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Saraf P, Naresh Bharti J. Mucormycosis presenting as intestinal perforation: A pathologist perspective. Arab J Gastroenterol 2024; 25:234-236. [PMID: 38378356 DOI: 10.1016/j.ajg.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/29/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
Mucormycosis is a life-threatening fungal infection mostly involving the ocular region, sinuses and brain. It is mostly seen in the immunocompromised host. Gastrointestinal (GI) mucormycosis is rare and mostly present as hematemesis, abdominal pain and melena. Here, we present a case of intestinal mucormycosis who presented as cecal perforation. Surgical resection was done, and the diagnosis was made by histopathology. Our case is unique in the way that GI mucormycosis is itself a rare entity and even rarer in an immunocompetent host.
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Affiliation(s)
- Pallavi Saraf
- All India Institute of Medical Science, Department of Pathology, Jodhpur, India
| | - Jyotsna Naresh Bharti
- All India Institute of Medical Science, Department of Pathology, Mangalagiri, India.
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2
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Bhana M, Laher N, McGrath NG, Moeng MS. Small bowel mucormycosis: An unexpected case in a penetrating trauma survivor. Int J Surg Case Rep 2023; 113:109071. [PMID: 37988989 PMCID: PMC10696230 DOI: 10.1016/j.ijscr.2023.109071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Small bowel mucormycosis is a rare entity with few reports in the literature. Mortality rates secondary to necrosis and perforation remain above 85 %, with an increase in populations at risk noted. PRESENTATION OF CASE This is a case report of a survivor of penetrating trauma who sustained small bowel injuries and was managed with damage control surgery. He required relook laparotomies due to extensive contamination and subsequently developed progressive ischaemia and necrosis of areas of his small bowel - histology confirming mucormycosis. There were no apparent risk factors noted in this case. Early addition of Amphotericin B and prompt surgical management resulted in a positive outcome. The patient was discharged from the hospital successfully. No further complications were noted post-discharge. DISCUSSION Small bowel mucormycosis can be a challenging diagnosis and requires a high index of suspicion. The lack of traditional risk factors should not deter a surgeon from considering this diagnosis in trauma patients as the micro-invasive properties of this organism can result in unexpected gastrointestinal ischaemia. Favourable outcomes are associated with prompt surgical debridement, histopathological diagnosis, and appropriate antifungal therapy. CONCLUSION Gastrointestinal Mucormycosis is a diagnosis that should be considered in trauma patients with unusual patterns of ischaemia. Prompt therapy can result in positive outcomes.
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Affiliation(s)
- Malini Bhana
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa.
| | - Naadiyah Laher
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
| | - Nathan George McGrath
- Division of Anatomical Pathology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
| | - Maeyane Stephens Moeng
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
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3
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Addasi Y, Nguyen AH, Sabri A, Ahmad F, Rangray R, Velagapudi M. Gastrointestinal Mucormycosis: A Clinical Review. Gastroenterology Res 2023; 16:249-253. [PMID: 37937225 PMCID: PMC10627358 DOI: 10.14740/gr1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 11/09/2023] Open
Abstract
Mucormycosis is a devastating fungal infection that is usually seen in immunocompromised hosts. It is caused by fungi of the subphylum Mucoromycotina, order Mucorales, with most cases caused by Mucor, Rhizopus, or Rhizomucor species. It can involve any organ system and can disseminate in severe cases. Lately, there has been an increased number of reports for mucormycosis infection in immunocompetent patients. Gastrointestinal system involvement is rare compared to other organ systems but has been increasingly reported in the literature. Mucormycosis can affect any part of the gastrointestinal tract and lead to different presentations depending on the area of involvement. Due to the paucity of the condition, there has been no specific guidelines on how to treat gastrointestinal mucormycosis. In this review, we discuss the risk factors of gastrointestinal mucormycosis, clinical presentation, approach to diagnosis, and most recent treatment modalities for gastrointestinal mucormycosis.
