1
|
Dar N, Wills A, Berg S, Gradecki SE, Cropley TG, Guffey D. Cutaneous mucormycosis with suspected dissemination in a patient with metastatic adrenocortical carcinoma. Med Mycol Case Rep 2024; 44:100646. [PMID: 38623179 PMCID: PMC11017034 DOI: 10.1016/j.mmcr.2024.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Mucormycosis is a frequently lethal fungal infection that most commonly affects patients with poorly controlled diabetes or other immunosuppressed states. We report the case of a suspected disseminated Rhizopus infection in a patient who was pursuing naturopathic treatment including mud baths for metastatic adrenocortical carcinoma. He was empirically treated with liposomal amphotericin B but opted to stop treatment following multiorgan failure. The patient passed away on the tenth day of his hospital admission.
Collapse
Affiliation(s)
- Nakul Dar
- School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Abigail Wills
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Scott Berg
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Sarah E. Gradecki
- Department of Pathology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Thomas G. Cropley
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Darren Guffey
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| |
Collapse
|
2
|
Zhou EM, Chen XA, Zhou MM, Xu LY, Wang D, Shen HP, Xu WQ. Dissecting the genome sequence of a clinical isolated Cunninghamella bertholletiae Z2 strain with rich cytochrome P450 enzymes (Article). Infect Genet Evol 2024; 120:105575. [PMID: 38403034 DOI: 10.1016/j.meegid.2024.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Mucormycosis is receiving much more attention because of its high morbidity and extremely high mortality rate in immunosuppressed populations. In this study, we isolated a Cunnignhamella bertholletiae Z2 strain from a skin lesion of a 14 year, 9 months old girl with acute lymphoblastic leukemia who die of infection from the Z2 strain. Genome sequencing was performed after isolation and amplification of the Z2 strain to reveal potential virulence factors and pathogenic mechanisms. The results showed that the genome size of the Z2 strain is 30.9 Mb with 9213 genes. Mucoral specific virulence factor genes found are ARF, CalN, and CoTH, while no gliotoxin biosynthesis gene cluster was found, which is a known virulence factor in Aspergillus fumigatus adapted to the environment. The Z2 strain was found to have 69 cytochrome P450 enzymes, which are potential drug resistant targets. Sensitivity testing of Z2 showed it was only inhibited by amphotericin B and posaconazole. Detailed genomic information of the C. bertholletiae Z2 strain may provide useful data for treatment.
Collapse
Affiliation(s)
- En-Min Zhou
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China
| | - Xin-Ai Chen
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Ming-Ming Zhou
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China
| | - Li-Yao Xu
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China
| | - Di Wang
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China
| | - He-Ping Shen
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China
| | - Wei-Qun Xu
- Children's Hospital, Zhejiang University School of Medicine(ZCH), Hangzhou 310058, China.
| |
Collapse
|
3
|
Urbain J, Dinahet T, Martin O, Lukaszewicz AC, Mojallal AA, Lherm M. [Local administration of amphotericin B by VAC instillation: Therapeutic aid in the treatment of mucormycosis]. ANN CHIR PLAST ESTH 2024; 69:222-227. [PMID: 37596143 DOI: 10.1016/j.anplas.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/20/2023]
Abstract
Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement.
Collapse
Affiliation(s)
- J Urbain
- Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France; Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
| | - T Dinahet
- Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France; Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - O Martin
- Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Service d'anesthésie réanimation, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - A C Lukaszewicz
- Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Service d'anesthésie réanimation, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - A-A Mojallal
- Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France; Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - M Lherm
- Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France; Centre de traitement des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| |
Collapse
|
4
|
Chen F, Shao Y, Huang Q, Chen Y, Yang B, Jiang L. Visual function loss in fungal sphenoid sinusitis: clinical characteristics and outcomes. Sci Rep 2024; 14:8649. [PMID: 38622183 PMCID: PMC11018747 DOI: 10.1038/s41598-024-59107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
Potentially fatal fungal sphenoid sinusitis (FSS) causes visual damage. However, few studies have reported on its visual impairment and prognosis. Five hundred and eleven FSS patients with ocular complications treated at Beijing Tongren Hospital were recruited and clinical features and visual outcomes were determined. Thirty-two of the 511 patients (6%) had visual impairment, with 13 and 19 patients having invasive and noninvasive FSS, respectively. Eighteen patients (56.25%) had diabetes and 2 patient (6.25%) had long-term systemic use of antibiotics (n = 1) and corticosteroids (n = 1). All patients had visual impairment, which was more severe in invasive FSS than in noninvasive FSS. Bony wall defects and sclerosis were observed in 19 patients (59.38%), and 11 patients (34.38%) had microcalcification in their sphenoid sinusitis on computed tomography (CT). After a 5-year follow-up, three patients (9.38%) died. Patients with noninvasive FSS had a higher improvement rate in visual acuity than their counterparts. In the multivariate analysis, sphenoid sinus wall sclerosis on CT was associated with better visual prognosis. FSS can cause vision loss with persistent headaches, particularly in those with diabetes. CT showed the sphenoid sinus wall sclerosis, indicating a better visual prognosis in FSS with visual impairment.
Collapse
Affiliation(s)
- Fei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100010, China
- Department of Ophthalmology, Tengzhou Central People's Hospital, No.181 Xingtan Road, Tengzhou City, 277500, Shandong Province, China
| | - Yonghui Shao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100010, China
| | - Qian Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100010, China
| | - Yue Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100010, China
| | - Bentao Yang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100010, China
| | - Libin Jiang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100010, China.
| |
Collapse
|
5
|
Kudva A, Saha M, G S, S A, Sharma S. Nintedanib-induced osteomyelitis of the jaw against the background of COVID-19 infection. J Stomatol Oral Maxillofac Surg 2024; 125:101651. [PMID: 37778458 DOI: 10.1016/j.jormas.2023.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Various medications are administered to treat Coronavirus Disease 2019 (COVID-19) infection and prevent its complications. Some medicines have complications and long-term effects, which may mimic other conditions, making precise diagnosis difficult. This report aims to bring to light one such complication, medication-related osteonecrosis of the jaw (MRONJ), secondary to a commonly prescribed medication for preventing lung fibrosis post-COVID-19 infection. METHOD A 33-year-old male reported to our department with the typical clinical and radiological features of Mucormycosis of the upper jaw post-COVID-19 infection. However, on detailed evaluation of his history (controlled diabetic and short duration of steroid therapy) and review of the mycology staining, bacteriology, culture, and histopathological reports, we came to a negative diagnosis for Mucormycosis. The patient was, however, on treatment for the prevention of lung fibrosis with Nintedanib (tyrosine kinase inhibitor) 150 mg twice a day for one month. RESULT In the absence of predisposing factors and negative laboratory findings for mucormycosis, we arrived at a diagnosis of MRONJ, attributable to Nintedanib therapy given to prevent lung fibrosis post-COVID-19 infection. CONCLUSION The use of Nintedanib has recently increased due to the high incidence of lung fibrosis post-COVID-19 infection. However, Nintedanib should be considered a causative agent for osteonecrosis of the jaw in the absence of other obvious predisposing factors. Therefore, Nintedanib must be administered after a thorough consideration of risk factors.
Collapse
Affiliation(s)
- Adarsh Kudva
- Department Of Oral and Maxillofacial Surgery, Manipal College Of Dental Sciences, MAHE, Manipal, India
| | - Mehul Saha
- Department Of Oral and Maxillofacial Surgery, Manipal College Of Dental Sciences, MAHE, Manipal, India
| | - Srikanth G
- Department Of Oral and Maxillofacial Surgery, Manipal College Of Dental Sciences, MAHE, Manipal, India
| | - Arun S
- Department Of Oral and Maxillofacial Surgery, Manipal College Of Dental Sciences, MAHE, Manipal, India.
| | - Swati Sharma
- Department of Pathology, Kasturba Medical College, MAHE, Manipal, India
| |
Collapse
|
6
|
Panda S, Sahu MC, Turuk J, Pati S. Mucormycosis: A Rare disease to Notifiable Disease. Braz J Microbiol 2024:10.1007/s42770-024-01315-z. [PMID: 38561499 DOI: 10.1007/s42770-024-01315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is the third most frequent invasive mycosis, following candidiasis and aspergillosis. It is frequently neglected due to its rare occurrence; but recently attend the status of notifiable disease due to its higher incidence in both developed and developing nations. India has received global notice since its estimated instances were greater than the global estimated figures. Mucormycosis has several clinical manifestations, including rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and diffuse Mucormycosis. ROCM is the most frequent clinical manifestation in India, although pulmonary mucormycosis is prevalent worldwide. This review also discusses host defenses, pre disposing risk factors and fungal virulence factors that impair host's ability to prevent fungus invasion and disease establishment. The diagnosis of the disease depends on clinical interventions, histological or microbiological procedures along with molecular methods to obtain timely results. But there are still unmet challenges for rapid diagnosis of the disease. Treatment of the disease is achieved by multimodal approaches such as reversal of underlying predisposing factors, rapid administration of antifungals in optimal doses and surgical procedures to remove infected tissues. Liposomal Amphotericin B, Posaconazole and Isavuconazoles are preferred as the first line of treatment procedures. clinical trials. Different studies have improved the existing drug and under clinical trials while several studies predicted the new potential targets as CotH and Ftr1 as shown in infection and in vitro models. Therefore, current scenario demands a multidisciplinary approach is needed to investigate the prevalence, pathogenesis which is highly important for the advancement of rapid diagnosis and effective treatment.
