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Kordjazi M, Bazgir N, Eftekharian K, Farajpour M, Dilmaghani NA. Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2024; 103:145S-152S. [PMID: 36583239 PMCID: PMC9805989 DOI: 10.1177/01455613221143859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. METHODS A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. RESULTS Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. CONCLUSIONS SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.
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Affiliation(s)
- Mohammadsmaeil Kordjazi
- Departmentof Otorhinolaryngology,
Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Narges Bazgir
- School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Kourosh Eftekharian
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Mostafa Farajpour
- Depatement of general surgery, Arak University of Medical
Sciences, Arak, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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Naurka S, Rana N, Singh N, Kishore A, Nagpal K. COVID-19 associated rhino-orbital-cerebral mucormycosis-an institutional series. EAR, NOSE & THROAT JOURNAL 2024; 103:134S-144S. [PMID: 35176884 PMCID: PMC8859478 DOI: 10.1177/01455613221077882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mucormycosis is almost always confined to the patients with altered host defenses amongst which diabetes is considered as the strongest risk factor. COVID-19 only been seen in severe cases but also in mild and moderate cases of SARS-CoV-2 infections. After preliminary clinical and radiological diagnosis, surgical management in the form of endoscopic sinus surgery, debridement, and orbital exenteration (8) was performed. Medical management in the form of antifungal therapy (amphotericin-B, posaconazole, and isavuconazole) was initiated. In this case series, 79 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from mid-April 2021 to mid-September 2021. 67 patients were known diabetics, whereas rest 12 had new onset diabetes mellitus. Of these 79 cases, 27 cases had the disease limited to sinuses (rhino-mucormycosis), 43 had orbital involvement also (rhino-orbital mucormycosis), and 9 had cerebral involvement as well (rhino-orbital-cerebral mucormycosis). During this time-period, a total of 14 mortalities occurred. Most of the patients were discharged after completion of amphotericin-B therapy and rest stayed little longer till their general condition improved. COVID-19 causes dysregulation and alteration of immune response in the body which predispose to invasive fungal infections. In addition, uncontrolled diabetes mellitus and corticosteroid treatment increase the risk of mucormycosis by many folds.
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Affiliation(s)
| | - Nishant Rana
- ENT, Indraprastha Apollo Hospital, New Delhi, India
| | - Neeraj Singh
- Maxillofacial Surgery, Indraprastha Apollo Hospital, New Delhi, India
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Fitero A, Negrut N, John HT, Ferician A, Marian P. Corona-Associated Mucormycosis: Case Series Reports and Review of the Literature. J Fungi (Basel) 2024; 10:305. [PMID: 38786660 PMCID: PMC11122562 DOI: 10.3390/jof10050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
During the COVID-19 pandemic, a significant increase in cases of mucormycosis was observed in COVID-19 patients, especially in India, but not exclusively. The presented cases highlight the heterogeneous nature of mucormycosis, emphasizing the importance of recognizing predisposing factors, such as immunosuppression, due to comorbidities or medication. Diagnosing mucormycosis poses a challenge due to nonspecific clinical manifestations, requiring a multidisciplinary approach for accurate diagnosis. Treatment involves a multi-pronged approach centered around the early initiation of antifungal therapy alongside surgical intervention and the management of underlying conditions, with an emphasis on controlling immunosuppression. Understanding the relationship between COVID-19 and predisposing factors for mucormycosis is fundamental for developing prevention and treatment strategies.
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Affiliation(s)
- Andreea Fitero
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Harrie Toms John
- Department of Ear, Nose and Throat, University Hospitals of Northamptonshire, Cliftonville, Northampton NN1 5BD, UK;
| | - Anca Ferician
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
| | - Paula Marian
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
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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] [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.
