipulation in Mucorales and New Developments to Study Mucormycosis. Int J Mol Sci 2022; 23:ijms23073454. [PMID: 35408814 PMCID: PMC8998210 DOI: 10.3390/ijms23073454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
The study of the Mucoralean fungi physiology is a neglected field that the lack of effective genetic tools has hampered in the past. However, the emerging fungal infection caused by these fungi, known as mucormycosis, has prompted many researchers to study the pathogenic potential of Mucorales. The main reasons for this current attraction to study mucormycosis are its high lethality, the lack of effective antifungal drugs, and its recent increased incidence. The most contemporary example of the emergence character of mucormycosis is the epidemics declared in several Asian countries as a direct consequence of the COVID-19 pandemic. Fortunately, this pressure to understand mucormycosis and develop new treatment strategies has encouraged the blossoming of new genetic techniques and methodologies. This review describes the history of genetic manipulation in Mucorales, highlighting the development of methods and how they allowed the main genetic studies in these fungi. Moreover, we have emphasized the recent development of new genetic models to study mucormycosis, a landmark in the field that will configure future research related to this disease.
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28
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An overview of COVID-19 related to fungal infections: what do we know after the first year of pandemic? Braz J Microbiol 2022; 53:759-775. [PMID: 35315001 PMCID: PMC8936386 DOI: 10.1007/s42770-022-00704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
In 2019, severe acute respiratory syndrome caused by CoV-2 virus became a pandemic worldwide, being the fast spread of the disease due to the movement of infected people from one country to another, from one continent to another, or within the same country. Associated comorbidities are important factors that predispose to any fungal coinfections. Because of the importance of fungal infections in COVID-19 patients, the aim of this work was to collect data of the more encountered mycoses related to patients undergoing this disease. Aspergillosis was the first COVID-19-related fungal infection reported, being A. fumigatus the most frequent species for CAPA. Other fungal infections related include mainly candidiasis and mucormycosis, being Rhizopus spp. the more prevalent species found. Influenza-associated pulmonary aspergillosis is well documented; thus, similar complications are expected in severe forms of COVID-19 pneumonia. Therefore, in patients with COVID-19, it is important to take special attention to the surveillance and suspicion of fungal coinfections that might worsen the patient's prognosis.
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29
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Samaranayake LP, Fakhruddin KS, Ngo HC, Bandara MHMN, Leung YY. Oro-facial Mycoses in Coronavirus Disease-2019 (COVID-19): A Systematic Review. Int Dent J 2022; 72:607-620. [PMID: 35367044 PMCID: PMC8885299 DOI: 10.1016/j.identj.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022] Open
Abstract
Objectives Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we review the major oral and maxillofacial mycoses of COVID-19, the associated comorbidities, and the probable precipitating factors. Methods English-language manuscripts published between March 2020 and October 2021 were searched using PubMed, OVID, SCOPUS, and Web of Science databases, using appropriate keywords. Results We identified 30 articles across 14 countries, which met the inclusion criteria of PRISMA guidelines. These yielded a total of 292 patients with laboratory-confirmed COVID-19, 51.4% (n = 150) of whom presented with oral and maxillofacial fungal infections, mainly comprising candidosis, mucormycosis, and aspergillosis. Candida infections were the most prevalent, present in 64% (n = 96), followed by mucormycosis, and only a single case of aspergillosis was noted. Oral and maxillofacial mycoses were predominantly seen in those with comorbidities, especially in those with diabetes (52.4%). Oral mucormycosis was noted in 8.6% (n = 13) and mainly manifested on the hard palate. An overall event rate of oral/maxillofacial mucormycosis manifestation in patients with COVID-19 with diabetes mellitus type 1/2 was about 94% (49/52; 95% confidence interval, 0.73%-0.89%), implying a very high association between diabetes mellitus and the latter condition. All fungal infections appeared either concurrently with COVID-19 symptoms or during the immediate recovery period. Conclusions SARS-CoV-2 infection–related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.
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30
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Kandasamy S, Muthuraju S, Vasugi A, Chandrasekar M, Murugan R, Inbasekaran P, R P. Clinicopathological Study of Mucormycosis in COVID-19 Patients: Experience From a Tertiary Care Center in South India. Cureus 2022; 14:e23016. [PMID: 35419223 PMCID: PMC8994129 DOI: 10.7759/cureus.23016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19. Materials and Methods: All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide. Results: Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 46 patients in reverse transcription polymerase chain reaction (RT-PCR) with high-resolution computed tomography (HRCT) Chest changes noted in 54 patients. Associated comorbidities were noted in 52 patients, with uncontrolled diabetes mellitus (46 patients; 88%) being the most common. Location was commonly in nasal and paranasal sinuses (43%), followed by orbital (2%), cerebral (10%) and pulmonary (8%) areas. Among the paranasal sinuses, the maxillary sinus was commonly involved. Mixed fungal infections (Aspergillus sp. and Candida sp.) were noted in eight (14%) cases. Oxygen therapy was given in 85% of cases; 30% of cases needed ventilator support; corticosteroid therapy was initiated in 49 patients, tocilizumab in six patients as treatment for mucormycosis. Amphotericin B was administered in 59% of patients based on clinical findings alone. After histopathological confirmation, 90% of them received amphotericin. Functional endoscopic sinus surgery (FESS) was done in 96% of cases, among them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management. Conclusion: Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.