Collapse
Affiliation(s)
- Sunita Panda
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | | | - Jyotirmayee Turuk
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India.
| | - Sanghamitra Pati
- Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India.
| |
Collapse
|
7
|
Jain AK, Gupta Y, Verma J, Godha S, Prajapati IP. Minimizing the Recurrence Rate in Covid Associated Mucormycosis: Our Experience in 500 Patients. Indian J Otolaryngol Head Neck Surg 2024; 76:1898-1902. [PMID: 38566733 PMCID: PMC10982205 DOI: 10.1007/s12070-023-04442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/08/2023] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is an aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. The main aim of this article is to emphasize over the knowledge of different diagnostic methods (diagnostic nasal endoscopy, ct/ contrast mri pns + orbit + brain, Wet KOH mount), the importance of practising an aggressive surgical resection, medical treatments (liposomal amphotericin B, amphotericin gel, tablet posaconazole, nasal douching, retrorbital amphotericin injection), suction cleaning and regular follow up of the patient after surgical management. This can greatly help in minimizing the recurrence of mucormycosis even in immunocompromised patients in a population. The study performed was a prospective study conducted from April 2021 to July 2021 in which we included 500 patients who presented to the OPD & Department of ENT or Emergency Department of Maharaja Yashwantrao Hospital with complaints suggestive of mucormycosis. The patients who were surgically fit were operated. Out of the 500 patients who were diagnosed with Mucormycosis, from April 2021 to July 2021 complete cure was achieved in 456 patients( 91.2%) and only 44 patients (8.8%) have shown recurrence due to various causes (specially those who did not came for regular follow up). Rhinorbital was the most common site to be involved. In the study it was found that most of the patients which showed recurrence were male, post covid and immunocompromised. Diabetes mellitus was found to be most common among immunocompromised patients. The recurrence in patients with mucormycosis can be minimise by educating the masses regarding importance of public and personal hygiene, and multidisciplinary management with regular follow up offers a better approach to treat this life-threatening condition. The study shows the importance of clinical diagnosis, concurrent surgical treatment, medical treatment, post op care, suction cleaning and regular follow up advice. It is necessary us to take the step forward in this regard, so that in the future we will be better prepared for such type of epidemic.
Collapse
Affiliation(s)
- Anchal Kumar Jain
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
- Indore, India
| | - Yamini Gupta
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Jagram Verma
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Surbhi Godha
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
| | - Indra Prakash Prajapati
- Department of Otorhinolaryngology, MGM Medical College, Madhya Pradesh Indore, India
- Indore, India
| |
Collapse
|
8
|
Ajdari A, Zolfagharypoor A, Firouzifar M, Akbarpour M. Rhinocerebral mucormycosis in immunocompetent patients: a case report and review of literature. Infection 2024; 52:673-684. [PMID: 38153685 DOI: 10.1007/s15010-023-02147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Mucormycosis of the head and neck region is a rare but aggressive fungal infection that usually involves immunocompromised patients. More infrequently, this infection can also occur in people with no otherwise known underlying immunological deficit. This rarity usually causes a delay in diagnosis and may severely decrease the chance of survival in these patients. In this study, we present an extreme case of mucormycosis in an immunocompetent patient. By conducting a thorough review of the literature, we aim to increase our knowledge on this matter. Our goal is to improve diagnosis and start treatment at an earlier stage. CASE PRESENTATION AND METHODS Our patient was a 31-year-old man who presented with bilateral face numbness, neck pain, headache, and a necrotic palatal lesion 45 days after a dental root canal procedure. There was extensive involvement of facial and skull base bony and soft tissues. Through two debridement sessions and intravenous antifungal treatment, the patient was discharged with near-complete disease resolution. We identified 48 cases in the literature that matched our study criteria. We searched the current literature for proven cases of mucormycosis in the head and neck region who didn't have any underlying disease. We extracted their data and added the data of our patient. Then, we re-analyzed them using descriptive analysis, chi-square, and binary logistic regression to better understand the different factors for survival and disease burden in these patients. RESULTS 49 patients were analyzed in this study. The mean age was 46.93 ± 15.75 (min 16 and max78 years old). The most prevalent subsite to be involved was the sino-nasal mucosa, followed by the surrounding soft tissues and the orbit. While both orbit and intracranial tissue involvement differed significantly between surviving and deceased patients, only intracranial tissue involvement could be used to predict survival. The overall survival rate was 91.8%. CONCLUSION Although very rare, mucormycosis can occur in immunocompetent patients. Physicians should consider mucormycosis when faced with refractory conditions and unusual symptoms such as exposed bones, facial numbness, headaches, and intractable pain. Complementary imaging (CT scan with or without MRI) and histopathological examination are critical for timely diagnosis or exclusion of this potentially fatal yet treatable disease.
Collapse
Affiliation(s)
- Atra Ajdari
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Zolfagharypoor
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maliheh Akbarpour
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
9
|
Lamoth F, Kontoyiannis DP. PCR diagnostic platforms for non- Aspergillus mold infections: ready for routine implementation in the clinic? Expert Rev Mol Diagn 2024; 24:273-282. [PMID: 38501431 DOI: 10.1080/14737159.2024.2326474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION While Aspergillus spp. remain the predominant cause of invasive mold infections, non-Aspergillus molds, such as the Mucorales or Fusarium spp., account for an increasing proportion of cases. The diagnosis of non-Aspergillus invasive mold infections (NAIMI) is challenging because of the low sensitivity and delay of conventional microbiological tests. Therefore, there is a particular interest to develop molecular tools for their early detection in blood or other clinical samples. AREAS COVERED This extensive review of the literature discusses the performance of Mucorales-specific PCR and other genus-specific or broad-range fungal PCR that can be used for the diagnosis of NAIMI in diverse clinical samples, with a focus on novel technologies. EXPERT OPINION PCR currently represents the most promising approach, combining good sensitivity/specificity and ability to detect NAIMI in clinical samples before diagnosis by conventional cultures and histopathology. Several PCR assays have been designed for the detection of Mucorales in particular, but also Fusarium spp. or Scedosporium/Lomentospora spp. Some commercial Mucorales PCRs are now available. While efforts are still needed for standardized protocols and the development of more rapid and simpler techniques, PCR is on the way to becoming an essential test for the early diagnosis of mucormycosis and possibly other NAIMIs.
Collapse
Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
10
|
Nayaka Basavanthappa P, Narayana Murthy C, Nandyal SS, Radhika TM. Effect of High Serum Ferritin on Extent of Involvement of COVID-19 Associated Mucormycosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1857-1861. [PMID: 38566737 PMCID: PMC10982228 DOI: 10.1007/s12070-023-04428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
Coronavirus disease 2019 attributed to severe acute respiratory syndrome has been implicated with life threatening opportunistic infections like mucormycosis. COVID-19 is a hyperferritinemic syndrome and emerging data project the role of iron in the susceptibility and pathogenesis of mucormycosis but whether high ferritin is an indicator of severity of mucormycosis is debated. The study aimed to determine the relationship between serum ferritin levels and the extent of involvement of COVID-19 associated mucormycosis. A hospital based observational study was conducted with a sample size of 70. All biopsy confirmed cases of COVID-19 associated mucormycosis were included. Retrospective data from hospital records prepared at the time of patient admission were retrieved. The imaging data was used to determine the extent of disease involvement and serum ferritin values were analysed. During the study period 40 patients had mild extent mucormycosis and 30 had severe extent. A statistically significant difference was seen in levels of serum ferritin between mild extent mucormycosis and severe extent involvement (p < 0.01). COVID-19 associated Mucormycosis patients tend to have higher serum ferritin values especially in severe extent disease and with active COVID-19 infection along with diabetes mellitus as a potent aggravating factor.
Collapse
Affiliation(s)
- Prahlada Nayaka Basavanthappa
- Department of ENT-Head and Neck surgery, Skull base surgery, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka 577501 India
| | - C Narayana Murthy
- Department of Pathology, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka 577501 India
| | - Sonam S. Nandyal
- Department of Pathology, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka 577501 India
| | - T. M Radhika
- Department of Pathology, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka 577501 India
| |
Collapse
|
11
|
Sharma A, Godha S, Verma J, Bhalot L, Gupta Y, Mundra RK. Novel Grading System Based on Nasal Endoscopy: Our Experience with 650 Mucormycosis Cases. Indian J Otolaryngol Head Neck Surg 2024; 76:1667-1673. [PMID: 38566709 PMCID: PMC10982223 DOI: 10.1007/s12070-023-04380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Rhinocerebralmucormycosis, is a progressive fungal invasion of a hard palate, paranasal sinuses, orbit, and brain. Post covid the huge number of mucor cases reported in our institute. To combat them a uniform assessment scale was needed as multiple healthcare workers were involved. Thus, a novel linear grading system on nasal endoscopy was developed for the early management of patients to prevent morbidity and mortality. A Prospective study of 650 patients in Epidemic duration from April to June 2021 in a tertiary health center, Central India. Patients subjected to Nasal Endoscopy with 0degree 4 mm Telescope and classified into 5 categories according to the severity of the disease. In a novel grading system, minimum patients were of grade 0, maximum was in Grade I. Maxillary sinus was most commonly involved. This novel grading system on nasal endoscopy makes the management of patients much easier in an epidemic, reducing human errors, morbidity, and mortality of the fulminant disease.
Collapse
Affiliation(s)
- Anshul Sharma
- Department of Otorhinolaryngology, Gandhi Medical College, Bhopal, MP India
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
| | - Surbhi Godha
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
| | - Jagram Verma
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
| | - Lokesh Bhalot
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
- Department of Otorhinolaryngology, Government Medical College, 289, Kasturba Nagar, Ratlam, MP India
| | - Yamini Gupta
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
| | - R. K. Mundra
- Department of Otorhinolaryngology, M.G.M Medical College, Indore, MP India
| |
Collapse
|
12
|
Mortada H, Albrahim R, Alrobaiea S, Ahmad M, Abdelraheem EHA, Hakami M. A rare case of mucormycosis in a diabetic patient: diagnostic challenges and clinical management of mucormycosis hand infection. Case Reports Plast Surg Hand Surg 2024; 11:2333879. [PMID: 38567104 PMCID: PMC10986432 DOI: 10.1080/23320885.2024.2333879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Mucormycosis hand infection in poorly controlled diabetic presented as rapidly progressive swelling, redness, pain, and necrosis unresponsive to antibiotics. Prompt diagnosis and aggressive surgery, antifungals, and diabetes management were critical, highlighting the need for early recognition and treatment of mucormycosis in diabetics.