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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
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Kusumesh R, Singh V, Sinha S, Ali MS, Mishra SK, Ambasta A, Prakash V, Sinha P, Sinha BP, Priyadarshi RN. Risk factors and clinical presentation of rhino-orbital mucormycosis: Lesson learnt during Covid pandemic. J Family Med Prim Care 2024; 13:1354-1361. [PMID: 38827672 PMCID: PMC11142005 DOI: 10.4103/jfmpc.jfmpc_1259_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 06/04/2024] Open
Abstract
Aim To analyze the potential predisposing factors and clinical presentation of mucormycosis in patients with COVID-19. Material and Methods Medical records of 141 patients with COVID-19-associated mucormycosis (CAM) treated at a tertiary care center in Bihar were reviewed. The predisposing factors, clinical features, and imaging findings of mucormycosis were analyzed. Results The median age was 48 years (IQR, 43-60). A total of 58 patients developed concurrent CAM and 83 post-CAM. The median interval between COVID-19 and onset of CAM symptoms was 15 days (IQR, 9-16). A total of 80 patients received at-home treatment for COVID-19, and 73 had mild-to-moderate disease. While 61 patients received in-hospital treatment, 57 had severe disease. At presentation, 131 patients had hyperglycemia: 64 type 2 diabetes mellitus (DM) and 67 new-onset DM. The history of glucocorticoid use for COVID-19 was present in 125 patients; 47% were administered at home without monitoring plasma glucose. The common presenting features were toothache, periocular or facial pain, and edema. Rhino-orbital mucormycosis was the most common. Imaging revealed rhinosinusitis in all patients, including pansinusitis (68%), pterygopalatine fossa involvement (21%), cavernous sinus thrombosis (38%), brain abscess (8%), and infarct (4%). All patients received intravenous liposomal amphotericin B, and surgical debridement was performed in 113. Conclusion COVID-19 patients with hyperglycemia are at risk of developing CAM, irrespective of the severity. Timely recognition of symptoms and prompt initiation of therapy by primary healthcare physicians are imperative for enhancing outcomes. Additionally, glucocorticoid overuse should be avoided, and close monitoring for hyperglycemia development is warranted.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vivek Singh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shivani Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mobashir S. Ali
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sarita K. Mishra
- Department of Otolaryngology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ved Prakash
- Department of Endocrinology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Pravek Sinha
- Northern Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Bibhuti P. Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rajeev N. Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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Alshanqeeti S, Szpunar S, Anne P, Saravolatz L, Bhargava A. Epidemiology, clinical features and outcomes of hospitalized patients with COVID-19 by vaccination status: a multicenter historical cohort study. Virol J 2024; 21:71. [PMID: 38515170 PMCID: PMC10958885 DOI: 10.1186/s12985-024-02325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION COVID-19 disease resulted in over six million deaths worldwide. Although vaccines against SARS-CoV-2 demonstrated efficacy, breakthrough infections became increasingly common. There is still a lack of data regarding the severity and outcomes of COVID-19 among vaccinated compared to unvaccinated individuals. METHODS This was a historical cohort study of adult COVID-19 patients hospitalized in five Ascension hospitals in southeast Michigan. Electronic medical records were reviewed. Vaccine information was collected from the Michigan Care Improvement Registry. Data were analyzed using Student's t-test, analysis of variance, the chi-squared test, the Mann-Whitney and Kruskal-Wallis tests, and multivariable logistic regression. RESULTS Of 341 patients, the mean age was 57.9 ± 18.3 years, 54.8% (187/341) were female, and 48.7% (166/341) were black/African American. Most patients were unvaccinated, 65.7%, 8.5%, and 25.8% receiving one dose or at least two doses, respectively. Unvaccinated patients were younger than fully vaccinated (p = 0.001) and were more likely to be black/African American (p = 0.002). Fully vaccinated patients were 5.3 times less likely to have severe/critical disease (WHO classification) than unvaccinated patients (p < 0.001) after controlling for age, BMI, race, home steroid use, and serum albumin levels on admission. The case fatality rate in fully vaccinated patients was 3.4% compared to 17.9% in unvaccinated patients (p = 0.003). Unvaccinated patients also had higher rates of complications. CONCLUSIONS Patients who were unvaccinated or partially vaccinated had more in-hospital complications, severe disease, and death as compared to fully vaccinated patients. Factors associated with severe COVID-19 disease included advanced age, obesity, low serum albumin, and home steroid use.