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Affiliation(s)
- Sangeetha Kandasamy
- Pathology, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, IND
| | | | - Arumugam Vasugi
- Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, IND
| | - Megala Chandrasekar
- Pathology, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, IND
| | - Roopmala Murugan
- Pathology, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, IND
| | - Poovizhi Inbasekaran
- Pathology, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, IND
| | - Prabu R
- General Internal Medicine, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, IND
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31
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Hamed H, Madia R, Ladadweh H, Falana H, AbuKhalil AD. Fatal Mucormycosis Post COVID-19 Infection in Uncontrolled Diabetes with Misuse of Glucocorticoids and Antibiotics. Infect Drug Resist 2022; 15:1121-1126. [PMID: 35330787 PMCID: PMC8939863 DOI: 10.2147/idr.s356465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Mucormycosis is a fulminant and rapidly progressing fungal infection associated with a high mortality rate. Mucormycosis is primarily seen in immunocompromised patients, especially those with uncontrolled diabetes mellitus (DM), and recently in coronavirus disease 2019 (COVID-19) patients. Case Presentation In this case report, we present a rare case of fatal mucormycosis in Palestine. A 34-year-old Palestinian female patient presented to the emergency department one-month post-COVID-19 infection with left facial pain. During her hospital stay, she deteriorated, with a random blood sugar level of 400 mg/dl and a hemoglobin A1c of 18% with metabolic acidosis and the appearance of swelling and black eschar on her left side of her face. Finally, she was diagnosed with mucormycosis and expired two days later. Conclusion In this unfortunate case report of mucormycosis, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection, delayed diagnosis, misuse of corticosteroids, inappropriate use of antibiotics, and uncontrolled diabetes with ketoacidosis contributed to patient mortality and fatality. Therefore, appropriate patient assessment, rapid diagnosis, and selection of appropriate treatment are important and lifesaving.
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Affiliation(s)
- Heba Hamed
- Palestine Medical Complex, Ministry of Health, Ramallah, Palestine
| | - Raed Madia
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
| | - Hosniyeh Ladadweh
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
- Correspondence: Hosniyeh Ladadweh, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine, Tel +972592060838, Fax +970-2-2982017, Email
| | - Hiba Falana
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
| | - Abdallah Damin AbuKhalil
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
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SeyedAlinaghi S, Karimi A, Barzegary A, Pashaei Z, Afsahi AM, Alilou S, Janfaza N, Shojaei A, Afroughi F, Mohammadi P, Soleimani Y, Nazarian N, Amiri A, Tantuoyir MM, Oliaei S, Mehraeen E, Dadras O. Mucormycosis infection in patients with
COVID
‐19: A systematic review. Health Sci Rep 2022; 5:e529. [PMID: 35252593 PMCID: PMC8885749 DOI: 10.1002/hsr2.529] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Several reports previously described mucormycosis co‐infection in patients with COVID‐19. As mucormycosis and COVID‐19 co‐infection might adversely affect patients' outcomes, we aimed to systematically review the related evidence and the subsequent outcomes. Methods We conducted a systematic review of relevant articles searching the keywords in the online databases of PubMed, Scopus, Embase, Cochrane, and Web of Science. All the records from the start of the pandemic until June 12th, 2021 underwent title/abstract and then full‐text screening process, and the eligible studies were included. We did not include any language or time restrictions for the included studies. Results We found 31 eligible studies reporting 144 total cases of COVID‐19 and mucormycosis co‐infection. The nose, cranial sinuses, and orbital cavity were the most commonly involved organs, although the cerebrum, lungs, and heart were also involved in the studies. Pre‐existing diabetes mellitus (DM), as well as corticosteroid use, were the most commonly identified risk factors, but other underlying conditions and immunomodulatory drug use were also present in several cases. Aspergillus was the most commonly reported micro‐organism that caused further co‐infections in patients with concurrent COVID‐19 and mucormycosis. As most of the studies were case reports, no reliable estimate of the mortality rate could be made, but overall, 33.6% of the studied cases died. Conclusion Early diagnosis of mucormycosis co‐infection in COVID‐19 patients and selecting the right treatment plan could be a challenge for physicians. Patients with underlying co‐morbidities, immunocompromised patients, and those receiving corticosteroids are at higher risk of developing mucormycosis co‐infection and it is crucial to have an eye examination for early signs and symptoms suggesting a fungal infection in these patients.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Amirali Karimi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | - Zahra Pashaei
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Amir Masoud Afsahi
- Department of Radiology School of Medicine, University of California, San Diego (UCSD) San Diego California USA
| | - Sanam Alilou