Collapse
Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Razan Albrahim
- College of Medicine and Surgery, Princess Noura Bin Abdulrahman University, Riyadh, Saudi Arabia
| | - Saad Alrobaiea
- Department of Plastic Surgery and Burn Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Moinuddin Ahmad
- Division of Plastic Surgery, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Muath Hakami
- Division of Plastic Surgery, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Bellanger AP, Gbaguidi-Haore H, Berceanu A, Gouzien L, El Machhour C, Bichard D, Lanternier F, Scherer E, Millon L. Use of the Mucorales qPCR on blood to screen high-risk hematology patients is associated with better survival. Med Mycol 2024; 62:myae030. [PMID: 38533663 DOI: 10.1093/mmy/myae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
Our objective was to determine whether the twice-weekly screening of high-risk hematology patients by Mucorales qPCR on serum affects the prognosis of mucormycosis. Results from all serum Mucorales qPCR tests performed on patients from the hematology unit from January 2017 to December 2022 were analyzed. Patients with positive results were classified as having proven, probable or 'PCR-only' mucormycosis. One-month mortality for the local cohort was compared with that of a national cohort of cases of mucormycosis collected by the French surveillance network for invasive fungal disease ('Réseau de surveillances des infections fongiques invasives en France' (RESSIF)) from 2012 to 2018. From 2017 to 2022, 7825 serum Mucorales qPCR tests were performed for patients from the hematology unit; 107 patients with at least one positive Mucorales qPCR (164 positive samples) were identified. Sixty patients (70 positive samples, median Cq = 40) had no radiological criteria for mucormycosis and were considered not to have invasive fungal disease (70/7825, 0.9% false positives). It was not possible to classify disease status for six patients (12 positive samples, median Cq = 38). Forty-one patients (82 positive samples, median Cq = 35) had a final diagnosis of mucormycosis. In comparison with the RESSIF cohort, the local cohort was independently associated with a 48% lower one-month all-cause mortality rate (age-, sex-, and primary disease-adjusted hazard ratio = 0.52; 95% confidence interval: 0.29-0.94; P 0.03). Proactive screening for invasive mold diseases in high-risk hematology patients, including twice-weekly Mucorales qPCR on serum, was associated with mucormycosis higher survival.
Collapse
Affiliation(s)
- Anne-Pauline Bellanger
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
| | - Houssein Gbaguidi-Haore
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
- Infection Control Department, University Hospital of Besançon, Besançon, France
| | - Ana Berceanu
- Hematological Intensive Care Unit, University Hospital of Besançon, Besançon, France
| | - Laura Gouzien
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Chaima El Machhour
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
| | - Damien Bichard
- Pharmacy Department, University Hospital of Besançon, Besançon, France
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - Emeline Scherer
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
| | - Laurence Millon
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
| |
Collapse
|
14
|
Pandey M, Xess I, Sachdev J, Sharad N, Gupta S, Singh G, Yadav RK, Rana B, Raj S, Ahmad MN, Nityadarshini N, Baitha U, Soneja M, Shalimar, Prakash B, Sikka K, Mathur P, Jyotsna VP, Kumar R, Wig N, Gourav S, Biswas A, Thakar A. Utility of an in-house real-time PCR in whole blood samples as a minimally invasive method for early and accurate diagnosis of invasive mould infections. J Infect 2024; 88:106147. [PMID: 38555035 DOI: 10.1016/j.jinf.2024.106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Invasive mould infections (IMIs) are a leading cause of death in patients with compromised immune systems. Proven invasive mould infection requires detection of a fungus by histopathological analysis of a biopsied specimen, sterile culture, or fungal DNA amplification by PCR in tissue. However, the clinical performance of a PCR assay on blood samples taken from patients suspected of invasive mould disease has not been fully evaluated, particularly for the differential diagnosis of invasive aspergillosis (IA) and invasive Mucormycosis (IM). OBJECTIVES To assess the diagnostic utility of our previously validated in-house real-time PCR in blood samples for diagnosis of invasive aspergillosis and mucormycosis in patients with suspected invasive mould infection. METHODS All patients with suspected invasive mould infection were prospectively enrolled from May 2021 to July 2021. Conventional fungal diagnosis was performed using tissue and respiratory samples. In-house PCR was performed on blood samples and its diagnostic performance evaluated. RESULTS A total of 158 cases of suspected invasive mould infection were enrolled in the study. The sensitivity and specificity of in-house PCR performed on blood samples was found to be 92.5% and 81.4% respectively for diagnosis of probable IA, and 65% and 84.62% respectively for diagnosis of proven and probable IM. It was also able to detect 3 out of 5 cases of possible IM where no other microbiological evidence of IM was obtained. CONCLUSIONS This assay could be helpful in minimally invasive diagnosis of IMIs for patients in whom invasive sampling is not feasible, especially as a preliminary or screening test. It can help in early diagnosis, anticipating conventional laboratory confirmation by days or weeks. Possible correlation between fungal load and mortality can help in initiating aggressive treatment for patients with high initial fungal load.
Collapse
Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Sharad
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonakshi Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Renu Kumari Yadav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Rana
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Stephen Raj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M Nizam Ahmad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Nityadarshini
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudesh Gourav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Osorio-Concepción M, Lax C, Lorenzo-Gutiérrez D, Cánovas-Márquez JT, Tahiri G, Navarro E, Binder U, Nicolás FE, Garre V. H3K4 methylation regulates development, DNA repair, and virulence in Mucorales. IMA Fungus 2024; 15:6. [PMID: 38481304 PMCID: PMC10938801 DOI: 10.1186/s43008-023-00136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Mucorales are basal fungi that opportunistically cause a potentially fatal infection known as mucormycosis (black fungus disease), which poses a significant threat to human health due to its high mortality rate and its recent association with SARS-CoV-2 infections. On the other hand, histone methylation is a regulatory mechanism with pleiotropic effects, including the virulence of several pathogenic fungi. However, the role of epigenetic changes at the histone level never has been studied in Mucorales. Here, we dissected the functional role of Set1, a histone methyltransferase that catalyzes the methylation of H3K4, which is associated with the activation of gene transcription and virulence. A comparative analysis of the Mucor lusitanicus genome (previously known as Mucor circinelloides f. lusitanicus) identified only one homolog of Set1 from Candida albicans and Saccharomyces cerevisiae that contains the typical SET domain. Knockout strains in the gene set1 lacked H3K4 monomethylation, dimethylation, and trimethylation enzymatic activities. These strains also showed a significant reduction in vegetative growth and sporulation. Additionally, set1 null strains were more sensitive to SDS, EMS, and UV light, indicating severe impairment in the repair process of the cell wall and DNA lesions and a correlation between Set1 and these processes. During pathogen-host interactions, strains lacking the set1 gene exhibited shortened polar growth within the phagosome and attenuated virulence both in vitro and in vivo. Our findings suggest that the histone methyltransferase Set1 coordinates several cell processes related to the pathogenesis of M. lusitanicus and may be an important target for future therapeutic strategies against mucormycosis.
Collapse
Affiliation(s)
- Macario Osorio-Concepción
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Carlos Lax
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Damaris Lorenzo-Gutiérrez
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | | | - Ghizlane Tahiri
- 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
| | - Ulrike Binder
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Francisco Esteban Nicolás
- 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.
| |
Collapse
|
16
|
Parashar A, Singh C. Angioinvasive mucormycosis in burn intensive care units: A case report and review of literature. World J Crit Care Med 2024; 13:86866. [PMID: 38633476 PMCID: PMC11019633 DOI: 10.5492/wjccm.v13.i1.86866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 12/01/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Mucormycosis is a rare, rapidly progressive and often fatal fungal infection. The rarity of the condition lends itself to unfamiliarity, delayed treatment, and poor outcomes. Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients. CASE SUMMARY An 11-year-old girl with a history of 15% total body surface area scald burns involving both lower limbs progressed to develop angioinvasive mucormycosis. This further led to a thrombosis of the right external iliac artery and vein and rapidly progressive necrosis of surrounding soft tissues. She also had dextrocardia and patent foramen ovale. A right hip disarticulation and serial aggressive debridements were performed but she went on to develop systemic sepsis with multisystem involvement and succumbed to the infection. Pathology revealed mucor species with extensive vascular invasion. CONCLUSION This case highlights the importance of maintaining vigilance for mycotic infections and acting appropriately when there are signs of fulminant wound infection.
Collapse
Affiliation(s)
- Atul Parashar
- Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Chandra Singh
- Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
17
|
Gupta N, Malla S, Tirlangi PK, Magazine R, Chandrashekar UK, Ravindra P, Bhat R, Varma M, Mukhopadhyay C. Reversed halo sign: Don't forget Melioidosis. J Travel Med 2024:taae036. [PMID: 38438163 DOI: 10.1093/jtm/taae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/16/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sundeep Malla
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Faridabad, India
| | - Praveen Kumar Tirlangi
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - U K Chandrashekar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Prithvishree Ravindra
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| |
Collapse
|
18
|
Al-Ghabra Y, Hamdi M, Alkheder A, Kammasha A, Shamso S, Mohsen ABA. Palatal mucormycosis in a 2-month-old child: A very rare case report and a literature review. Med Mycol Case Rep 2024; 43:100628. [PMID: 38318119 PMCID: PMC10840097 DOI: 10.1016/j.mmcr.2024.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
A 2-month-old Syrian male child presented with a large blackish ulcerating lesion on his hard palate, along with fever, diarrhea, vomiting, and milk regurgitation from the nose. The child was diagnosed with palatal mucormycosis by histopathology and underwent treatment with liposomal amphotericin B and surgical debridement. However, despite treatment, the child's condition deteriorated, and he died from respiratory failure. An underlying immunodeficiency was not diagnosed, but the family history revealed several deaths of the child's siblings at very early ages due to poorly documented complicated metabolic syndromes. An autopsy was refused by the parents due to cultural reasons.