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Affiliation(s)
- Shatha Alshanqeeti
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, USA
| | - Premchand Anne
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
- Department of Pediatrics, Ascension St. John Hospital, Detroit, MI, USA
| | - Louis Saravolatz
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
- Division of Infectious Disease, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
- Thomas Mackey Center for Infectious Disease Research, Ascension St John Hospital, Detroit, MI, USA
| | - Ashish Bhargava
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA.
- Division of Infectious Disease, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA.
- Thomas Mackey Center for Infectious Disease Research, Ascension St John Hospital, Detroit, MI, USA.
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Veisi A, Aletaha M, Abolhosseini M, Ownagh V, Fekri S, Feizi M, Amoushahi Khouzani S, Najafi M. Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report. J Fr Ophtalmol 2024; 47:104139. [PMID: 38696866 DOI: 10.1016/j.jfo.2024.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To investigate the long-term outcomes of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM) patients. METHODS Retrospective, observational study including all COVID-19 patients who developed ROCM and were referred to our oculoplastic clinic. RESULTS Twenty-one patients with COVID-19-associated ROCM were included in this study. Twelve (57.1%) individuals were female with a mean age of 50.7±7.6 years (range 33-59), and nine (38.1%) were male with a mean age of 58.7±14.4 years (range 37-82). Corticosteroids were used in 85.7% of patients, and three patients received no systemic corticosteroids; 76.2% were diabetic and two of these developed new-onset diabetes mellitus (DM) after receiving corticosteroids during their treatment course. The average interval between COVID-19 and the development of ROCM in our subjects was 18.6 days (range 8-46 days). In our series of patients, decreasing vision, proptosis, and periorbital edema constituted the most prevalent presentation, seen in 52.4% of subjects. Endoscopic paranasal sinus debridement was performed a mean of 3.4 times in 95.2%, abscess drainage in one, and orbital exenteration in three (14.2%) patients. Orbital apex and bilateral paranasal sinus involvement were significantly associated with higher mortality, and the overall 18-month survival rate was 52.3%. CONCLUSION Based upon common factors among the COVID-19-associated ROCM patients, we presume that DM and drug-induced immunosuppression are two main factors, which may lead to a higher rate of ROCM infection in areas where fungal spores are more likely to be present, such as hospitals.
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Affiliation(s)
- A Veisi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Abolhosseini
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - V Ownagh
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - S Fekri
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Feizi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amoushahi Khouzani
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Najafi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Dacey S, Velu PS, Wilson N, Levi JR, Paz-Lansberg M. Invasive fungal sinusitis: A comparison of pediatric versus adult cases. Am J Otolaryngol 2024; 45:104143. [PMID: 38101130 DOI: 10.1016/j.amjoto.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Invasive fungal sinusitis (IFS) is a rare infection with high mortality, mainly impacting immunocompromised patients. Given its significant mortality, timely recognition and treatment is crucial. This study aims to highlight the differences in presentation of IFS between pediatric and adult patients to aid in prompt diagnosis and treatment of this condition. METHODS A comprehensive literature search of PubMed, EMBASE, Web of Science, Global Index Medicus, Global Health (EBSCO) and Cochrane Database of Systematic Reviews was conducted to identify articles relating to IFS. Patient demographics, comorbidities, presentation, disease characteristics, treatments and outcomes were extracted from the studies, and statistical analyses were conducted to compare these variables between pediatric and adult patients. RESULTS 111 studies identified 22 pediatric and 132 adult patients worldwide. Children were more likely to have hematologic malignancies compared to adults (59.1 % vs. 15.2 %, p < 0.001). Facial symptoms such as pain, edema, and numbness were the most common symptoms for both age groups. In the pediatric population, fever and nasal or oral mucosal lesions were more common presenting symptoms (both p < 0.001). Pediatric patients were more likely to present without disease extension beyond the sinuses (p < 0.001). There was no significant difference in either medication treatment or mortality between the two cohorts. CONCLUSION IFS often presents with non-specific symptoms and a unique presentation in pediatric and adult populations. Clinical awareness of the varying presentations in both populations is important to treat in a timely manner given the rapid progression and high mortality rates of IFS.
