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Sahin M, Yilmaz M, Mert A, Naghili B, Ravanbakhsh F, Varshochi M, Darazam IA, Ebrahimi MJ, Moafi M, Tehrani HA, Mahboob A, Rashid N, Khan EA, Hakamifard A, Eser-Karlidag G, Babamahmoodi A, El-Kholy A, Mosawi SH, Albayrak A, Al Ramahi JW, Addepalli SK, Özer Balin Ş, Khan A, Pandya N, Gurbuz E, Sincan G, Azami H, Dumlu R, Khedr R, Ripon RK, Alkan S, Kose Ş, Ceylan B, Erdem H. Factors influencing mortality in COVID-19-associated mucormycosis: The international ID-IRI study. Med Mycol 2024; 62:myae064. [PMID: 38914466 DOI: 10.1093/mmy/myae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/31/2024] [Accepted: 06/23/2024] [Indexed: 06/26/2024] Open
Abstract
The emergence of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggered a global pandemic. Concurrently, reports of mucormycosis cases surged, particularly during the second wave in India. This study aims to investigate mortality factors in COVID-19-associated mucormycosis (CAM) cases, exploring clinical, demographic, and therapeutic variables across mostly Asian and partly African countries. A retrospective, cross-sectional analysis of CAM patients from 22 medical centers across eight countries was conducted, focusing on the first 3 months post-COVID-19 diagnosis. Data collected through the ID-IRI included demographics, comorbidities, treatments, and outcomes. A total of 162 CAM patients were included. The mean age was 54.29 ± 13.04 years, with 54% male. Diabetes mellitus (85%) was prevalent, and 91% had rhino-orbital-cerebral mucormycosis. Surgical debridement was performed in 84% of the cases. Mortality was 39%, with advanced age (hazard ratio [HR] = 1.06, [P < .001]), rituximab use (HR = 21.2, P = .05), and diabetic ketoacidosis (HR = 3.58, P = .009) identified as risk factors. The mortality risk increases by approximately 5.6% for each additional year of age. Surgical debridement based on organ involvement correlated with higher survival (HR = 8.81, P < .001). The utilization of rituximab and diabetic ketoacidosis, along with advancing age, has been associated with an increased risk of mortality in CAM patients. A combination of antifungal treatment and surgical intervention has demonstrated a substantial improvement in survival outcomes.
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Affiliation(s)
- Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Behrouz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ravanbakhsh
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Varshochi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ilad Alavi Darazam
- Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Ebrahimi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maral Moafi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Azhdari Tehrani
- Department of Hematology-Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amjad Mahboob
- Department of Medicine, Gajju Khan Medical College, Swabi, Pakistan
| | - Naveed Rashid
- Department of Infectious Diseases, Shifa Tameer-e-Millat University and Shifa International Hospital, Islamabad, Pakistan
| | - Ejaz Ahmed Khan
- Department of Infectious Diseases, Shifa Tameer-e-Millat University and Shifa International Hospital, Islamabad, Pakistan
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Isfahan University of Medical Sciences, School of Medicine, Isfahan, Iran
| | - Gülden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Abdolreza Babamahmoodi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sayed Hussain Mosawi
- Department of Molecular Research, Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Ayşe Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Jamal Wadi Al Ramahi
- Department of Medicine, Jordan University Hospital, School of Medicine, Amman, Jordan
| | - Syam Kumar Addepalli
- Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Şafak Özer Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Asfandiyar Khan
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Nirav Pandya
- Consultant Microbiologist & Infection Preventionist Bhailal Amin General Hospital, Vadodara, India
| | - Esra Gurbuz
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Gülden Sincan
- Department of Internal Medicine, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Hadia Azami
- Department of Molecular Research, Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Rıdvan Dumlu
- Department of Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital, Istanbul, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt, Department of Pediatric Oncology, Children Cancer Hospital, Cairo, Egypt
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Bangladesh
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Şükran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
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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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Thornton CR, Davies GE, Dougherty L. Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker. Front Cell Infect Microbiol 2023; 13:1305662. [PMID: 38145040 PMCID: PMC10739493 DOI: 10.3389/fcimb.2023.1305662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.
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Affiliation(s)
- Christopher R. Thornton
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Genna E. Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Laura Dougherty
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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