Collapse
Affiliation(s)
- Yasser Al-Ghabra
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Hamdi
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Ahmad Alkheder
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Ahmad Kammasha
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Shams Shamso
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Adham Bader Aldeen Mohsen
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| |
Collapse
|
19
|
Lamoth F, Prakash K, Beigelman-Aubry C, Baddley JW. Lung and sinus fungal infection imaging in immunocompromised patients. Clin Microbiol Infect 2024; 30:296-305. [PMID: 37604274 DOI: 10.1016/j.cmi.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Imaging is a key diagnostic modality for suspected invasive pulmonary or sinus fungal disease and may help to direct testing and treatment. Fungal diagnostic guidelines have been developed and emphasize the role of imaging in this setting. We review and summarize evidence regarding imaging for fungal pulmonary and sinus disease (in particular invasive aspergillosis, mucormycosis and pneumocystosis) in immunocompromised patients. OBJECTIVES We reviewed data on imaging modalities and findings used for diagnosis of invasive fungal pulmonary and sinus disease. SOURCES References for this review were identified by searches of PubMed, Google Scholar, Embase and Web of Science through 1 April 1 2023. CONTENT Computed tomography imaging is the method of choice for the evaluation of suspected lung or sinus fungal disease. Although no computed tomography radiologic pattern is pathognomonic of pulmonary invasive fungal disease (IFD) the halo sign firstly suggests an angio-invasive pulmonary aspergillosis while the Reversed Halo Sign is more suggestive of pulmonary mucormycosis in an appropriate clinical setting. The air crescent sign is uncommon, occurring in the later stages of invasive aspergillosis in neutropenic patients. In contrast, new cavitary lesions should suggest IFD in moderately immunocompromised patients. Regarding sinus site, bony erosion, peri-antral fat or septal ulceration are reasonably predictive of IFD. IMPLICATIONS Imaging assessment of the lung and sinuses is an important component of the diagnostic work-up and management of IFD in immunocompromised patients. However, radiological features signs have sensitivity and specificity that often vary according to underlying disease states. Periodic review of imaging studies and diagnostic guidelines characterizing imaging findings may help clinicians to consider fungal infections in clinical care thereby leading to an earlier confirmation and treatment of IFD.
Collapse
Affiliation(s)
- Frederic Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratory Medicine and Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katya Prakash
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Catherine Beigelman-Aubry
- Radiodiagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John W Baddley
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
20
|
Mojtahedi SS, Zarrinfar H, Bakhshaee M. Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis. Iran J Otorhinolaryngol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
21
|
Hai L, Li P, Xiao Z, Zhou J, Xiao B, Zhou L. Rhizopus microsporus and Mucor racemosus coinfection following COVID-19 detected by metagenomics next-generation sequencing: A case of disseminated mucormycosis. Heliyon 2024; 10:e25840. [PMID: 38370187 PMCID: PMC10869847 DOI: 10.1016/j.heliyon.2024.e25840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/27/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Mucormycosis is an invasive opportunistic fungal infection, which may be lethal and mostly affects patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. is the most common cause of mucormycosis, followed by genera such as Mucor and Lichtheimia. Here we report a patient with severe COVID-19 infection who developed nasal pain, facial swelling, prominent black eschar on the nasal root. CT scan revealed pansinusitis along the maxillary, ethmoidal, and sphenoid sinuses. Mixed mold infection with Rhizopus microsporus and Mucor racemosus was detected by blood metagenomics next-generation sequencing (mNGS) and later nasal mucosa histological investigation confirmed mucormycosis. Severe COVID-19 infection led to the patient's thrombocytopenia and leukopenia. Later disseminated mucormycosis aggravated the infection and sepsis eventually resulted in death. It is the first case report of mucormycosis in which R. microsporus and M. racemosus as the etiologic agents were found simultaneously in one patient. COVID-19 infection combined with disseminated mucormycosisis can be fatal and mNGS is a fast, sensitive and accurate diagnostic method for fungi detection.
Collapse
Affiliation(s)
- Lihan Hai
- Department of Neurology, Xing'an League People's Hospital, Ulanhot, Inner Mongolia, China
| | - Peihong Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zheng Xiao
- Department of Pathology, First Hospital of Changsha, Changsha, Hunan, China
| | - Jinxia Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Luo Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| |
Collapse
|
22
|
SamimiArdestani S, Firouzifar M, Akbarpour M, Karimi Yarandi K, SamimiArdestani S. Endoscopic Access to Brain Abscess Due to Sinonasal Infection. World Neurosurg 2024:S1878-8750(24)00319-X. [PMID: 38417625 DOI: 10.1016/j.wneu.2024.02.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Brain abscesses caused by sinonasal infections have become more common during the coronavirus pandemic, particularly due to the increase in sinonasal mucormycosis. This study aimed to evaluate the efficacy and safety of endoscopic endonasal brain abscess drainage as a therapeutic technique for these cases. METHODS Clinical outcomes and retrospective evaluations were performed in patients who underwent endoscopic endonasal brain abscess drainage between May 2019 and August 2022. A total of 7 patients diagnosed with 9 brain abscesses caused by sinonasal infections were included in the study. The main outcome of this study was to evaluate the success and safety of this technique. RESULTS The average age of the patients was 40.71 ± 14.17 years. The most common symptom observed in these patients was nasal discharge, and the frontal lobe was the most common site of abscess. Notably, the majority of cases were associated with COVID-19. CONCLUSIONS Based on the results of this study, endoscopic endonasal brain abscess drainage is considered a viable treatment option for skull base brain abscesses caused by sinonasal infections. Further research in this field can help establish this technique as a mainstay approach for managing brain abscesses at the skull base.
Collapse
Affiliation(s)
- SeyedHadi SamimiArdestani
- Otorhinolaryngology Research Center, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otorhinolaryngology Research Center, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Akbarpour
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Kourosh Karimi Yarandi
- Department of Neurosurgery, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
23
|
Tomer R, Patiyal S, Kaur D, Choudhury S, Raghava GPS. Genome-based solutions for managing mucormycosis. Adv Protein Chem Struct Biol 2024; 139:383-403. [PMID: 38448141 DOI: 10.1016/bs.apcsb.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
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/).
Collapse
Affiliation(s)
- Ritu Tomer
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi, India
| | - Sumeet Patiyal
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi, India
| | - Dilraj Kaur
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi, India
| | - Shubham Choudhury
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi, India
| | - Gajendra P S Raghava
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi, India.
| |
Collapse
|
24
|
Urias-Barreras CM, Rodríguez-Archilla A, Canizalez-Roman A, Bastidas DA, León-Sicairos NM. Maxillary mucormycosis and aspergillosis in post-COVID-19 patients in Mexico: A case series. J Stomatol Oral Maxillofac Surg 2024; 125:101615. [PMID: 37648209 DOI: 10.1016/j.jormas.2023.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Fungal infections, during or as a consequence of SARS-CoV-2 infection, associated with uncontrolled diabetes mellitus and indiscriminate use of corticosteroids have been reported. In the jaw, mostly mucormycosis has been diagnosed in hospitals. METHODS A retrospective, cross-sectional, descriptive study of the clinical, imaging, and histopathologic characteristics of maxillary invasive fungal infection in post-COVID-19 patients diagnosed in a private non-hospital oral pathology service in Mexico during 2020-2022 was conducted. RESULTS We found 20 cases of maxillary invasive fungal infections in post-COVID-19 patients, 75% including a diagnosis of mucormycosis and 25% diagnosed as probable aspergillosis. The most common signs and symptoms were exposed necrotic bone followed by tooth mobility, discharge, and pain. On imaging, unilateral maxillary sinus involvement was observed in 6 cases (30%), and bilateral maxillary sinus involvement was observed in 3 cases (15%). CONCLUSIONS It is essential to consider the association of osteonecrosis of the jaw in post-COVID-19 patients, with aspergillosis, not only mucormycosis, for early diagnosis and appropriate treatment.
Collapse
Affiliation(s)
- Cynthia M Urias-Barreras
- School of Dentistry, Autonomous University of Sinaloa, Culiacan, Sinaloa 80013, Mexico; Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Alberto Rodríguez-Archilla
- Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Secretariat of Health, The Women's Hospital, Culiacan, Sinaloa 80020, Mexico
| | - Daniela A Bastidas
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico
| | - Nidia M León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Departamento de Investigación, Hospital Pediátrico de Sinaloa "Dr. Rigoberto Aguilar Pico" Servicios de Salud de Sinaloa. Blvd. Constitución S/N, Colonia Jorge Almada, C.P, Culiacan, Sinaloa 80200, Mexico.
| |
Collapse
|
25
|
Muhammed N, Hiriyanna S, Prasad RS, Dakaraju SP, Reddy A, Das PJ, De Padua M, Singhal R, Mohan A. Pictorial Review of Post COVID-19 Acute Invasive Fungal Sinusitis: Clinical Radiologists' Perspective. Indian J Otolaryngol Head Neck Surg 2024; 76:392-402. [PMID: 38440560 PMCID: PMC10908705 DOI: 10.1007/s12070-023-04171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/20/2023] [Indexed: 03/06/2024] Open
Abstract
Acute invasive fungal sinusitis (AIFS) is a rapidly progressive infection predominantly seen in immunocompromised patients. There is an increasing incidence of AIFS post COVID-19 infection. Yet, there is sparse literature regarding spectrum of cross-sectional imaging findings (CT and MRI) in these patients, which is prudent for appropriate timely surgical intervention. This study aims to highlight spectrum of imaging findings in patients with post-COVID-19 AIFS integrating the clinical details from presentation to follow-up. We retrospectively reviewed the demographics, clinical details and radiological imaging of 31 histopathological proven cases of post COVID-19 AIFS. MR and CT images of these patients were retrieved from the PACS and analysed. 90-day follow-up of these patients was obtained. Statistical analysis was performed using descriptive statistics. Cross-sectional imaging showed nasal cavity involvement in all patients, bilateral in (15, 48%) cases; predominant involvement of maxillary (31, 100%) followed by ethmoid sinuses (29, 93.5%) was seen. MR showed patchy/complete loss of normal mucosal enhancement in the turbinates and sinuses as predominant imaging finding. Maxillary sinus walls erosions were seen in 28 cases (90%). Rhino-orbital and rhino-orbito-cerebral mycosis was seen in 24 (77%) and 14 (45%) respectively. Optic nerve-sheath complex was involved in 15 (48%) cases. Cerebral involvement was seen in form of meningeal enhancement, cerebritis, ischemic changes, cavernous sinus and intracranial arterial thrombosis and aneurysms. Comprehensive knowledge of imaging features of AIFS and recognition of extent of their spread allows radiologists to play pivotal role in alerting the clinician for appropriate therapy to avoid protracted and fatal outcome.