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Affiliation(s)
- Sydney Dacey
- Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America
| | - Nicholas Wilson
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America
| | - Jessica R Levi
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
| | - Marianella Paz-Lansberg
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
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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. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 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] [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.
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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.
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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] [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.
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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
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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] [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.
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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
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12
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Thornton CR, Davies GE, Dougherty L. Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker. Front Cell Infect Microbiol 2023; 13:1305662. [PMID: 38145040 PMCID: PMC10739493 DOI: 10.3389/fcimb.2023.1305662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.
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Affiliation(s)
- Christopher R. Thornton
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Genna E. Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Laura Dougherty
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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13
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Verma V, Sarkar D, Moharana B, Singh P, Noyadu R, Sharma B. Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India. Indian J Ophthalmol 2023; 71:3669-3676. [PMID: 37991302 PMCID: PMC10788766 DOI: 10.4103/ijo.ijo_356_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. METHODS A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. RESULTS ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. CONCLUSION Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM.
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Affiliation(s)
- Vidhya Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bruttendu Moharana
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Richa Noyadu
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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14
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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] [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.
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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
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15
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Schiffmann N, Liang Y, Nemcovsky CE, Almogy M, Halperin-Sternfeld M, Gianneschi NC, Adler-Abramovich L, Rosen E. Enzyme-Responsive Nanoparticles for Dexamethasone Targeted Delivery to Treat Inflammation in Diabetes. Adv Healthc Mater 2023; 12:e2301053. [PMID: 37498238 DOI: 10.1002/adhm.202301053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/25/2023] [Indexed: 07/28/2023]
Abstract
Diabetes is a global epidemic accompanied by impaired wound healing and increased risk of persistent infections and resistance to standard treatments. Therefore, there is an immense need to develop novel methods to specifically target therapeutics to affected tissues and improve treatment efficacy. This study aims to use enzyme-responsive nanoparticles for the targeted delivery of an anti-inflammatory drug, dexamethasone, to treat inflammation in diabetes. These nanoparticles are assembled from fluorescently-labeled, dexamethasone-loaded peptide-polymer amphiphiles. The nanoparticles are injected in vivo, adjacent to labeled collagen membranes sub-periosteally implanted on the calvaria of diabetic rats. Following their implantation, collagen membrane resorption is linked to inflammation, especially in hyperglycemic individuals. The nanoparticles show strong and prolonged accumulation in inflamed tissue after undergoing a morphological switch into microscale aggregates. Significantly higher remaining collagen membrane area and less inflammatory cell infiltration are observed in responsive nanoparticles-treated rats, compared to control groups injected with free dexamethasone and non-responsive nanoparticles. These factors indicate improved therapeutic efficacy in inflammation reduction. These results demonstrate the potential use of enzyme-responsive nanoparticles as targeted delivery vehicles for the treatment of diabetic and other inflammatory wounds.
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Affiliation(s)
- Nathan Schiffmann
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Yifei Liang
- Department of Chemistry, International Institute for Nanotechnology, Simpson-Querrey Institute, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
| | - Carlos E Nemcovsky
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Michal Almogy
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Michal Halperin-Sternfeld
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Nathan C Gianneschi
- Department of Chemistry, International Institute for Nanotechnology, Simpson-Querrey Institute, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science & Engineering, Department of Biomedical Engineering, Department of Pharmacology, Northwestern University, Evanston, IL, 60208, USA
| | - Lihi Adler-Abramovich
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Eyal Rosen
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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16
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Mustafa SS, Stern RA, Patel PC, Chu DK. COVID-19 Treatments: Then and Now. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3321-3333. [PMID: 37558163 DOI: 10.1016/j.jaip.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has evolved over the past 3+ years, and strategies to prevent illness and treat infection have changed over time. As COVID-19 transitions from a pandemic to an endemic infection, widespread nonpharmaceutical interventions such as mask mandates and governmental policies requiring social distancing have given way to more selective strategies for risk mitigation. Monoclonal antibody therapies used for disease prevention and treatment lost utility owing to the emergence of resistant viral variants. Oral antiviral medications have become the mainstay of treatment in nonhospitalized individuals, whereas systemic corticosteroids remain the cornerstone of therapy in those requiring supplemental oxygen. Emerging literature also supports the use of additional immune-modulating therapies in select admitted patients. Importantly, the COVID-19 pandemic highlighted both unprecedented research and development of medical interventions while also drawing attention to significant pitfalls in the global response. This review provides a comprehensive update in prevention and management of COVID-19.