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Nazanin Janfaza
- Internal Medicine Department Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences Tehran Iran
| | - Alireza Shojaei
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Fatemeh Afroughi
- School of Medicine Islamic Azad University Tehran Iran
- Pars Hospital Iran University of Medical Sciences Tehran Iran
| | - Parsa Mohammadi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | | | | | - Ava Amiri
- Iranian Research Center for HIV/AIDS Iranian Institute for Reduction of High‐Risk Behaviors, Tehran University of Medical Sciences Tehran Iran
| | - Marcarious M. Tantuoyir
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Biomedical Engineering Unit University of Ghana Medical Center (UGMC) Accra Ghana
| | - Shahram Oliaei
- HBOT Research Center Golestan Hospital, Islamic Republic of Iran, Navy and AJA Medical University Tehran Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology Ardebil University of Medical Sciences Ardebil Iran
| | - Omid Dadras
- Department of Global Health and Socioepidemiology Graduate School of Medicine, Kyoto University Kyoto Japan
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Nagalli S, Kikkeri NS. Mucormycosis in COVID-19: A systematic review of literature. LE INFEZIONI IN MEDICINA 2022; 29:504-512. [PMID: 35146358 DOI: 10.53854/liim-2904-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an acute viral illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Opportunistic infections such as mucormycosis have been reported among COVID-19 patients particularly in South Asian countries during the second wave of this pandemic. It is necessary to re-evaluate any changes in traditional risk factors associated with mucormycosis such as diabetes mellitus, organ transplant, etc in the precedent of ongoing COVID-19 pandemic. We conducted a systematic review using electronic databases. A total of 115 COVID-19 patients who were diagnosed with mucormycosis were included in this study. Diabetes mellitus was the most common co-morbidity with 77.1%, followed by hypertension (29.5%) and renal disease (14.3%). 55.2% of the patients had received dexamethasone for COVID-19 infection. Ten patients (11.5%) had received tocilizumab. Sinuses were the most common site of mucormycosis among COVID-19 patients at 79.4% with maxillary sinus (47.4%) being most commonly infected. Orbits were the second most prevalent site at 56.7% and lungs were infected with mucor at 11.3%. The mean duration between the diagnosis of COVID-19 infection and mucormycosis was 16.15 days (range 2-90 days). Cavernous sinus was either infiltrated or encased in 14 patients (14.4%). Cerebral involvement was seen in terms of abscess, infarcts, or edema in 12 patients (12.4%). Only 76 patients had data on the outcomes, out of which 37 (48.7%) patients had died. Diabetes mellitus is still the most common co-morbidity similar to non-COVID-19 patients. More than 90% of the patients with COVID-19 infection had received steroids. Complications such as cavernous sinus thrombosis, cerebral infarcts, abscesses were common. Indiscriminate use of steroids in patients needs to be avoided and focus needs to be put on tight blood sugar control in diabetic patients. Studies are needed to confirm the role of the SARS-CoV-2 virus in causing immune dysfunction and mucormycosis.
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Affiliation(s)
- Shivaraj Nagalli
- Department of Internal Medicine, Brookwood Baptist Health, Alabaster, USA
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Azhar A, Khan WH, Khan PA, Al-hosaini K, Owais M, Ahmad A. Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach. J Infect Public Health 2022; 15:466-479. [PMID: 35216920 PMCID: PMC8855610 DOI: 10.1016/j.jiph.2022.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
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Chao CM, Lai CC, Yu WL. COVID-19 associated mucormycosis - An emerging threat. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:183-190. [PMID: 35074291 PMCID: PMC8755409 DOI: 10.1016/j.jmii.2021.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/22/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly become a global threaten since its emergence in the end of 2019. Moreover, SARS-CoV-2 infection could also present with co-infection or secondary infection by other virus, bacteria, or fungi. Among them, mucormycosis is a rare but aggressive fungal disease and it mainly affects patients particularly with poorly controlled diabetes mellitus with diabetic ketoacidosis (DKA). We here did a comprehensive review of literature reporting COVID-19 associated with mucormycosis (CAM) cases, which have been reported worldwide. The prevalence is higher in India, Iran, and Egypt than other countries, particularly highest in the states of Gujarat and Maharashtra in India. Poor diabetic control and the administration of systemic corticosteroids are the common precipitating factors causing mucormycosis in the severe and critical COVID-19 patients. In addition, COVID-19 itself may affect the immune system resulting in vulnerability of the patients to mucormycosis. Appropriate treatments of CAM include strict glycemic control, extensive surgical debridement, and antifungal therapy with amphotericin B formulations.
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Affiliation(s)
- Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, 73657, Taiwan; Department of Dental Laboratory Technology, Min-Hwei College of Health Care Management, Tainan, 73657, Taiwan.