Collapse
Affiliation(s)
- Noamaan Muhammed
- Department of Radiology, Teleradiology Solutions, Bengaluru, 560048 India
- Apollo Hospital, Jubilee hills, Hyderabad, India
| | - Sneha Hiriyanna
- Department of Radiology, CMCH, Vellore, Tamil Nadu India
- Apollo Hospital, Jubilee hills, Hyderabad, India
| | - Ravikanti S. Prasad
- Department of Radiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500033 India
| | | | - Archana Reddy
- Department of Radiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500033 India
| | - Prabuddha Jyoti Das
- Department of Radiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500033 India
| | - Michelle De Padua
- Department of Pathology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500033 India
| | - Rajat Singhal
- Department of Radiology, CMCH, Vellore, Tamil Nadu India
| | - Akhila Mohan
- Department of Radiology, Goverment Medical College, Kochi, Kerala India
- Apollo Hospital, Jubilee hills, Hyderabad, India
| |
Collapse
|
26
|
Bhambhani D, Bhambhani G, Thomas S, Bhambhani S, Parlani S, Tandon R. Comparison Between Pre-COVID and Post-COVID Mucormycosis: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2024; 23:135-144. [PMID: 38312959 PMCID: PMC10831006 DOI: 10.1007/s12663-023-02028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/22/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Mucormycosis has emerged as one of the most fatal complications arising due to COVID-19, though it has to be mentioned that the disease is capable of causing serious illness even on its own. Objectives Through this investigation, we would review the threat that mucormycosis poses, in terms of its prevalence and degree of severity both in the pre- and post-COVID world. Materials and Methods A comprehensive examination of the studies published in online databases turned up 207 papers, 103 of which had undergone in-depth analysis, using both inclusion and exclusion criteria, shortlisting 15 studies that were appropriate for reviewing. Results The incidence of mucormycosis was linked to coronavirus in 7 of the 15 studies that were chosen. The remaining eight studies had sufferers of various systemic diseases, like HIV/AIDS and diabetes. Discussion All the cases suffered diabetes mellitus. Regardless of the time period of the chosen article, corticosteroids and antifungal medications were administered to all patients. There were noticeable differences in terms of mortality, predisposing factors, and virulence between pre-COVID and post-COVID mucormycosis. Summary and Conclusion The prevalence of systemic conditions such as diabetes in cases of mucormycosis has remained the same even after the incidence of this pandemic, showing that the basic treatment modalities continue to remain the same irrespective of the damage that corona virus has caused to the sufferer, although mucormycosis arising due to COVID-19 differs from mucormycosis that was incident before the advent of the pandemic.
Collapse
Affiliation(s)
| | - Garima Bhambhani
- Department of Public Health Dentistry, People’s College of Dental Sciences and Research Centre, Bhopal, 462037 India
| | - Shaji Thomas
- Department of Oral and Maxillofacial Surgery, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh 462037 India
| | - Suresh Bhambhani
- Department of General Medicine, Chirayu Medical College, Bhopal, Madhya Pradesh 462037 India
| | - Swapnil Parlani
- Department of Prosthodontics, Crown and Bridge, Bhopal, Madhya Pradesh 462037 India
| | - Riddhi Tandon
- Mahavir Institute of Medical Sciences and Research, Bhopal, India
| |
Collapse
|
27
|
Vasani A, Mistry S, Parmar S, Shah R. Ansel Mucormycosis Staging and Outcome Evaluation Score: Our Experience in Soaring Stage of Mucormycosis. Indian J Otolaryngol Head Neck Surg 2024; 76:118-122. [PMID: 38440620 PMCID: PMC10909059 DOI: 10.1007/s12070-023-04103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/24/2023] [Indexed: 03/06/2024] Open
Abstract
To propose Mucormycosis staging and Outcome evaluation score. (i) To provide method of conveying clinical experience to others without ambiguity. (ii) To facilitate an estimation of prognosis. (iii) To provide useful information for treatment decision. Retrospective observational study. Tertiary care center, Rajkot. 556 confirmed operated case of mucormycosis. It was a single center observational study of 556 confirmed cases of mucormycosis. In suspected cases of fungal infection, clinical symptoms were noted along with covid history and comorbid condition. Clinical findings were noted after nasal endoscopy. Rest neurological examination was done to rule out CNS involvement. Representative sample from nasal mucosa sent for microbiological examination. MRI PNS with Brain and Orbit was advised. After surgery, specimen was sent for histopathological confirmation. We reported most common age group was 51-60 years. 52% cases presented early with only nasal involvement and 1.8% cases with late cerebral involvement presentation. From recorded all above findings we have described this diseases progression in 4 components limited to nasal, orbital, palate and/or skull base, cerebral involvement. It is bases on anatomical progression on clinical and radiological findings. Considering all four components, staging system is designed that includes stage I to stage Vb. Outcome evaluation score designed to consider factors like patient's age, comorbidity, stage of disease while presentation, IV antifungal coverage and patient's psychological condition. Our clinical and radiological diagnostic staging and outcome evaluation score may helpful for others for early and better management of mucormycosis.
Collapse
|
28
|
Erami M, Raiesi O, Momen-Heravi M, Mirhendi H, Aboutalebian S, Getso MI, Matini AH, Ahsaniarani AH, Ganjizadeh M, Hassani Josheghani H, Amiri S, Pakzad R, Hashemi SJ. COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes. Infect Dis (Lond) 2024; 56:81-90. [PMID: 37816067 DOI: 10.1080/23744235.2023.2267669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran. METHODS A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination. RESULTS We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40-79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O2 required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO2 were also significantly higher in survivors than non-survivors. CONCLUSION Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.
Collapse
Affiliation(s)
- Mahzad Erami
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Raiesi
- Department of Parasitology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Head and Neck Surgery, Department, Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Ganjizadeh
- Kashan Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Sasan Amiri
- Roozbeh hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
29
|
Aggarwal A, Arora RD, Nagarkar NM, Banjare A. Covid-Associated Mucormycosis in a Case of Wegener's Granulomatosis: A Management Challenge. Indian J Otolaryngol Head Neck Surg 2024; 76:1033-1036. [PMID: 38440646 PMCID: PMC10908762 DOI: 10.1007/s12070-023-04096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 03/06/2024] Open
Abstract
A Gentleman in his 40s presented to us with left-sided hemifacial pain and nasal discharge for the last three days. He has been on immunosuppressive therapy for Wegener's Granulomatosis for over five years. Crusting was seen in the Left middle meatus upon clinical examination. Based on the post-covid status, steroid therapy, KOH mount, and radiologic imaging, a provisional diagnosis of Sinonasal mucormycosis was considered. He was posted for emergency debridement followed by Liposomal Amphotericin B and steroid therapy. Surgical histopathological specimens were suggestive of Mucormycosis. Limited sinonasal disease with no intracranial, orbital, or palatal involvement was seen in a background of Wegener's Granulomatosis, Covid, and immunosuppressive therapy. Steroids are condemned as a predisposing factor to mucormycosis. Still, the combination of Liposomal Amphotericin B and steroids was used, opening new avenues for managing mucormycosis in patients with vasculitis. The patient is well nine months post-surgery with no signs of disease relapse.
Collapse
Affiliation(s)
- Aakash Aggarwal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India
| | - Ripu Daman Arora
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India
| | - Nitin M. Nagarkar
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India
| | - Amit Banjare
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India
| |
Collapse
|
30
|
Gotecha S, Chugh A, Punia P, Lachake A. Endoscopic Transnasal Navigation Guided Treatment of Clivus Abscess in Adult with Mucormycosis: A Rare Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1066-1070. [PMID: 38440532 PMCID: PMC10908655 DOI: 10.1007/s12070-023-04117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 03/06/2024] Open
Abstract
Osteomyelitis and abscess of the clivus are rare conditions thought to arise from contiguous spread of infection from the paranasal sinuses. Clival osteomyelitis is a rare potentially life-threatening skull base infection which is generally challenging to diagnose and treat. It is typically seen in the pediatric population and is very rare in the adult population. The exact pathophysiology of osteomyelitis of the clivus is relatively uncertain. Here, we describe a case of a 32-year-old immunocompetent female with a primary complaint of headache, with no significant medical history of diabetes, hypertension or rhinosinusitis or SARS COV-2 for the past 18 months. This case report demonstrates an image-guided and endoscopic approach to surgical localization and treatment of abscesses in the clival area.
Collapse
Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra 411018 India
| | - Ashish Chugh
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra 411018 India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra 411018 India
| | - Apurva Lachake
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra 411018 India
| |
Collapse
|
31
|
Kurien R, Varghese L, Cherian LM, Inja RR, Thampi M, Chowdhary S, Bright RR, Abraham L, Panicker R, Rajendran N, Ganesan P, Sahu S, Irodi A, Manesh A, Peter J, Michael JS, Thomas M, Karuppusami R, Varghese GM, Rupa V. A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 2024; 76:611-619. [PMID: 38440599 PMCID: PMC10909060 DOI: 10.1007/s12070-023-04226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.
Collapse
Affiliation(s)
- Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Ranjeetha Racheal Inja
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Manu Thampi
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Stuti Chowdhary
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Rakesh R Bright
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Abraham
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Raga Panicker
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Nithya Rajendran
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Priya Ganesan
- Department of Emergency Medicine, Christian Medical College, Vellore, 632004 India
| | - Shalini Sahu
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Aparna Irodi
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College, Vellore, 632004 India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, 632004 India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002 India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| |
Collapse
|
32
|
de Lucena LA, de Oliveira FG, de Andrade MMP, de Paula KC, Praxedes MRG, de Oliveira RA. Mucormycosis-induced hypercalcemia: a case report. CEN Case Rep 2024; 13:66-71. [PMID: 37289341 PMCID: PMC10248959 DOI: 10.1007/s13730-023-00800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Hypercalcemia is a vital laboratory marker because it can show underlying severe diseases like cancer and infections. Of all the causes of hypercalcemia, primary hyperparathyroidism, and malignancies are the most common, but granulomatous diseases, such as certain fungal infections, can also be the cause. Here we describe the case of a 29-year-old woman, an insulin-dependent diabetic, found unconscious and tachypneic at home. In the emergency room, the medical team diagnosed diabetic ketoacidosis (DKA) and acute kidney injury (AKI). During hospitalization, despite resolving acidemia, persistent hypercalcemia attracted attention. Laboratory tests showed decreased parathyroid hormone (PTH) levels, confirming non-PTH-dependent hypercalcemia. Computed tomography (CT) of the chest and abdomen demonstrated no alterations, but an upper digestive endoscopy revealed an ulcerated and infiltrative lesion in the stomach. A biopsy showed a granulomatous infiltrate due to mucormycosis infection. The patient received liposomal amphotericin B for 30 days and isavuconazonium for two months. Serum calcium levels improved during treatment. Inquiry of the etiology of hypercalcemia should begin with the PTH assay; high levels are consistent with hyperparathyroidism; low levels, with calcium or vitamin D intoxication, malignancies, prolonged immobilization, and granulomatous diseases. In the latter cases, the overproduction of 1-alpha-hydroxylase by the granulomatous tissue increases the conversion of 25(OH)vitamin D into 1-25(OH)vitamin D, which causes the intestinal absorption of calcium. We have described the first hypercalcemia related to mucormycosis infection in a young diabetic patient, although case presentations associate other fungal infections with elevated serum calcium.
