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GB P, B K, Sivapathasundharam B, Manodh P, Raj AT, Ghosh S, Dhungel S. Accidental finding of COVID-associated mucormycosis (CAM) in a patient presenting as toothache: A case report and review of literature. Clin Case Rep 2023; 11:e7292. [PMID: 37151941 PMCID: PMC10160432 DOI: 10.1002/ccr3.7292] [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: 01/28/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/09/2023] Open
Abstract
Mucormycosis is an angio-invasive rapidly progressing fungal infection, usually reported in immunocompromised individuals. We present a case of COVID-associated mucormycosis in a patient with a presenting symptom of toothache in the maxilla with a possible mild case of COVID-19. Abstract Coronavirus-associated mucormycosis (CAM) had reached epidemic status, especially during the second wave of COVID-19. It was especially prevalent in India with a large mortality rate. Mucormycosis, particularly the rhinocerebral type is seen to be greatly associated with COVID-19, especially in patients with altered immunity. Uncontrolled diabetes, chronic kidney disease, immunocompromised patients, malignant hematological diseases, etc. are the major risk factors of CAM, precipitated by the injudicious use of corticosteroids for the treatment of COVID-19. CAM may often present in the maxillofacial region which warrants that dental clinicians be aware of the clinical presentation, diagnostic guidelines, and appropriate management measures for the disease. This report is one such case of CAM involving the posterior maxilla in a middle-aged individual with mild COVID-19 symptoms.
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Affiliation(s)
- Protyusha GB
- Department of Oral Pathology and MicrobiologyMeenakshi Ammal Dental College and HospitalChennaiIndia
| | - Kavitha B
- Department of Oral Pathology and MicrobiologyMeenakshi Ammal Dental College and HospitalChennaiIndia
| | | | - P. Manodh
- Department of Oral and Maxillofacial SurgeryMeenakshi Ammal Dental College and HospitalChennaiIndia
| | - A. Thirumal Raj
- Department of Oral Pathology and MicrobiologySri Venkateshwara Dental College and HospitalChennaiIndia
| | - Snehashish Ghosh
- Department of Oral PathologyCollege of Medical SciencesBharatpurNepal
| | - Safal Dhungel
- Department of Oral and Maxillofacial SurgeryCollege of Medical SciencesBharatpurNepal
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Mahajan N, Khan NA, Khatri A, Bano S, Gupta CR, Sengar M, Saigal K, Chattopadhyay A, Gupta N. Gastrointestinal mucormycosis in the pediatric age group: an evolving disease. Int J Clin Exp Pathol 2022; 15:323-331. [PMID: 36106073 PMCID: PMC9441857] [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] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mucormycosis is a devastating opportunistic fungal infection resulting in significant mortality, especially in pediatric patients with predisposing risk factors. MATERIALS & METHODS Biopsies and surgical specimens reported and proven as Mucormycosis in children under 12 years of age were retrieved from the records for three years (January 2018 to January 2021). Complete data, predisposing factors, treatment, and clinical outcome were recorded. RESULTS 15 cases were identified, ranging from 9 days to 5 years. The male-female ratio was 3:1; three children were preterm. Fourteen children were diagnosed with gastrointestinal Mucormycosis (14/15), and one had palatal and sinusoidal involvement. Abdominal pain with distention was the most typical complaint. On microscopy, biopsies and surgical specimens showed extensive liquefactive necrosis with broad aseptate fungal hyphae. An intraoperative diagnosis was rendered in two cases. All neonates underwent exploratory laparotomy with surgical debridement and were administered Liposomal Amphotericin B. However, only two neonates survived out of the fifteen cases, one with disease limited to the appendix and pouch colon. The others succumbed to the disease despite antifungal therapy and surgical debridement. Thus, the overall mortality in the current study was calculated to be 86%, with neonatal mortality of 75%. CONCLUSION Gastrointestinal involvement is more common in neonates and infants with a male preponderance. The diagnosis relies on direct microscopy, histopathology, and fungal culture. Intraoperative tissue may be sent in all suspected cases for direct microscopic examination for rapid diagnosis and treatment.