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, 71051, Taiwan.
| | - Wen-Liang Yu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
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Pritam M, Singh G, Kumar R, Singh SP. Screening of potential antigens from whole proteome and development of multi-epitope vaccine against Rhizopus delemar using immunoinformatics approaches. J Biomol Struct Dyn 2022; 41:2118-2145. [PMID: 35067195 DOI: 10.1080/07391102.2022.2028676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Mucormycosis is a deadly fungal disease mainly caused by Rhizopus oryzae (strain 99-880), also known as Rhizopus delemar. Previously, mucormycosis occurs in immunocompromised patients of diabetes mellitus, cancer, organ transplant, etc. But there was a drastic increase in mucormycosis cases in the ongoing COVID-19 pandemic. Despite several available therapies and antifungal treatments, the mortality rate of mucormycosis is about more than 50%. Currently, there is no vaccine available in the market for mucormycosis that urgently needs to develop a potential vaccine against mucormycosis with high efficacy. In the present study, we have screened 4 genome-derived predicted antigens (GDPA) through sequential filtration of the whole proteome of R. delemar using different benchmarked bioinformatics tools. These 4 GDPA along with 4 randomly selected experimentally reported antigens (ERA) were sourced for prediction of B- and T- cell epitopes and utilized in designing of two potential multi-epitope vaccine candidates which can induce both innate and adaptive immunity against R. delemar. Besides these, comparative immune simulation studies and in silico cloning were performed using L. lactis as an expression system for their possible uses as oral vaccines. This is the first multi-epitope vaccine designed against R. delemar through systematic pipelined reverse vaccinology and immunoinformatic approaches. Although the wet-lab based experimental validation of designed vaccines is required before testing in the preclinical model, the current study will significantly help in reducing the cost of experimentation as well as improving the efficacy of vaccine therapy against mucormycosis and other pathogenic diseases.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Manisha Pritam
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
| | - Garima Singh
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
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Pushparaj K, Kuchi Bhotla H, Arumugam VA, Pappusamy M, Easwaran M, Liu WC, Issara U, Rengasamy KRR, Meyyazhagan A, Balasubramanian B. Mucormycosis (black fungus) ensuing COVID-19 and comorbidity meets - Magnifying global pandemic grieve and catastrophe begins. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 805:150355. [PMID: 34818767 PMCID: PMC8443313 DOI: 10.1016/j.scitotenv.2021.150355] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/25/2021] [Accepted: 09/11/2021] [Indexed: 05/02/2023]
Abstract
Post COVID-19, mucormycosis occurred after the SARS-CoV-2 has rampaged the human population and is a scorching problem among the pandemic globally, particularly among Asian countries. Invasive mucormycosis has been extensively reported from mild to severe COVID-19 survivors. The robust predisposing factor seems to be uncontrolled diabetes mellitus, comorbidity and immunosuppression acquired through steroid therapy. The prime susceptive reason for the increase of mucormycosis cases is elevated iron levels in the serum of the COVID survivors. A panoramic understanding of the infection has been elucidated based on clinical manifestation, genetic and non- genetic mechanisms of steroid drug administration, biochemical pathways and immune modulated receptor associations. This review lime-lights and addresses the "What", "Why", "How" and "When" about the COVID-19 associated mucormycosis (CAM) in a comprehensive manner with a pure intention to bring about awareness to the common public as the cases are inevitably and exponentially increasing in India and global countries as well. The article also unearthed the pathogenesis of mucormycosis and its association with the COVID-19 sequela, the plausible routes of entry, diagnosis and counter remedies to keep the infection at bay. Cohorts of case reports were analysed to spotlight the link between the pandemic COVID-19 and the nightmare-mucormycosis.
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Affiliation(s)
- Karthika Pushparaj
- Department of Zoology, School of Biosciences, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore 641 043, Tamil Nadu, India
| | - Haripriya Kuchi Bhotla
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India
| | - Vijaya Anand Arumugam
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore 641 046, Tamil Nadu, India
| | - Manikantan Pappusamy
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India
| | - Murugesh Easwaran
- International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Wen-Chao Liu
- Department of Animal Science, College of Coastal Agricultural Sciences, Guangdong Ocean University, Zhanjiang 524088, PR China
| | - Utthapon Issara
- Division of Food Science and Technology Management, Faculty of Science and Technology, Rajamangala University of Technology Thanyaburi, Pathum Thani 12110, Thailand
| | - Kannan R R Rengasamy
- Green Biotechnologies Research Centre of Excellence, University of Limpopo, Private Bag X1106, Polokwane, Sovenga 0727, South Africa
| | - Arun Meyyazhagan
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka 560076, India.
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Verma V, Acharya S, Kumar S, Gaidhane SA, Thatere U. Rhinocerebral Mucormycosis With Brain Abscess Presenting as Status Epileptucus in a COVID-19-Infected Male: A Calamitous Complication. Cureus 2022; 14:e21061. [PMID: 35155024 PMCID: PMC8825442 DOI: 10.7759/cureus.21061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 12/03/2022] Open
Abstract
With the evolution of COVID-19 disease, the emergence of more complications associated with COVID-19 is taking place. Mucormycosis is the most common opportunistic fungal infection encountered after COVID-19. In this case report, we describe a case of a 61-year-old male type 2 diabetic with sino-orbital-cerebral mucormycosis infection who was treated with conventional guidelines for a recent COVID-19 infection and further presented with generalized tonic-clonic status seizures. Neuroimaging revealed sino-orbital mucormycosis with right frontal lobe abscess. He was treated with anti-epileptics, steroids, amphotericin-B, and functional endoscopic sinus surgery (FESS).