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Affiliation(s)
- Yazan Addasi
- Department of Internal Medicine, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | | | - Ahmed Sabri
- Department of Pathology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Faran Ahmad
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Rajani Rangray
- Division of Gastroenterology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Manasa Velagapudi
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
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Zackariah NM, Rajakrishnan H, Surendran S, Paulose RR. Gastrointestinal mucormycosis following liver transplantation: lessons learnt. BMJ Case Rep 2023; 16:e253460. [PMID: 37673462 PMCID: PMC10496686 DOI: 10.1136/bcr-2022-253460] [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: 09/08/2023] Open
Abstract
Gastrointestinal mucormycosis (GIM) is an uncommonly encountered fungal infection following solid-organ transplantation. GIM is known to be associated with immunocompromised states, remains difficult to diagnose and often results in fatal outcomes. It is plausibly the delay in initiation of appropriate treatment strategies that leads to failure of response and patient demise. We report two cases of GIM following live donor liver transplantation, presenting with bleeding and perforation, respectively, highlighting the challenges in making a timely diagnosis of mucormycosis, particularly in immunocompromised patients.
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Affiliation(s)
- Nafiya Muhammed Zackariah
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Haritha Rajakrishnan
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Sudhindran Surendran
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Roopa Rachel Paulose
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
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Khsiba A, Moalla M, Nechi S, Bani A, Elloumi A, Jemal S, Azouz MM, Medhioub M, Hamzaoui L. Fatal invasive gastric mucormycosis: Two case reports. Clin Case Rep 2022; 10:e6330. [PMID: 36172336 PMCID: PMC9468655 DOI: 10.1002/ccr3.6330] [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: 06/13/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
Mucormycosis is a fungal infection affecting most commonly immunocompromised patients. Hereby, we report two cases: the first one is about a 61‐year‐old female with diabetes who presented with vomiting. The upper gastrointestinal endoscopy showed a budding grayish process which corresponded to an invasive mucormycosis in histology. As laboratory tests showed renal dysfunction, conventional amphotericin B was started at low doses since liposomal form was unavailable in Tunisia. Evolution was marked by a worsening of renal function leading to drug therapy withdrawal. Total gastrectomy was delayed because of a pulmonary embolism and was practiced 2 months later. The patient passed away 10 days after surgery. The second patient was a 59‐year‐old man who presented with vomiting and fast worsening of general state. At admission, he had a septic shock. Explorations revealed an invasive gastric mucormycosis. He died few days after admission. Thus, prompt diagnosis of mucormycosis and rapid initiation of treatment based on amphotericin B and surgical debridement is necessary to improve prognosis.
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Affiliation(s)
- Amal Khsiba
- Department of Gastroenterology Mohamed Taher Maamouri Hospital Nabeul Tunisia
| | - Manel Moalla
- Department of Gastroenterology Mohamed Taher Maamouri Hospital Nabeul Tunisia
| | - Salwa Nechi
- Department of Cytology Mohamed Taher Maamouri Hospital Nabeul Tunisia
| | - Amina Bani
- Department of Cytology Mohamed Taher Maamouri Hospital Nabeul Tunisia
| | - Aicha Elloumi
- Parasitology and Entomology Laboratory La Rabta Hospital Tunis Tunisia
| | - Sana Jemal
- Parasitology and Entomology Laboratory La Rabta Hospital Tunis Tunisia
| | | | - Mouna Medhioub
- Department of Gastroenterology Mohamed Taher Maamouri Hospital Nabeul Tunisia
| | - Lamine Hamzaoui
- Department of Gastroenterology Mohamed Taher Maamouri Hospital Nabeul Tunisia