Collapse
Affiliation(s)
- Larissa Araújo de Lucena
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil
| | | | | | | | | | - Rodrigo Azevedo de Oliveira
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil.
- Casa de Saúde São Lucas, CSSL, Natal, 59020-160, Brazil.
| |
Collapse
|
33
|
Ji R. Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report. BMC Infect Dis 2024; 24:136. [PMID: 38287258 PMCID: PMC10823596 DOI: 10.1186/s12879-023-08220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/04/2023] [Indexed: 01/31/2024] Open
Abstract
Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
Collapse
Affiliation(s)
- Ran Ji
- Department of the Surgical Intensive Care Unit (SICU), The Second Affiliated Hospital Zhejiang, University School of Medicine, NO. 88 Jiefang Road,Shangcheng District Hangzhou, 310009, Zhejiang, China.
| |
Collapse
|
34
|
Kaur G, Kaur R, Kaur S, Kaur M. Association of COVID with Mycosis in General. Infect Disord Drug Targets 2024; 24:IDDT-EPUB-137573. [PMID: 38251692 DOI: 10.2174/0118715265266815231130063931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 is a respiratory disease which created havoc worldwide, was accompanied by another peculiar, otherwise rare, secondary fungal infection Mucormycosis which was observed at exceptionally high incidence in India during the second wave of COVID-19. The article explores possible links between the two infectious diseases to understand a higher-than-normal occurrence of Mucormycosis in COVID-19 patients. Coronavirus enters the patients through ACE-2 and many other receptors like- NRP-1, TfR, CD-126, and CD-26. Virus bind to cells possessing these receptors and affect their proper functioning, disturbing homeostatic metabolism and resulting in conditions like hyperglycemia, Diabetic Ketoacidosis (DKA), low serum pH, iron overload, anemia, hypoxia, and immunosuppression as explained in the article. All these outcomes provide a very supportive environment for the attack and spread of Mucormycosis fungi. The major receptor for Mucormycosis in humans is the GRP-78. Its expression is upregulated by coronavirus entry and by hyperferritinemia, hyperglycemia, and acidic conditions prevalent in COVID patients, thus providing an easy entry for the fungal species. Upregulation of GRP-78 furthermore damages pancreatic β-cells and intensifies hyperglycemia, showing quite a synergic relationship. Inordinate rise of Mucormycosis cases in India might be explained by facts like- India possessing a large proportion of diabetic patients, emergence of a very deadly strain of coronavirus- Delta strain, higher doses of steroids and antibodies used to treat patients against this strain, overburdened health care services, sudden much higher need of oxygen supply and use of industrial oxygen could explain the Mucormycosis outbreak observed in India during the second wave of COVID-19. OBJECTIVE The present review discusses the functional interdependence between COVID-19 and Mucormycosis and summarizes the possible synergic links between COVID and Mucormycosis. CONCLUSION The receptors and metabolic pathways affected by COVID-19 result in severe physiological conditions- hyperglycemia, DKA, anemia, iron overload, immunosuppression, and hypoxia. All these conditions not only increase the expression of GRP-78, the major receptor for entry of fungi but also play a crucial role in providing quality media for Mucormycosis fungus to establish and grow. Hence explains the fungal epidemic observed in India during the second wave of COVID-19 in India.
Collapse
Affiliation(s)
- Gurpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala- 147002, India
| | - Rajinder Kaur
- Department of Human Genetics, Punjabi University, Patiala- 147002, India
| | - Sumanpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala- 147002, India
| | - Manpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala- 147002, India
| |
Collapse
|
35
|
Sasani E, Pakdel F, Khodavaisy S, Salehi M, Salami A, Sohrabi M, Aminishakiba P, Amirafzali I, Salami Khaneshan A. Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review. Mycopathologia 2024; 189:10. [PMID: 38231407 DOI: 10.1007/s11046-023-00808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Mucormycosis and aspergillosis are angioinvasive infections mainly occurring in immunocompromised patients. However, mixed infection with mucormycosis and aspergillosis in post-COVID-19 patients is rare. In this report, we will report four cases and comprehensively review the published literature on COVID-19 associated mixed infection of aspergillosis and mucormycosis. METHOD Besides four of our cases, we searched for published articles using PubMed/MEDLINE, Scopus, and Web of Science databases from the beginning of 2020 until October 2023. RESULT During the COVID-19 pandemic, we analyzed 52 cases (4 from our research and 48 from other studies). The most common underlying disease (59.6%) was diabetes mellitus. However, 19.2% of COVID-19 patients had no underlying condition. Interestingly, rhino-orbital-cerebral mucormycosis featured prominently in India and Iran, while other countries primarily reported a higher prevalence of pulmonary cases. CONCLUSION In conclusion, this study highlights the presence of mixed aspergillosis and mucormycosis in COVID-19 patients who previously had common underlying diseases or even a healthy immune system. Therefore, managing COVID-19 patients should involve screening serum and respiratory samples using biomarkers to detect superinfections.
Collapse
Affiliation(s)
- Elahe Sasani
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzad Pakdel
- Department of Oculo-Facial Plastic Surgery, Farabi Eye Hospital, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Zoonoses Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Salami
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Sohrabi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouyan Aminishakiba
- Pathology Department, Cancer Institute Hospital, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Amirafzali
- Resident of Internal Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arezoo Salami Khaneshan
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
36
|
Abdulkader RS, Ponnaiah M, Bhatnagar T, S D, Rozario AG, K G, Mohan M, E M, Saravanakumar D, Moorthy A, Tyagi AK, Parmar BD, Devaraja K, Medikeri G, Ojah J, Srivastava K, K K, Das N, B N, Sharma P, Kumar Parida P, Kumar Saravanam P, Kulkarni P, S P, Patil S P, Kumar Bagla R, D R, S Melkundi R, S Satpute S, Narayanan S, Jahagirdar S, Dube S, Kumar Panigrahi S, Babu D S, Saini V, Singh Saxena R, Srivastava A, Chandra Baishya A, Garg A, Kumar Mishra A, Jyoti Talukdar A, Kankaria A, Karat A, Sundaresh Kumar A, Chug A, Vankundre A, Ramaswamy B, MB B, R Jadav B, Dhiwakar M, Ghate G, Shah HV, Saha I, Sivapuram K, J Joshi K, Singh M, Chand Bairwa M, K D, K K, E M, Samagh N, Dinakaran N, Gupta N, Gupta N, M Nagarkar N, Solanki N, Kumar Panda P, Bachalli P, Shanbag R, Patil R, Kumar A R, Narayan Patil R, Thookkanaickenpalayam Vijayaraghavan R, Hanumantappa R, A R, Mandal SK, Kishve SP, Varghese Thomas S, Sarkar S, Thakur S, Patil S, Lakshmanan S, D Rao S, V S, Nayak T, Dixit UR, B U, Backiavathy V, Shenoy V, Hallur VK, Bhatnagar A, Murhekar MV. Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India. Mycology 2024; 15:70-84. [PMID: 38558844 PMCID: PMC10976993 DOI: 10.1080/21501203.2023.2271928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.
Collapse
Affiliation(s)
| | | | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Devika S
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Gayathri K
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malu Mohan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Michaelraj E
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Aditya Moorthy
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhagirathsinh D Parmar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - K Devaraja
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gaurav Medikeri
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Kajal Srivastava
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Niharika B
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Parul Sharma
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Prasanna Kumar Saravanam
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Priya S
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Pushpa Patil S
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rahul Kumar Bagla
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Ramesh D
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Renuka S Melkundi
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Satish S Satpute
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shubhashri Jahagirdar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Panigrahi
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Surendra Babu D
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
| | - Vaibhav Saini
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rita Singh Saxena
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Abhinav Srivastava
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | | | - Ajai Garg
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Amit Kumar Mishra
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Anjan Jyoti Talukdar
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Ankita Kankaria
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Arathi Karat
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
| | - Arul Sundaresh Kumar
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Ashi Chug
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Vankundre
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharathi MB
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Bhargav R Jadav
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
| | - Muthuswamy Dhiwakar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Girija Ghate
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Hardik V Shah
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Ipsita Saha
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavya Sivapuram
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Krupal J Joshi
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Mahendra Singh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Chand Bairwa
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan K
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Muthurajesh E
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Navneh Samagh
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Nethra Dinakaran
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Nikhil Gupta
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Nitin Gupta
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Nitin Solanki
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
| | - Prasan Kumar Panda
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prithvi Bachalli
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Raghunath Shanbag
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajashri Patil
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Rajesh Kumar A
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Rakesh Narayan Patil
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | | | - Ramesh Hanumantappa
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Rathinavel A
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saleel Kumar Mandal
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Sara Varghese Thomas
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Shalini Thakur
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
| | - Siddaram Patil
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | - Somu Lakshmanan
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Srinivas D Rao
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
| | - Sumathi V
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
| | - Umesh R Dixit
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Backiavathy
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
| | - Vijendra Shenoy
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kumar Hallur
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals Private Limited, Bengaluru, Karnataka, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), CU Shah Medical College, Surendranagar, Gujarat, India
- Department of Otorhinolaryngology (ENT), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Skull base Surgery, Healthcare Global Pvt Ltd, Bengaluru, Karnataka, India
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
- Department of Community Medicine, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Pathology, Medical College and Hospital, Kolkata, West Bengal, India
- Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh, India
- Department of Community Medicine, GMERS Medical College, Dharpur, Patan, Gujarat, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
- Department of Otorhinolaryngology (ENT), Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
- Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
- Department of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
- Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
- Department of Otorhinolaryngology (ENT), Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
- Department of Otorhinolaryngology (ENT), Sundaram Medical Foundation, Dr Rangarajan Memorial Hospital, Chennai, Tamil Nadu, India
- Department of Otorhinolaryngology (ENT), Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
- Department of Otorhinolaryngology & Head and Neck Surgery (ENT-HNS), All India Institute of Medical Sciences, Raipur, Chattisgarh, India
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
- Department of Community Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telengana, India
- Department of Otorhinolaryngology (ENT), All India Institute of Medical Sciences, Bathinda, Punjab, India
- Department of Otorhinolaryngology (ENT), Medikeri Super speciality ENT Centre, Bangalore, Karnataka, India
- Department of Ophthalmology, Apollo Specialty Hospitals, Vanagaram, Chennai, India
| |
Collapse
|
37
|
Barahimi E, Hamidi M, Hassani-Azad M, Farshidi F, Ardeshiri M, Sheybani-Arani M. Bell's palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis. J Med Case Rep 2024; 18:29. [PMID: 38217020 PMCID: PMC10790248 DOI: 10.1186/s13256-023-04298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Mucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell's palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve. CASE PRESENTATION A 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient's vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell's palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa. CONCLUSION Fungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell's palsy.