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Kamat M, Datar U, Byakodi S, Kamat S, Vimal Kumar V. COVID-19-associated mucormycosis of head-and-neck region: A systematic review. J Clin Transl Res 2022; 8:31-42. [PMID: 35187287 PMCID: PMC8848761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/06/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIM With the second wave of COVID-19, there has been a substantial rise in opportunistic infections like mucormycosis. Mucormycosis is a fatal fungal infection and understanding the associated risk factors and their management plays a key role to reduce mortality and morbidity caused due to such infections. This systematic review was conducted to assess the risk factors, clinical characteristics and to understand the pathogenesis of COVID-19-associated mucormycosis (CAM) affecting the head-and-neck region. METHODS The PubMed database was searched with the keywords; ((Mucormycosis) OR (invasive fungal sinusitis)) AND (COVID-19) and the PRISMA chart was prepared for the selection of the reports based on the inclusion and exclusion criteria. RESULTS A total of 261 cases of CAM affecting the head-and-neck region were analyzed in this systematic review. Most of the patients presented with rhino-orbital/rhino-orbito-cerebral form of mucormycosis (rhino-orbital mucormycosis/rhino-orbital-cerebral mucormycosis). Pulmonary mucormycosis along with rhino-orbital form, involvement of hard palate, and maxillary sinus was seen in one case each. A total of 224 (85.8%) patients were diabetic, 68 (30.3%) of them had poor glycemic control. Steroids were administered in 210 (80.4%) patients. Except for two, antifungal treatment was given to all patients. Follow-up data revealed 67 (25.6%) deaths and 193 (73.9%) were alive with one patient lost during follow-up. CONCLUSION The findings of this systematic review suggested that the occurrence of mucormycosis in COVID-19 patients is related to the inherent effects of COVID-19 infection on the immune system, comorbidities especially diabetes, and treatment aspects. Hence, a detailed understanding of these factors may aid in the personalized management of CAM and improve the disease outcome. RELEVANCE FOR PATIENTS The risk factors in patients affected by CAM should be recognized and closely monitored in post-COVID-19 patients. A multidisciplinary team must be in place to reduce the mortality and morbidity in such patients.
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Affiliation(s)
- Mamata Kamat
- 1Department of Oral and Maxillofacial Pathology, BV(DU) Dental College and Hospital, Sangli, Maharashtra, India,Corresponding author: Dr. Mamata Kamat MDS, PhD Department of Oral and Maxillofacial Pathology, BV(DU) Dental College and Hospital, Sangli, Maharashtra - 416 416, India.
| | - Uma Datar
- 1Department of Oral and Maxillofacial Pathology, BV(DU) Dental College and Hospital, Sangli, Maharashtra, India
| | - Sanjay Byakodi
- 2Department of Oral and Maxillofacial Surgery, BV(DU) Dental College and Hospital, Sangli, Maharashtra, India
| | - Sharad Kamat
- 3Department of Conservative Dentistry and Endodontics, BV(DU) Dental College and Hospital, Sangli, Maharashtra, India
| | - Varsha Vimal Kumar
- 4Department of Oral and Maxillofacial Pathology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
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Akhtar N, Khurshid Wani A, Kant Tripathi S, Prakash A, Amin-Ul Mannan M. The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review. CURRENT RESEARCH IN BIOTECHNOLOGY 2022; 4:337-349. [PMID: 35942223 PMCID: PMC9347179 DOI: 10.1016/j.crbiot.2022.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/02/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Since December 2019 SARS-CoV-2 infections have affected millions of people worldwide. Along with the increasing number of COVID-19 patients, the number of cases of opportunistic fungal infections among the COVID-19 patients is also increasing. There have been reports of the cases of aspergillosis and candidiasis in the COVID-19 patients. The COVID-19 patients have also been affected by rare fungal infections such as histoplasmosis, pneumocystosis, mucormycosis and cryptococcosis. These fungal infections are prolonging the stay of COVID-19 patients in hospital. In this study several published case reports, case series, prospective and retrospective studies were investigated to explore and report the updated information regarding candidiasis, crytptococcosis, aspergillosis, mucormycosis, histoplasmosis, and pneumocystosis infections in COVID-19 patients. In this review, the risk factors of these co-infections in COVID-19 patients have been reported. There have been reports that the comorbidities and the treatment with corticoids, monoclonal antibodies, use of mechanical ventilation, and use of antibiotics during COVID-19 management are associated with the emergence of fungal infections in the COVID-19 patients. Hence, this review analyses the role of these therapies and comorbidities in the emergence of these fungal infections among COVID-19 patients. This review will help to comprehend if these fungal infections are the result of the co-morbidities, and treatment protocol followed to manage COVID-19 patients or directly due to the SARS-CoV-2 infection. The analysis of all these factors will help to understand their role in fungal infections among COVID-19 patients which can be valuable to the scientific community.