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Affiliation(s)
- S Shahzad Mustafa
- Department of Medicine, Rochester Regional Health, Rochester, NY; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Rebecca A Stern
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pratish C Patel
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek K Chu
- Department of Medicine, Evidence in Allergy Group, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada
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Singh A, Goel G, Khan M, Kanodia A, Sikka K, Thakar A. Factors affecting clinical outcome in COVID-associated rhino-orbito-cerebral mucormycosis (CAROM) patients-An ambispective, single-arm, observational study. Am J Otolaryngol 2023; 44:103975. [PMID: 37478538 DOI: 10.1016/j.amjoto.2023.103975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND COVID-associated Rhino-Orbito-Cerebral Mucormycosis (CAROM) appeared as an epidemic in India during the second wave of the COVID-19 pandemic during the months of March to May 2021. Though many reports have highlighted cross sectional and short-term attributes related to CAROM, long term follow up data is sparse. OBJECTIVE This report aims to analyze the follow-up outcomes in consecutive patients presenting to us during the epidemic. PATIENTS AND METHODS This was an ambispective observational analytical study, recruiting the consecutive patients admitted to our tertiary care centre during the period of the CAROM epidemic. The mortality rate during the follow-up and various factors affecting survival were studied using univariable and multivariable statistics with the Stata 14.0 software. RESULTS Of the 189 patients studied, eight were lost to follow-up. The outcome analysis was performed for the 181 patients. 93.6 % (162/173) of the patients had diabetes. The All-cause mortality was 45 % (81/181), while the ROCM-specific mortality was found to be 24 % (46/181) at a median follow-up of 176 days (IQR: 21-217 days). With univariable analysis, increasing age, higher serum IL-6 levels, presence of additional comorbidities (in addition to Diabetes and hypertension), bilateral disease, skin necrosis, palatal involvement, infratemporal fossa involvement, and impaired vision/ocular movements were found to be associated with increased mortality. However, on multivariable analysis, only 1) increasing age, 2) raised serum IL-6 levels, and 3) bilateral disease were predictive of increased mortality. Surgical debridement (endoscopic, palatal removal, orbital exenteration, neurosurgical intervention) was associated with significantly reduced mortality on both univariable and multivariable analysis. CONCLUSION Our intermediate-term follow-up data showed advanced age at presentation, raised IL-6 levels, and bilateral sinonasal involvement to be predictive of increased mortality, while surgical debridement is significantly protective from mortality in CAROM patients.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Goel
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kanodia
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Thakar
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Aboul-Fotouh S, Mahmoud AN, Elnahas EM, Habib MZ, Abdelraouf SM. What are the current anti-COVID-19 drugs? From traditional to smart molecular mechanisms. Virol J 2023; 20:241. [PMID: 37875904 PMCID: PMC10594888 DOI: 10.1186/s12985-023-02210-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 10/13/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) is the disease caused by SARS-CoV-2, a highly infectious member of the coronavirus family, which emerged in December 2019 in "Wuhan, China". It induces respiratory illness ranging from mild symptoms to severe disease. It was declared a "pandemic" by the World Health Organization (WHO) in March 2020. Since then, a vast number of clinical and experimental studies have been conducted to identify effective approaches for its prevention and treatment. MAIN BODY The pathophysiology of COVID-19 represents an unprecedented challenge; it triggers a strong immune response, which may be exacerbated by "a cytokine storm syndrome". It also induces thrombogenesis and may trigger multi-organ injury. Therefore, different drug classes have been proposed for its treatment and prevention, such as antivirals, anti-SARS-CoV-2 antibody agents (monoclonal antibodies, convalescent plasma, and immunoglobulins), anti-inflammatory drugs, immunomodulators, and anticoagulant drugs. To the best of our knowledge, this review is the first to present, discuss, and summarize the current knowledge about the different drug classes used for the treatment of COVID-19, with special emphasis on their targets, mechanisms of action, and important adverse effects and drug interactions. Additionally, we spotlight the latest "October 2023" important guidelines (NIH, IDSA, and NICE) and FDA approval or authorization regarding the use of these agents in the management of COVID-19. CONCLUSION Despite the wide array of therapeutic strategies introduced for the treatment of COVID-19, one of the most prominent therapeutic challenges is SARS-CoV-2 mutations and emerging new variants and subvariants. Currently, the anti-COVID-19 drug pipeline is continuously affording novel treatments to face this growing challenge.