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Affiliation(s)
- Nidhi Mahajan
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
| | | | - Arti Khatri
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
| | - Shafqat Bano
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
| | | | - Mamta Sengar
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
| | - Karnika Saigal
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
| | | | - Natasha Gupta
- Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi 110031, India
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Abstract
Mucormycosis is a rare opportunistic fungal infection, often life-threatening. We report an unusual case of rhinocerebral mucormycosis in an immunocompetent patient. A 23-year-old male presented with headache, speech disturbance and hearing difficulty for 4 weeks. Magnetic resonance imaging (MRI) revealed right cerebellar abscess and enhancing soft tissue in the nasal cavity, extending to cranial and infratemporal fossae. Computed tomography (CT) revealed the widening of foramen rotundum and sclerosis involving the sphenoid and ethmoid sinuses. MR Spectroscopy revealed multiple peaks between 3.6 and 3.8 parts per million (ppm) which could represent trehalose. Nasal mucosa scrapings confirmed mucormycosis. Suspicion of a fungal infection needs to be considered even in the absence of immunocompromised status.
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Affiliation(s)
- Sagar Maheshwari
- Department of Radiodiagnosis, B J Govt. Medical College & Sassoon General Hospitals, Pune, India
| | - Monica Patil
- Department of Radiodiagnosis, B J Govt. Medical College & Sassoon General Hospitals, Pune, India
| | - Shweta Shendey
- Department of Radiodiagnosis, B J Govt. Medical College & Sassoon General Hospitals, Pune, India
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Abstract
Mucormycosis or zygomycosis, also called phycomycosis, is an uncommon, invasive, potentially lethal and an aggressive fungal infection of the order Mucorales that usually affects patients with alteration of their immunological system. From its initial description (Paltauf, 1885), this entity still has a high mortality. Imaging techniques are not usually diagnostic, and cultures are not totally reliable. Definitive diagnosis is exclusively obtained by means of histopathological examination. Early recognition and aggressive treatment are of paramount importance and have reduced the mortality and morbidity. We present here a case report of oral mucormycosis in a 32-year-old male, immunocompetent individual resulting in extensive maxillary sequestration.
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Affiliation(s)
- Deepak Venkatesh
- Department of Dentistry, ESIC Medical College, PGIMSR and Model Hospital, Bengaluru, Karnataka, India
| | - Satyajit Dandagi
- Department of Oral and Maxillofacial Surgery, P.M.N.M. Dental College and Hospital, Bagalkot, Karnataka, India
| | | | - K N Hema
- Department of Oral Pathology and Microbiology, V S Dental College and Hospital, Bengaluru, Karnataka, India
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Abstract
Mucormycosis is a rare potentially fatal opportunistic fungal infection that affects human beings. Normally, a healthy is immune to such infections but there are some risk factors which predispose a person to mucormycosis, of which malnutrition and diabetes mellitus are the most common risk factors. India is the most commonly affected country by mucormycosis because of high proportion people with low socioeconomic status and diabetes mellitus. In diabetes mellitus, mucormycosis is more aggressive and fatal due to an impaired host defense mechanism. In spite of being a rare and fatal fungal infection, early diagnosis and prompt multidisciplinary treatment comprising control of underlying predisposing factor, surgical management, and medical management can be helpful in such cases.
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Affiliation(s)
- Nandini Bhaskar
- Department of Periodontology, Dr. HS Judge Dental College, Panjab University, Chandigarh, India
| | | | - Nitin Kaushal
- Department of Oral Pathology and Microbiology, BRS Dental College, Sultanpur, Haryana, India
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Manesh A, John AO, Mathew B, Varghese L, Rupa V, Zachariah A, Varghese GM. Posaconazole: an emerging therapeutic option for invasive rhino-orbito-cerebral mucormycosis. Mycoses 2016; 59:765-772. [PMID: 27443253 DOI: 10.1111/myc.12529] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 02/23/2016] [Revised: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 11/30/2022]
Abstract
Posaconazole has significant activity against the Mucormycetes. However, data are limited on the clinical efficacy of posaconazole for treating rhino-orbito-cerebral mucormycosis (ROCM). The aim of this study is to assess the efficacy and safety of posaconazole in patients with ROCM. We included 12 consecutive adult patients admitted with ROCM and treated with posaconazole between January 2010 and February 2015. The main outcome of the study was the overall success rate (i.e. either complete or partial response) at the end of treatment. We also assessed serum posaconazole concentrations in a subgroup of patients. Of the 12 patients who received posaconazole, eight patients (66.6%) had complete resolution with median follow-up of 6.5 months (range 2-24 months). Two patients (16.6%) had significant reduction of disease and two (16.6%) had marked residual disease on follow-up. Uncontrolled diabetes was the predisposing factor in all except one patient. One patient developed diarrhoea on posaconazole, which settled without discontinuation of the drug. Posaconazole appears to be a safe and effective antifungal agent in diabetic patients with ROCM, especially in those who have toxicity with polyene therapy.