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Affiliation(s)
- Nahid Akhtar
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Atif Khurshid Wani
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Surya Kant Tripathi
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ajit Prakash
- Department of Biochemistry and Biophysics, University of North Carolina, Chapel Hill, NC 27599, United States
| | - M Amin-Ul Mannan
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
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Ermilov VV, Smirnov AV, Dorofeev NA, Grigor'eva NV, Tarasova NV, Kushniruk PI, Karadzhe M, Barkanov VB, Chernetsky OA, Poplavsky AE, Nesterova AA, Lozovik VV, Somova VV. [COVID-19-associated mucormycosis in ophthalmological practice in the Volgograd region]. Arkh Patol 2022; 84:43-49. [PMID: 36178222 DOI: 10.17116/patol20228405143] [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: 06/16/2023]
Abstract
The problem of fungal infections in the era of COVID-19 has acquired special significance. This infection, directly or indirectly, through the use of glucocorticoids and antibiotics in its treatment, as well as poorer self-management of chronic diseases, has led to a wide spread of risk factors for fungal diseases among people who have had a novel coronavirus infection. The article presents two cases of COVID-19-associated mycosis, more related to mucormycosis, which were diagnosed by ophthalmologists in the Volgograd region. In the first case, the severe course of rhino-orbito-cerebral form of mucormycosis required a number of surgical interventions and prolonged treatment in the intensive care unit. In the second case, the patient asked for help without signs of aggravation of the general condition, but with irreversible local manifestations. In both cases, the eyeball was removed. Morphological examination revealed aseptal ribbon hyphae of different diameters, branching mainly at right angles, more typical for fungi of the Mucorales family. Due to the severe consequences of the disease, clinicians, including ophthalmologists, need to be especially alertness in patients with the described symptoms and risk factors in the post-COVID period.
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Affiliation(s)
- V V Ermilov
- Volgograd State Medical University, Volgograd, Russia
| | - A V Smirnov
- Volgograd State Medical University, Volgograd, Russia
- Volgograd Medical Research Center, Volgograd, Russia
| | - N A Dorofeev
- Volgograd State Medical University, Volgograd, Russia
- Volgograd Medical Research Center, Volgograd, Russia
| | | | - N V Tarasova
- Volgograd State Medical University, Volgograd, Russia
| | - P I Kushniruk
- Volgograd State Medical University, Volgograd, Russia
| | - M Karadzhe
- Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
| | - V B Barkanov
- Volgograd State Medical University, Volgograd, Russia
| | - O A Chernetsky
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - A E Poplavsky
- Volgograd Regional Pathological Bureau, Volgograd, Russia
| | - A A Nesterova
- Volgograd State Medical University, Volgograd, Russia
| | - V V Lozovik
- Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
| | - V V Somova
- Volgograd State Medical University, Volgograd, Russia
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Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, Nasir N, Bonifaz A, Araiza J, Klimko N, Serris A, Lagrou K, Meis JF, Cornely OA, Perfect JR, White PL, Chakrabarti A. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. THE LANCET MICROBE 2022; 3:e543-e552. [PMID: 35098179 PMCID: PMC8789240 DOI: 10.1016/s2666-5247(21)00237-8] [Citation(s) in RCA: 200] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Reports of COVID-19-associated mucormycosis have been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes. Patients with diabetes and hyperglycaemia often have an inflammatory state that could be potentiated by the activation of antiviral immunity to SARS-CoV2, which might favour secondary infections. In this Review, we analysed 80 published and unpublished cases of COVID-19-associated mucormycosis. Uncontrolled diabetes, as well as systemic corticosteroid treatment, were present in most patients with COVID-19-associated mucormycosis, and rhino-orbital cerebral mucormycosis was the most frequent disease. Mortality was high at 49%, which was particularly due to patients with pulmonary or disseminated mucormycosis or cerebral involvement. Furthermore, a substantial proportion of patients who survived had life-changing morbidities (eg, loss of vision in 46% of survivors). Our Review indicates that COVID-19-associated mucormycosis is associated with high morbidity and mortality. Diagnosis of pulmonary mucormycosis is particularly challenging, and might be frequently missed in India.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Clinical and Translational Fungal Working Group, University of California San Diego, La Jolla, CA, USA
| | - Danila Seidel
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department of Internal Medicine, ECMM Center of Excellence for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, Guimarães, Portugal
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Jean-Pierre Gangneux
- Environnement et Travail, Univ Rennes, CHU Rennes, Inserm, Institut de Recherche en Santé, Rennes, France
| | - Nosheen Nasir
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University Karachi, Karachi, Pakistan
| | - Alexandro Bonifaz
- Dermatology Service, Hospital General De México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Javier Araiza
- Dermatology Service, Hospital General De México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Nikolai Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University named after II Mechnikov, St Petersburg, Russia
| | - Alexandra Serris
- Department of Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Centre for Mycosis, ECMM Center of Excellence for Medical Mycology, University Hospitals Leuven, Leuven, Belgium
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department of Internal Medicine, ECMM Center of Excellence for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, UHW, Cardiff, UK
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lax C, Navarro-Mendoza MI, Pérez-Arques C, Navarro E, Nicolás FE, Garre V. Stable and reproducible homologous recombination enables CRISPR-based engineering in the fungus Rhizopus microsporus. CELL REPORTS METHODS 2021; 1:100124. [PMID: 35475217 PMCID: PMC9017206 DOI: 10.1016/j.crmeth.2021.100124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 04/22/2023]
Abstract
Mucormycosis is a lethal and emerging disease that has lacked a genetic model fulfilling both high virulence and the possibility of performing stable and reproducible gene manipulation by homologous recombination (HR). Here, we developed a new methodology to successfully perform HR in Rhizopus microsporus. We isolated an uracil auxotrophic recipient strain and optimized the critical steps in the genetic transformation of this fungus. This was followed by an adaptation of a plasmid-free CRISPR-Cas9 system coupled with microhomology repair templates. We reproducibly generated stable mutants in the genes leuA and crgA, encoding a 3-isopropylmalate dehydratase and an ubiquitin ligase, respectively. Our new genetic model showed that mutations in the gene pyrF, a key virulence gene in several bacterial and fungal pathogens, correlated with an avirulent phenotype in an immunocompetent murine host. This was reverted by gene complementation, showing the broad possibilities of our methodology.