Collapse
Affiliation(s)
- Elham Barahimi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Makiye Hamidi
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Hassani-Azad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzaneh Farshidi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Ardeshiri
- Department of Radiology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | |
Collapse
|
38
|
Sachdeva A, Targhotra M, Chauhan MK, Chopra M. Role of Amphotericin B in the Treatment of Mucormycosis. Curr Pharm Des 2024; 30:1-9. [PMID: 38178658 DOI: 10.2174/0113816128272443231221101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Regardless of the most recent inclusion of mold-active agents (isavuconazole and posaconazole) to antifungal agents against mucormycosis, in conjunction with amphotericin B (AMB) items, numerous uncertainties still exist regarding the treatment of this rare infection. The order Mucorales contains a variety of fungi that cause the serious but uncommon fungal illness known as mucormycosis. The moulds are prevalent in nature and typically do not pose significant risks to people. Immunocompromised people are affected by it. OBJECTIVE This article's primary goal is to highlight the integral role that AMB plays in this condition. METHODS Like sinusitis (including pansinusitis, rhino-orbital, or rhino-cerebral sinusitis) is one of the many signs and symptoms of mucormycosis. The National Center for Biotechnology Information (NCBI) produces a variety of online information resources for review articles on the topic-based mucormycosis, AMB, diagnosis of mucormycosis and the PubMed® database of citations and abstracts published in life science journals. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov. RESULTS The article provides a summary of the pharmacological attributes of the various AMB compositions accessible for systemic use. CONCLUSION The article demonstrates the traits of the drug associated with its chemical, pharmacokinetics, stability, and other features, and illustrates their most useful characteristics for clinical application.
Collapse
Affiliation(s)
- Alisha Sachdeva
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Monika Targhotra
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Meenakshi Kanwar Chauhan
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar Sec-3, MB Road, New Delhi 110017, India
| | - Monica Chopra
- Department of Pharmaceutical Chemistry, Centre for Healthcare, Allied Medical and Paramedical Sciences, Delhi Skill and Entrepreneurship University, (CHAMPS-DSEU Okhla-II Campus), Maa Anandmayi Marg, Okhla Industrial Area Phase II, New Delhi 110020, India
| |
Collapse
|
39
|
Yedikian T, Yoshida R, McCullough M, Deptula P, Kulber D. An Uncommon Case of Upper-Extremity Mucormycosis in a Patient With Acute Myeloid Leukemia. J Hand Surg Glob Online 2024; 6:123-125. [PMID: 38313606 PMCID: PMC10837283 DOI: 10.1016/j.jhsg.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024] Open
Abstract
Upper-extremity mucormycosis is a rare, life-threatening fungal infection mainly affecting immunocompromised patients. We report a case of a 30-year-old woman with acute myelogenous leukemia who developed this infection during her hospital stay. The culprit was Mucorales, a subgroup of Zygomycetes species known for fast-progressing, highly lethal infections. She presented with fever, chills, and a lesion on her left forearm that worsened despite initial broad-spectrum antibiotics. A punch biopsy confirmed the diagnosis, leading to antifungal therapy with isavuconazonium sulfate and later amphotericin B, combined with surgery. Timely intervention is critical because delayed treatment can result in severe complications and death. Early suspicion, histology, microscopy, and fungal cultures are vital for accurate diagnosis. Treatment primarily involves amphotericin B, whereas adjunctive therapies such as topical amphotericin B and hyperbaric oxygen show promise. This case underscores the importance of prompt medical and surgical action, enhancing early detection of mucormycosis in immunocompromised patients.
Collapse
Affiliation(s)
- Teren Yedikian
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ryu Yoshida
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meghan McCullough
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peter Deptula
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David Kulber
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
40
|
Motevasseli S, Nazarpour A, Dalili Kajan Z, Yousefi Z, Khosravifard N, Kashi F, Roudbari N. Post-COVID mucormycosis osteomyelitis and its imaging manifestations in the North of Iran: case series. Oral Radiol 2024; 40:69-80. [PMID: 36063355 PMCID: PMC9441844 DOI: 10.1007/s11282-022-00650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022]
Abstract
Mucormycosis is an invasive fungal infection that usually affects patients with immunocompromised conditions. In the context of the COVID-19 pandemic and the following corticosteroid therapy, mucormycosis prevalence has increased. The situation may be more complicated with some underlying diseases such as diabetes mellitus. In addition, due to the vicinity of maxillary bone to the nasal cavity and paranasal sinuses, which are the main routes for the infection to spread, dentists, maxillofacial radiologists, and surgeons may be the first to encounter these patients. Post-COVID mucormycosis osteomyelitis is one of the complications of this infection Bone destruction and the erosion or breach of cortical boundaries of the maxilla and the bone structures in the vicinity of paranasal sinuses are the most critical radiographic findings of post-covid osteomyelitis. Herein, there are some cases of post-covid mucormycosis osteomyelitis involving the maxillary and other facial bones.
Collapse
Affiliation(s)
- Safa Motevasseli
- Department of Maxillofacial Surgery, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Nazarpour
- Department of Maxillofacial Surgery, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Dalili Kajan
- Department of Maxillofacial Radiology, Dental Sciences Research Center, Dental School, Guilan University of Medical Sciences, End of Professor Samii Blvd., Rasht, 41941-73774 Iran
| | - Zahra Yousefi
- Department of Dentomaxillofacial Radiology, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Negar Khosravifard
- Department of Maxillofacial Radiology, Dental Sciences Research Center, Dental School, Guilan University of Medical Sciences, End of Professor Samii Blvd., Rasht, 41941-73774 Iran
| | - Faezeh Kashi
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Niousha Roudbari
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
41
|
Tieulié N, Martel A, Lassalle S, Nourrisson F, Paccoud O, Vandersteen C, Queyrel V. [A swollen eye]. Rev Med Interne 2024; 45:52-54. [PMID: 37981510 DOI: 10.1016/j.revmed.2023.10.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/21/2023]
Affiliation(s)
- N Tieulié
- Service de rhumatologie, CHU de Nice, Nice, France
| | - A Martel
- Service d'ophtalmologie, CHU de Nice, Nice, France
| | - S Lassalle
- Laboratoire d'anatomopathologie, CHU de Nice, Nice, France
| | - F Nourrisson
- Institut universitaire de la face et du cou, CHU de Nice, Nice, France
| | - O Paccoud
- Service de maladies infectieuses, hôpital Necker-Enfant Malades, AP-HP, 75015 Paris, France
| | - C Vandersteen
- Institut universitaire de la face et du cou, CHU de Nice, Nice, France
| | - V Queyrel
- Service de rhumatologie, CHU de Nice, Nice, France.
| |
Collapse
|
42
|
Fakhruddin KS, Matsubara VH, Warnakulasuriya S, Tilakaratne WM, Ngo HC, Samaranayake LP. Mucormycosis of the Mandible and Tongue: A Systematic Scoping Review. Int Dent J 2023:S0020-6539(23)00976-0. [PMID: 38143163 DOI: 10.1016/j.identj.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023] Open
Abstract
AIM Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis. METHODS An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total. RESULTS Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2-related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully. CONCLUSIONS Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection.
Collapse
Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Hien Chi Ngo
- Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman P Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong. Special Administrative Region, China.
| |
Collapse
|
43
|
Lass-Flörl C, Steixner S. The changing epidemiology of fungal infections. Mol Aspects Med 2023; 94:101215. [PMID: 37804792 DOI: 10.1016/j.mam.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/19/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
Invasive fungal diseases are common complications in critically ill patients and in those with significant underlying imbalanced immune systems. Fungal co-, and/or super-infections are emerging and have become a rising concern within the last few years. In Europe, cases of candidiasis and aspergillosis dominate, followed by mucormycosis in India. Epidemiological studies show an increasing trend in the incidence of all three entities. Parallel to this, a shift within the underlying fungal pathogens is observed. More non-albicans Candida infections and aspergillosis with cryptic species are on the rise; cryptic species may cover intrinsic resistance to azoles and other antifungal drugs. The recent COVID-19 pandemic led to a significantly increasing incidence of invasive fungal diseases among hospitalized patients.
Collapse
Affiliation(s)
- Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, A-6020, Innsbruck, Austria.
| | - Stephan Steixner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, A-6020, Innsbruck, Austria
| |
Collapse
|
44
|
Thakur (Rai) N, Misra M, Misra S, Misra S, Shukla DK, Singh AK, Dheer Y, Jaiswal V, Rai N. Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India. J Diabetes Metab Disord 2023; 22:1459-1469. [PMID: 37975119 PMCID: PMC10638341 DOI: 10.1007/s40200-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Introduction Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and methods An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.