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Affiliation(s)
- Abi Manesh
- Christian Medical College, Vellore, India
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Bonifaz A, Tirado-Sánchez A, Calderón L, Romero-Cabello R, Kassack J, Ponce RM, Mena C, Stchigel A, Cano J, Guarro J. Mucormycosis in children: a study of 22 cases in a Mexican hospital. Mycoses 2014; 57 Suppl 3:79-84. [PMID: 25175081 DOI: 10.1111/myc.12233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 01/06/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/12/2022]
Abstract
We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.
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Affiliation(s)
- Alexandro Bonifaz
- Mycology Department, Dermatology Service, Hospital General de México (HGM), Reus, Spain
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Abstract
Mucormycosis is a rare opportunistic infection caused by fungus belonging to the order Mucorales. A case of a controlled diabetic male with rhino maxillary mucormycosis, with cerebral extension, is described. The patient presented with hemifacial swelling, a nasal twang in his voice, fever, ocular signs, gross tissue destruction, and was sluggish. Early recognition of mucormycosis is necessary to limit the spread of infection, which can lead to high morbidity and mortality. Therefore, health practitioners should be familiar with the signs and symptoms of the disease.
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Affiliation(s)
- Shikha Goel
- Department of Oral and Maxillofacial Pathology, MM College of Dental Sciences and Research, Mullana, Ambala Cantt - 133 001, Haryana, India
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Air EL, Vagal AA, Kendler A, McPherson CM. Isolated cerebellar mucormycosis, slowly progressive over 1 year in an immunocompetent patient. Surg Neurol Int 2010; 1:81. [PMID: 21206542 PMCID: PMC3011109 DOI: 10.4103/2152-7806.73800] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 12/31/2022] Open
Abstract
Background: Mucormycosis is a rare, aggressive fungal disease with high mortality, typically presenting as rhinosinusitis in immunocompromised patients. Case Description: A 43-year-old man with a history of intravenous drug use, Hepatitis C, and no evidence of immunocompromise presented with worsening balance problems. He had received intravenous antibiotics 2.5 years earlier for local infection after injecting heroin into a neck vein. Imaging studies revealed a lesion, likely of neoplastic origin. At resection, purulent fluid sampled by neuropathology revealed right-angled, branching hyphae, suggesting mucormycosis. No further resection was performed, no other disease sites were found, and HIV findings were negative. Two weeks postoperatively, he developed renal failure; intravenous antifungal treatment and hemodialysis were discontinued. When kidney function recovered 2 weeks later, he declined additional treatment. Conclusion: In our immunocompetent patient, both the location of the infection in the posterior fossa and its slowly progressive characteristic were unique variations of this typically aggressive disease.
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Affiliation(s)
- Ellen L Air
- Department of Neurosurgery, University of Cincinnati College of Medicine, Brain Tumor Center at University of Cincinnati (UC) Cincinnati, OH
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Lujber L, Gerlinger I, Kuncz Á, Pytel J. Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient. Curr Ther Res Clin Exp 2003; 64:473-83. [PMID: 24944397 PMCID: PMC4053017 DOI: 10.1016/s0011-393x(03)00111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy. OBJECTIVE The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy. METHODS Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient. RESULTS After treatment, the patient experienced 3 years of disease-free follow-up. CONCLUSION Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
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Affiliation(s)
- László Lujber
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
- Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Imre Gerlinger
- Department of Otolaryngology, Head and Neck Surgery, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom, and
| | - Ádám Kuncz
- Tawam Hospital, Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Department of Neurosurgery, Szeged University, Szeged, Hungary
| | - József Pytel
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
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