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Affiliation(s)
- Carlos Lax
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | | | - Carlos Pérez-Arques
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Eusebio Navarro
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | - Francisco Esteban Nicolás
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | - Victoriano Garre
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
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Marzban-Rad S, Marzban-Rad Z, Khanbanan A, Bahmani S, Kazemi A. Early percutaneous tracheostomy in COVID19 patients with failed intubation: A case series. Ann Med Surg (Lond) 2021; 72:103030. [PMID: 34777796 PMCID: PMC8576056 DOI: 10.1016/j.amsu.2021.103030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION COVID19 and pulmonary dysfunction leading to acute respiratory distress syndrome (ARDS). CASE STUDY PRESENTATION Herein we presented the cases of failed intubation that was replaced by early percutaneous dilational tracheostomy. The procedure is safe for the patients, doctors and clinical staff. CONCLUSION Additionally, we report mucormycosis after COVID19 treatment that was potentially due to immunosuppressive drugs.
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Affiliation(s)
- Saeid Marzban-Rad
- Department of Surgery, Imam-Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Marzban-Rad
- Department of Obstetrics and Gynecology, School of Medicine, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khanbanan
- General Practitioner, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Sahar Bahmani
- Zist Takhmir Pharmaceutical Company, Tehran University of Medical Sciences, Tehran, Iran
| | - Amenehsadat Kazemi
- Department of Psychology, Faculty of Medical, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Bakshi SS, Kalidoss VK. COVID 19 infection and mucormycosis—a dangerously increasing combination. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021. [PMCID: PMC8159069 DOI: 10.1186/s43163-021-00121-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World. Mycopathologia 2021; 186:739-754. [PMID: 34414555 PMCID: PMC8375614 DOI: 10.1007/s11046-021-00584-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to a concerning resurgence of mucormycosis. More than 47,000 cases of mucormycosis were reported in three months from India. We update our systematic review on COVID-19-associated mucormycosis (CAM) till June 21st, 2021, comparing cases reported from India and elsewhere. We included individual patient details of 275 cases of CAM, of which 233 were reported from India and 42 from the rest of the world. Diabetes mellitus was the most common underlying risk factor for CAM in India than in other countries. The fatality rate of cases reported from India (36.5%) was less than the globally reported cases (61.9%), probably due to the predominance of rhino-orbital mucormycosis. On a multivariate analysis, we found that pulmonary or disseminated mucormycosis cases and admission to the intensive care unit were associated with increased mortality, while combination medical therapy improved survival. The paucity of pulmonary and disseminated mucormycosis cases from India suggests that these cases were either not diagnosed or reported, further supported by a trend of search data from the Google search engine. In this review, we discuss the factors explaining the substantial rise in cases of CAM. We also propose a hypothetical model describing the epidemiologic triad of CAM.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Shivaprakash M Rudramurthy
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Arunaloke Chakrabarti
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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Abstract
Mucormycosis, commonly known as ‘Black Fungus’ which was then a rare fungal infection, has suddenly come to light post the COVID-19- pandemic, more so during the second wave in India. It thus becomes important not only for the medical fraternity but also the general population to build awareness about the same. The present review will focus on the pathophysiology, etiology, outcomes of some case studies, and current treatment methods of mucormycosis infection. Major focus of the current article is on rhino-orbital-cerebral mucormycosis. All the studies included in the present review article was extracted from the PubMed database.