Collapse
Affiliation(s)
- Neha Thakur (Rai)
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Maitreyi Misra
- Intern, Department Of Surgery, TSM Medical College, Lucknow, Uttar Pradesh India
| | - Samir Misra
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | | | - Devesh Kumar Shukla
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Arvind Kumar Singh
- Department of Social and Preventive Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Yadvendra Dheer
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Vaibhav Jaiswal
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Narendra Rai
- Department of Paediatrics, Chandan Hospital, Lucknow, Uttar Pradesh India
| |
Collapse
|
45
|
Somkuwar S, Vijayabharathi P, Galhotra V, Rao S, Nagarkar NM, Raghani M, Pathak VK, Mehta R. Clinical, Demographic, and Oral Presentations of COVID-19 Associated Mucormycosis from a Tertiary Care Hospital in India: A Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:1130-1138. [PMID: 38105823 PMCID: PMC10719169 DOI: 10.1007/s12663-023-01970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/26/2023] [Indexed: 12/19/2023] Open
Abstract
Background The black fungus, mucormycosis, is on the list of lethal complications reported in recent times in COVID patients. Methodology This cross-sectional study included all cases of post-COVID-19 mucormycosis. Patients' demographics, clinical presentations, and general health information were collected using a pre-designed form. Results The study included 171 participants with the mean (SD) age as 49 (10) years with the sex distribution as 71% (122/171) male and 29% (49/122) females. About half of the admitted patients (47%) were known cases of Diabetes Mellitus type II with a median (IQR) Glycosylated Haemoglobin (HbA1c) of 9.1% (7-11.1%). Only 28% (48/171) had received the first COVID vaccination, and 2.9% (5/171) were fully vaccinated with two doses. During COVID-19, 76% (130/171) required hospitalisation for a mean (SD) stay of 11 (6.4) days. Eighty percent of the patients (136/171) received steroids during therapy, while 87% (150/171) and 51% (88/171) received antibiotics and antivirals, respectively. Oxygen was administered to 71% of hospitalised patients (120/171), with 39.1% (47/120) receiving it for more than 7 days. About the development of the first symptoms of mucormycosis (headache, nasal congestion, black crusts in the nose, facial pain, swelling in cheeks and eyes, and loss of vision) after being diagnosed with COVID-19, 16% (28/171) reported it within 7 days, 75% (127/171) between 8 and 30th days and 9% (16/171) after a month. On examination, 20% of mucor patients had hard palate findings, eschars, fistulas, and perforations, 38% had periodontal abscesses, and 5% reported tenderness to percussion. Conclusion Generally, oral manifestations involved the palate and included varying degrees of mucosal discolouration, swelling, ulcers, superficial necrotic areas, and bone exposure and necrosis with dark eschars.
Collapse
Affiliation(s)
- Surabhi Somkuwar
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - P. Vijayabharathi
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
| | - Virat Galhotra
- Department of Dentistry—Prosthodontics, All India Institute of Medical Sciences, Raipur, India
- Department of Dentistry—Pediatric and Preventive Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Santhosh Rao
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Nitin M. Nagarkar
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Manish Raghani
- Department of Dentistry—Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | | | - Rupa Mehta
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| |
Collapse
|
46
|
Velumani K, Arasu A, Issac PK, Kishore Kumar MS, Guru A, Arockiaraj J. Advancements of fish-derived peptides for mucormycosis: a novel strategy to treat diabetic compilation. Mol Biol Rep 2023; 50:10485-10507. [PMID: 37917415 DOI: 10.1007/s11033-023-08882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Mucormycosis, an extremely fatal fungal infection, is a major hurdle in the treatment of diabetes consequences. The increasing prevalence and restricted treatment choices urge the investigation of novel therapeutic techniques. Because of their effective antimicrobial characteristics and varied modes of action, fish-derived peptides have lately emerged as viable options in the fight against mucormycosis. This review examines the potential further application of fish-derived peptides in diagnosing and managing mucormycosis in relation to diabetic complications. First, we examine the pathophysiology of mucormycosis and the difficulties in treating it in diabetics. We emphasize the critical need for alternative therapeutic methods for tackling the limitations of currently available antifungal medicines. The possibility of fish-derived peptides as an innovative approach to combat mucormycosis is then investigated. These peptides, derived from several fish species, provide wide antimicrobial properties against a variety of diseases. They also have distinct modes of action, such as rupture of cell membranes, suppression of development, and modification of the host immunological response. Furthermore, we investigate the problems and prospects connected with the clinical application of fish-derived peptides. Ultimately, future advances in fish-derived peptides, offer interesting avenues for the management of mucormycosis in the context of diabetic comorbidities. More research and clinical trials are needed to properly investigate these peptide's therapeutic potential and pave the way for their adoption into future antifungal therapies.
Collapse
Affiliation(s)
- Kadhirmathiyan Velumani
- Institute of Biotechnology, Department of Medical Biotechnology and Integrative Physiology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, 602 105, India
| | - Abirami Arasu
- Department of Microbiology, SRM Arts and Science College, Kattankulathur, Chennai, Tamil Nadu, 603 203, India
| | - Praveen Kumar Issac
- Institute of Biotechnology, Department of Medical Biotechnology and Integrative Physiology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, 602 105, India.
| | - Meenakshi Sundaram Kishore Kumar
- Biomedical Research Unit and Laboratory Animal Centre (BRULAC), Department of Anatomy, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600 077, India
| | - Ajay Guru
- Department of Cariology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Jesu Arockiaraj
- Toxicology and Pharmacology Laboratory, Department of Biotechnology, Faculty of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India.
| |
Collapse
|
47
|
Lubis IND, Farah S, Pasaribu AP, Evalina R, Daulay RS, Wijaya H. A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting. Narra J 2023; 3:e426. [PMID: 38450345 PMCID: PMC10914060 DOI: 10.52225/narra.v3i3.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024]
Abstract
Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.
Collapse
Affiliation(s)
- Inke ND. Lubis
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- University of Oxford, Oxford, United Kingdom
- Menzies School of Health Research, Darwin, Australia
| | - Sara Farah
- University of Oxford, Oxford, United Kingdom
| | - Ayodhia P. Pasaribu
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rita Evalina
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rini S. Daulay
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Hendri Wijaya
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| |
Collapse
|
48
|
Thammathiwat T, Tatiyanupanwong S, Parinyasiri U, Wannigama DL, Chatsuwan T, Kanjanabuch T. Peritoneal dialysis-associated peritonitis from pauci-septated mold: Life-threatening but curable. Med Mycol Case Rep 2023; 42:100612. [PMID: 37854361 PMCID: PMC10579521 DOI: 10.1016/j.mmcr.2023.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Two cases of PD-associated peritonitis due to Cunninghamella (C. bertholletiae and C. guizhouensis) were reported here with favorable outcomes, albeit presenting with septicemia. Both patients presented with classic features of bacterial peritonitis, cloudy effluent with a neutrophil predominance, followed by fever and septicemia/septic shock. The pathogen species were confirmed and verified by molecular phylogeny using universal and specific fungal primers. All isolations were susceptible/intermediately susceptible to amphotericin B but resistant to other antifungal agents, including triazoles, caspofungin, and terbinafine. Both cases were successfully treated with timely PD catheter removal and antifungal medications for 2-4 weeks.
Collapse
Affiliation(s)
- Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Sajja Tatiyanupanwong
- Division of Nephrology, Department of Internal Medicine, Chaiyaphum Hospital, Thailand
| | - Uraiwan Parinyasiri
- Kidney Diseases Clinic, Department of Internal Medicine, Songkhla Hospital, Songkhla, Thailand
| | - Dhammika Leshan Wannigama
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
49
|
Nucci M, Nouér SA. Practical issues related to non-Aspergillus invasive mold infections. Mol Aspects Med 2023; 94:101230. [PMID: 38011770 DOI: 10.1016/j.mam.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/04/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
Infection by non-Aspergillus molds has been increasingly reported. The management of such infections is challenging both for diagnosis and treatment, including the need of well-trained mycologists to properly identify rare fungi, difficulties in distinguishing between contamination, colonization and infection, the lack of randomized studies comparing different drugs or regimens, poor activity of available antifungal agents, lack of correlation between in vitro antifungal susceptibility tests and clinical outcome, and poor prognosis. Mucormycosis and fusariosis are the most frequent non-Aspergillus mold infections. Mucormycosis occurs more frequently in four major groups of patients: solid organ transplant recipients, patients with hematologic malignancies receiving chemotherapy or hematopoietic cell transplantation, diabetic patients, and immunocompetent individuals who suffer various types of skin and soft tissue trauma. Invasive fusariosis occurs almost exclusively in patients with hematologic malignancies. In this review we discuss practical issues related to the management of these and other non-Aspergillus mold infections.
Collapse
Affiliation(s)
- Marcio Nucci
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Grupo Oncoclínicas, Rio de Janeiro, Brazil.
| | - Simone A Nouér
- Department of Infectious Diseases, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
50
|
Zhang M, Song G, Zheng H, Pathakumari B, Liu W, Liang G. In vitro combination with doxycycline plus antifungals against clinical Mucorales pathogens. Braz J Microbiol 2023; 54:2597-2602. [PMID: 37934403 PMCID: PMC10689593 DOI: 10.1007/s42770-023-01167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Since systematic antifungals for mucormycosis showed variable MICs depending on strains, effective and safe antifungal therapy was still needed. This study is aimed to evaluate the in vitro activity of doxycycline combined with antifungal therapy against dominant Mucorales pathogens. METHODS Multidrug susceptibility testing was performed with doxycycline and antifungals, including itraconazole, posaconazole, and amphotericin, in 21 isolates of 8 dominant Mucorales pathogens. RESULTS The fractional inhibitory concentration index according to M38 showed one Rhizopus arrhizus isolate synergic (∑FICI = 0.375) and other isolates in addition (0.5 < ∑FICI < 4). CONCLUSIONS Doxycycline was found to have in vitro advantages in combined antifungal treatment over antifungals alone.
Collapse
Affiliation(s)
- Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ge Song
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Hailin Zheng
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 211166, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
| | - Balaji Pathakumari
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, 55901, USA
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 211166, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 211166, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
| |
Collapse
|