Diagnosis and treatment of pulmonary mucormycosis: A case report

Mucormycosis: A Rare disease to Notifiable Disease

Mucormycosis is the third most frequent invasive mycosis, following candidiasis and aspergillosis. It is frequently neglected due to its rare occurrence; but recently attend the status of notifiable disease due to its higher incidence in both developed and developing nations. India has received global notice since its estimated instances were greater than the global estimated figures. Mucormycosis has several clinical manifestations, including rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and diffuse Mucormycosis. ROCM is the most frequent clinical manifestation in India, although pulmonary mucormycosis is prevalent worldwide. This review also discusses host defenses, pre disposing risk factors and fungal virulence factors that impair host's ability to prevent fungus invasion and disease establishment. The diagnosis of the disease depends on clinical interventions, histological or microbiological procedures along with molecular methods to obtain timely results. But there are still unmet challenges for rapid diagnosis of the disease. Treatment of the disease is achieved by multimodal approaches such as reversal of underlying predisposing factors, rapid administration of antifungals in optimal doses and surgical procedures to remove infected tissues. Liposomal Amphotericin B, Posaconazole and Isavuconazoles are preferred as the first line of treatment procedures. clinical trials. Different studies have improved the existing drug and under clinical trials while several studies predicted the new potential targets as CotH and Ftr1 as shown in infection and in vitro models. Therefore, current scenario demands a multidisciplinary approach is needed to investigate the prevalence, pathogenesis which is highly important for the advancement of rapid diagnosis and effective treatment.

Oral Isavuconazole Combined with Nebulized Inhalation and Bronchoscopic Administration of Amphotericin B for the Treatment of Pulmonary Mucormycosis: A Case Report and Literature Review

Pulmonary mucormycosis (PM) is an invasive and potentially fatal fungal infection, with Rhizopus microsporus (R. microsporus) being the most common pathogen. The routine therapy for this infection includes surgery and antifungal agents. However, the therapeutic effects of single agents are unsatisfactory due to the rapid progression of mucormycosis, while not all patients can tolerate surgery. Innovative treatment methods like combination therapy await validations of their clinical efficacy. We report a case of PM that was diagnosed via metagenomics next-generation sequencing (mNGS) of black drainage fluid from the patient's lung. The patient eventually recovered and was discharged after a combination therapy of oral isavuconazole, inhaled amphotericin B, and local perfusion of amphotericin B through bronchoscopy, which may be a promising strategy for the treatment of PM, especially for cases where surgery is not possible. A retrospective study of 297 cases in a literature review highlights the different treatment methods used in clinical practice.

Genome-based solutions for managing mucormycosis

An uncommon opportunistic fungal infection known as mucormycosis is caused by a class of molds called mucoromycetes. Currently, antifungal therapy and surgical debridement are the primary treatment options for mucormycosis. Despite the importance of comprehensive knowledge on mucormycosis, there is a lack of well-annotated databases that provide all relevant information. In this study, we have gathered and organized all available information related to mucormycosis that include disease's genome, proteins, diagnostic methods. Furthermore, using the AlphaFold2.0 prediction tool, we have predicted the tertiary structures of potential drug targets. We have categorized the information into three major sections: "genomics/proteomics," "immunotherapy," and "drugs." The genomics/proteomics module contains information on different strains responsible for mucormycosis. The immunotherapy module includes putative sequence-based therapeutics predicted using established tools. Drugs module provides information on available drugs for treating the disease. Additionally, the drugs module also offers prerequisite information for designing computationally aided drugs, such as putative targets and predicted structures. In order to provide comprehensive information over internet, we developed a web-based platform MucormyDB (https://webs.iiitd.edu.in/raghava/mucormydb/).

Pulmonary mucormycosis mimicking lung tumour in an uncontrolled diabetic patient

Mucormycosis is a fungal infection that can affect a variety of organs, one of which being the respiratory system. The most common form of infection with mucormycetes is pulmonary mucormycosis, which has a poor prognosis if infected. The clinical signs and radiological findings of this infection are non-specific and very similar to lung tumours. Here, we describe a 62-year-old obese man with uncontrolled diabetes mellitus who was referred for a tumour-like mass in the left lung, which after bronchoscopy was diagnosed as mucormycosis.