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Affiliation(s)
- Natarajan Sundaram
- Genetic Lab, Aditya Jyot Research in Vision and Ophthalmology, Aditya Jyot Foundation for Twinkling little Eyes, Wadala, Mumbai, Maharashtra, India
| | - Tejas Bhende
- Genetic Lab, Aditya Jyot Research in Vision and Ophthalmology, Aditya Jyot Foundation for Twinkling little Eyes, Wadala, Mumbai, Maharashtra, India
| | - Runali Yashwant
- Genetic Lab, Aditya Jyot Research in Vision and Ophthalmology, Aditya Jyot Foundation for Twinkling little Eyes, Wadala, Mumbai, Maharashtra, India
| | - Siddhita Jadhav
- Genetic Lab, Aditya Jyot Research in Vision and Ophthalmology, Aditya Jyot Foundation for Twinkling little Eyes, Wadala, Mumbai, Maharashtra, India
| | - Astha Jain
- Genetic Lab, Aditya Jyot Research in Vision and Ophthalmology, Aditya Jyot Foundation for Twinkling little Eyes, Wadala, Mumbai, Maharashtra, India
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Lin TP, Ko CN, Zheng K, Lai KH, Wong RL, Lee A, Zhang S, Huang SS, Wan KH, Lam DS. COVID-19: Update on Its Ocular Involvements, and Complications From Its Treatments and Vaccinations. Asia Pac J Ophthalmol (Phila) 2021; 10:521-529. [PMID: 34839344 PMCID: PMC8673850 DOI: 10.1097/apo.0000000000000453] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) came under the attention of the international medical community when China first notified the World Health Organization of a pneumonia outbreak of then-unknown etiology in Wuhan in December 2019. Since then, COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has appalled the world by spreading at a pandemic speed. Although ophthalmologists do not directly engage in the clinical care of COVID-19 patients, the ophthalmology community has become aware of the close ties between its practice and the pandemic. Not only are ophthalmologists at heightened risk of SARS-CoV-2 exposure due to their physical proximity with patients in routine ophthalmic examinations, but SARS-CoV-2 possesses ocular tropism resulting in ocular complications beyond the respiratory tract after viral exposure. Furthermore, patients could potentially suffer from adverse ocular effects in the therapeutic process. This review summarized the latest literature to cover the ophthalmic manifestations, effects of treatments, and vaccinations on the eye to aid the frontline clinicians in providing effective ophthalmic care to COVID-19 patients as the pandemic continues to evolve.
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Affiliation(s)
- Timothy P.H. Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | | | - Ke Zheng
- C-MER (Beijing) Dennis Lam Eye Hospital, Beijing, China
| | - Kenny H.W. Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Raymond L.M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Allie Lee
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Suber S. Huang
- Retina Center of Ohio, Cleveland, OH, US
- Bascom Palmer Eye Institute, Miami, FL, US
| | - Kelvin H. Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Dennis S.C. Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), China
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Dilek A, Ozaras R, Ozkaya S, Sunbul M, Sen EI, Leblebicioglu H. COVID-19-associated mucormycosis: Case report and systematic review. Travel Med Infect Dis 2021; 44:102148. [PMID: 34454090 PMCID: PMC8387131 DOI: 10.1016/j.tmaid.2021.102148] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing number of patients with COVID-19-associated mucormycosis have been reported, especially from India recently. We have described a patient with COVID-19-associated mucormycosis and, searched and analyzed current medical literature to delineate the characteristics of COVID-19-associated mucormycosis. METHOD We reported a patient developed mucormycosis during post-COVID period. We searched literature to describe the incidence, clinical features, and outcomes of COVID-19-associated mucormycosis. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed. RESULTS We describe a 54-year-old male, hospitalized due to severe COVID-19 pneumonia. He was given long-term, high doses of systemic steroids. He developed maxillo-fascial mucormycosis and died of sepsis. Our literature search found 30 publications describing 100 patients including present case report. The majority (n = 68) were reported from India. 76% were male. The most commonly seen risk factors were corticosteroid use (90.5%), diabetes (79%), and hypertension (34%). Also, excessive use of broad-spectrum antibiotics were noted in cases. Most frequent involvements were rhino-orbital (50%), followed by rhino-sinusal (17%), and rhino-orbito-cerebral (15%). Death was reported as 33 out of 99 patients (33,3%). CONCLUSIONS Steroid use, diabetes, environmental conditions, excessive use of antibiotics, and hypoxia are main risk factors. Despite medical and surgical treatment, mortality rate is high. A multidisciplinary approach is essential to improve the conditions facilitating the emergence of COVID-19-associated mucormycosis.
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Affiliation(s)
- Ahmet Dilek
- Intensive Care Unit, VM Medicalpark Samsun Hospital, Samsun, Turkey; Istinye University, Faculty of Medicine, Istanbul, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases, Medilife Health Group, Istanbul, Turkey.
| | - Sevket Ozkaya
- Department of Pulmonology, VM Medicalpark Samsun Hospital, Samsun, Turkey; Department of Pulmonology, Bahcesehir University Medical School, Istanbul, Turkey.
| | - Mustafa Sunbul
- Department of Infectious Diseases, Samsun Liv Hospital, Samsun, Turkey.
| | - Elif Itir Sen
- Intern, Bahcesehir University, Medical School, Istanbul, Turkey.
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey.
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Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:jof7110921. [PMID: 34829210 PMCID: PMC8620819 DOI: 10.3390/jof7110921] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.
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