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Ralaizanaka BM, Razafindrazoto CI, Bolot E, Bors G, Housson-Wetzel S, Razafimahefa SH, Ramanampamonjy RM, Claude P. Gastrointestinal Mucormycosis-Induced Massive Lower Gastrointestinal Bleeding, Rectal Perforation, and Pulmonary Embolism: A Long Diagnostic Pathway in a Case Report. Clin Exp Gastroenterol 2022; 15:145-151. [PMID: 35983373 PMCID: PMC9381012 DOI: 10.2147/ceg.s373728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. It is responsible for surface and deep tissue destruction leading to perforations and hemorrhage. Its pathogenesis represented by an angio-invasion is at the origin of a local infarction and a vascular thrombosis. We report a case of gastrointestinal (GI) mucormycosis-induced multiple gastric ulcers, GI bleeding and rectal perforation. Case Presentation A 75-year-old man, with type II diabetes mellitus, was admitted to the intensive care unit for an acute abdominal pain associated with massive hematochezia. Clinical examination was that of an acute peritonitis and a hemorrhagic shock state. Abdominal and pelvic CT scan with intravenous contrast concluded to a perforation of the anterior wall of the rectum. He underwent immediate laparotomy with temporary colostomy. Several upper GI endoscopies had shown multiple gastric ulcer lesions. Lower GI endoscopy showed a fistulous orifice of the rectum on its anterior surface. Histopathology of the gastric biopsy showed acute and subacute inflammatory changes with filamentous elements suggesting mucormycosis. Histopathology of the rectal biopsy showed a subacute non-specific inflammation. Culture of the secretions from the rectal fistula orifice showed the strain Rhizopus sp. Antifungal susceptibility testing reported sensitivity to liposomal amphotericin B. The diagnosis of GI mucormycosis-induced multiple gastric ulcers, rectal perforation and pulmonary embolism in the patient with type II diabetes mellitus was retained. The outcomes were favorable after 6 weeks of treatment with liposomal amphotericin B associated with temporary colostomy and appropriate diabetes management. Conclusion GI mucormycosis remains a multidisciplinary diagnostic challenge, less frequent in clinical practice, with a long diagnostic pathway. This opportunistic systemic mycosis can lead to numerous GI complications including perforation, massive GI bleeding and even multiple extra-GI complications. GI mucormycosis has a good prognosis if it is treated early with medical and surgical treatment.
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Affiliation(s)
| | | | - Eloïse Bolot
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | - Georges Bors
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | - Stéphanie Housson-Wetzel
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
| | | | | | - Pierre Claude
- Unity of Gastroenterology, Emile Müller Hospital of Regional Hospital Group of Mulhouse South Alsace, Mulhouse, France
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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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Risks of mucormycosis in the current Covid-19 pandemic: a clinical challenge in both immunocompromised and immunocompetent patients. Mol Biol Rep 2022; 49:4977-4988. [PMID: 35107737 PMCID: PMC8808276 DOI: 10.1007/s11033-022-07160-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
Mucormycosis, also called "Black Fungus", is a new cause for worry in the current Coronavirus disease 2019 (covid-19) pandemic. Mucormycosis is devasting due to its high rate of morbidity and mortality which is a great cause of concern. Mucormycosis, in general, affects immunocompromised patients including diabetic, people with malignancies, organ and stem cell transplants and people affected with pandemic diseases like covid-19. Diagnosis of Mucormycosis is often delayed either due to clinical complications or misdiagnosed as symptoms of other diseases, especially covid-19. This could delay the treatment protocol which results in the failure of treatment. Mortality rate due to secondary infections in covid-19 patients with uncontrolled diabetics and who are on steroid therapy can soon reach 100% if diagnosis and treatment doesn't happen on timely basis. Risk of Mucormycosis is not just in immunosuppressed patients, but immunocompetent people with late diagnosis are also prone to infection. In view of this, we present a comprehensive review on risks of Mucormycosis in immunocompromised and immunocompetent patients highlighting the epidemiology, forms of Mucormycosis, immune response against Mucorales, difficulties in diagnosis and challenges in treatment of Mucormycosis, with emphasis on covid-19 associated Mucormycosis. Importantly, we have discussed the precautions and care to effectively manage Mucormycosis in immunocompromised and immunocompetent patients. Thus, current review helps clinicians in understanding various risk factors in both immunocompromised (especially covid-19 patients) and immunocompetent patients which is critical in managing Mucormycosis in current covid-19 pandemic.