Storm of a rare opportunistic life threatening mucormycosis among post COVID-19 patients: A tale of two pathogens

Mucormycosis is a rare but life-threatening opportunistic fungal infection caused by a group of molds that belong to Zygomycetes of the order Mucorales. These fungi are found in the environment such as soil, decaying vegetation, and organic matters. Sporangiospores present in the environment enter the human body through inhalation or direct skin inoculation by trauma or ingestion and result in pulmonary, cutaneous, and gastrointestinal mucormycosis, respectively, in immunocompromised hosts. Patients with uncontrolled diabetes, hematological malignancies, high-dose glucocorticoid therapy, iron overload, and organ transplantation are at high risk of acquiring mucormycosis. The second wave of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] affected India severely with the highest number of cases and deaths compared to all other countries. Additionally, the country was affected by emergence of rare but life-threatening mucormycosis. Currently, many coronavirus disease 2019 patients with underlying risk factors such as uncontrolled diabetes, high-dose steroid therapy, and exposure to mechanical ventilation have developed mucormycosis. Inhalation is the most common mode of transmission that results in colonization of sporangiospores in the nose. In immunocompromised host, sporangiospores germinate, and subsequently form hyphae. These hyphae invade into tissues, and produce tissue infarction, necrosis, and thrombosis. Angioinvasion causes hematogenous dissemination to many organs, predominantly to brain, that result in rhino-orbital-cerebral mucormycosis. Clinical characteristics, radio imaging, fungal culture, histopathology, and molecular techniques are the key diagnostic methods. Surgical intervention and aggressive antifungal therapy are the main management strategies. Amphotericin B is the drug of choice for treatment of mucormycosis, whereas posaconazole or isavuconazole is used for step-down therapy and salvage therapy.

Pulmonary Mucormycosis: An Interesting Case of Rhizopus Mucormycosis

We report a case of a 57-year-old Vietnamese gentleman who presented with chest pain and shortness of breath for four weeks. The patient had a history of diabetes mellitus and kidney transplant in the past year and was currently on immunosuppressive agents. The patient's condition worsened despite broad-spectrum antibiotics, so amphotericin was added. Further evaluation with bronchoscopy and transbronchial biopsy was suggestive of Rhizopus mucormycosis. Despite antifungal therapy, his condition worsened, resulting in multi-organ failure and eventual mortality.

Pulmonary mucormycosis in immunocompetent hosts diagnosed by bronchioalveolar lavage

Mucormycosis is a rare infection caused by Mucorales fungi belonging to Zygomycetes class. It can present with spectrum of symptoms and signs based of organ involvement. Common forms of mucormycosis includes rhinocerebral, cutaneous, gastrointestinal, pulmonary, disseminated and miscellaneous forms involving bones, breast, kidney and central nervous system. Pulmonary mucormycosis usually present with fever, cough, haemoptysis and is usually seen in immunocompromised patients like patients with diabetes or leukaemia, or those on chemotherapy or immunosuppressive therapy and rare in immunocompetent patients (6.25% of cases). Pulmonary mucormycosis can be diagnosed by radiological imaging studies, bronchoalveolar lavage (BAL) and histopathological evaluation of biopsy of the lesion; however, the gold standard is a positive fungal culture. Here, we describe two cases of pulmonary mucormycosis diagnosed by BAL in an immunocompetent patient.

Pulmonary Mucormycosis: A Case Report of a Rare Infection with Potential Diagnostic Problems

Pulmonary mucormycosis is a relatively rare pulmonary fungal disease, which is difficult to diagnose early and lacks effective treatment. It is seen in patients with hematological malignancies, diabetes mellitus, and immunocompromised states. The diagnosis depends primarily on the detection of fungi in lung tissue. Here, we present a case of a 52-year-old male who has type 2 diabetes mellitus and a past history of treated pulmonary tuberculosis. Clinical diagnosis is difficult in pulmonary mucormycosis, and early diagnosis is needed for this life-threatening infection. Histopathological examination of a resected cavity confirmed the diagnosis of pulmonary mucormycosis. This report highlights the difficulty of diagnosis and the importance of histological examination in detecting mucormycosis which will help for early management.

Breaking the mold: A case of pulmonary mucormycosis treated with isavuconazole

Pulmonary mucormycosis is a rare opportunistic invasive fungal infection that disproportionately affects immunocompromised hosts and carries high morbidity and mortality. It is traditionally treated with combined pharmacologic and surgical modalities. Here we present a case of pulmonary mucormycosis in a patient whose disease burden precluded surgical management, and in whom acute kidney injury necessitated therapy with an alternative to the recommended pharmacologic antifungal therapy.

Pulmonary mucormycosis mimicking an endobronchial mass

Mucormycosis is an opportunistic fungal infection that can infect different regions of the body. This entity may present in rhinocerebral, pulmonary, cutaneous, and disseminated forms. Although pulmonary mucormycosis is usually seen as an invasive parenchymal consolidation or cavitation, it may rarely present as an endobronchial mass. We describe a case of endobronchial mucormycosis in which the fungal mass was completely removed via rigid bronchoscopy before medical therapy.