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Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog 2022; 163:105388. [PMID: 34995749 DOI: 10.1016/j.micpath.2022.105388] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND GI mucormycosis (GI) is a rare but highly lethal infection in patients. There is no single comprehensive review of the literature that demonstrates the various clinical aspects of this infection. METHODS A structured search of PubMed/Medline was used to collect case reports of GI mucormycosis in patients of all ages published between 2015 and November 2021. RESULTS Eighty-seven cases were identified through PubMed bibliographic database searches, and final analyses were conducted on 70 adults and ten neonatal patients with GI mucormycosis. Asia had the highest number of reported cases, with 46 (57.5%). Neonatal cases had a mortality rate of 70%, while other cases had a mortality rate of 44%. Corticosteroid therapy and diabetes were the most significant risk factors in patients, while 11% were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in four adult patients. Moreover, neonatal cases included premature and low-weight infants, metabolic acidosis, and malnutrition. Abdominal pain, fever, and GI perforation were the most common signs of infection, while vomiting occurred in 40% of neonatal cases. In 97% of patients, a histopathologic examination was used to detect infection, whereas culture and molecular methods were used in only 28% and 17% of patients, respectively. Surgery plus anti-infection therapy, anti-infection therapy alone, and surgery alone were used in 61%, 28%, and 11% of patients, respectively. Nonetheless, all neonatal patients underwent surgery. Although used in a small number of patients, posaconazole (30%) and isavuconazole (11%) demonstrated high efficacy in treating patients. CONCLUSION GI mucormycosis is a rare but highly lethal disease. Treatment of underlying conditions, the use of multiple diagnostic techniques, and appropriate antifungals in conjunction with surgery can all contribute to infection control.
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Affiliation(s)
- Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Moradabadi
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Ali Arash Anoushirvani
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seidamir Pasha Tabaeian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Yousefimashouf
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Borujerd Branch, Islamic Azad University, Borujerd, Iran
| | - Aref Shariati
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran.
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Mahalaxmi I, Jayaramayya K, Venkatesan D, Subramaniam MD, Renu K, Vijayakumar P, Narayanasamy A, Gopalakrishnan AV, Kumar NS, Sivaprakash P, Sambasiva Rao KRS, Vellingiri B. Mucormycosis: An opportunistic pathogen during COVID-19. ENVIRONMENTAL RESEARCH 2021; 201:111643. [PMID: 34237335 PMCID: PMC8258024 DOI: 10.1016/j.envres.2021.111643] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 05/06/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second wave of this disease has led to panic in many countries, including India and some parts of the world suffering from the third wave. As there are no proper treatment options or remedies available for this deadly infection, supportive care equipment's such as oxygen cylinders, ventilators and heavy use of steroids play a vital role in the management of COVID-19. In the midst of this pandemic, the COVID-19 patients are acquiring secondary infections such as mucormycosis also known as black fungus disease. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid high rate of mortality and morbidity rates. Mucormycosis is caused by the inhalation of its filamentous (hyphal form) fungi especially in the patients who are immunosuppressed. Recent studies have documented alarming number of COVID-19 patients with mucormycosis infection. Most of these patients had diabetes and were administered steroids for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and were consequently more prone to mucormycosis. Hence, the present review emphasizes mucormycosis and its related conditions, its mechanism in normal and COVID-19 affected individuals, influencing factors and challenges to overcome this black mold infection. Early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in COVID-19 affected patients.
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Affiliation(s)
- Iyer Mahalaxmi
- Livestock Farming and Bioresource Technology, Tamil Nadu, India
| | - Kaavya Jayaramayya
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Dhivya Venkatesan
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Mohana Devi Subramaniam
- SN ONGC, Department of Genetics and Molecular Biology, Vision Research Foundation, Chennai, 600 006, Tamil Nadu, India
| | - Kaviyarasi Renu
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Padmavathi Vijayakumar
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Arul Narayanasamy
- Disease Proteomics Laboratory, Department of Zoology, Bharathiar University, Coimbatore, 641046, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Nachimuthu Senthil Kumar
- Department of Biotechnology, Mizoram University (A Central University), Aizawl, 796 004, Mizoram, India
| | - Palanisamy Sivaprakash
- Centre for Environmental Awareness, Dr. N.G.P. Institute of Technology, Coimbatore, 641048, Tamil Nadu, India
| | | | - Balachandar Vellingiri
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India.
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