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Affiliation(s)
- Sawsan Aboul-Fotouh
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Clinical Pharmacology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Nageh Mahmoud
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Esraa M Elnahas
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Z Habib
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sahar M Abdelraouf
- Department of Biochemistry, Faculty of Pharmacy, Misr International University, Cairo, Egypt
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19
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Raina D, Rohilla R, Patwal S, Pandita A. The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India. Cureus 2023; 15:e47358. [PMID: 38021725 PMCID: PMC10657149 DOI: 10.7759/cureus.47358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. MATERIAL AND METHODS A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. RESULTS Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. CONCLUSION The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.
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Affiliation(s)
- Dimple Raina
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ranjana Rohilla
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Shiwang Patwal
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ajay Pandita
- Community Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
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20
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Kumari K, Rathod D, Meshram T, Mohammed S, Raju S, Sharma A, Chaudhary B, Bhatia P. Perioperative anesthesia challenges and outcomes of patients with Rhino-Orbito-Cerebral Mucormycosis during the second wave of COVID-19 pandemic: An observational study. J Anaesthesiol Clin Pharmacol 2023; 39:615-621. [PMID: 38269163 PMCID: PMC10805186 DOI: 10.4103/joacp.joacp_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aims A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients. Material and Methods This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted. Results The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%). Conclusion Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality.
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Affiliation(s)
- Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Darshana Rathod
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Tanvi Meshram
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sachith Raju
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bikram Chaudhary
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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21
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Chen R, Xie M, Wang S, Yu F, Zhang D, Yuan L, Zheng J, Wang J, Zhou J, Li B, Zheng S, Fan Y, Han D. Secondary Infection Surveillance with Metagenomic Next-Generation Sequencing in COVID-19 Patients: A Cross-Sectional Study. Infect Drug Resist 2023; 16:6463-6472. [PMID: 37795203 PMCID: PMC10546932 DOI: 10.2147/idr.s424061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Background Metagenomic next-generation sequencing (mNGS) is a promising tool for improving antimicrobial therapy and infection control decision-making in complex infections. Secondary infection surveillance using mNGS in COVID-19 patients has rarely been reported. Methods Respiratory pathogen and antibiotic resistance prediction were evaluated by BALF mNGS for 192 hospitalized COVID-19 patients between December 2022 and February 2023. Results Secondary infection was confirmed in 83.3% (160/192) of the COVID-19 patients, with bacterial infections (45%, 72/160) predominating, followed by mixed bacterial and fungal infections (20%, 32/160), and fungal infections (17.5%, 28/160). The incidence of bacterial or viral secondary infection was significantly higher in patients who were admitted to the ICU, received mechanical ventilation, or developed severe pneumonia (all p<0.05). Klebsiella pneumoniae (n=30, 8.4%) was the most prevalent pathogen associated with secondary infection followed by Acinetobacter baumannii (n=29, 8.1%), Candida albicans (n=29, 8.1%), Aspergillus fumigatus (n=27, 7.6%), human herpes simplex virus type 1 (n=23, 6.4%), Staphylococcus aureus (n=20, 5.6%) and Pneumocystis jiroveci (n=14, 3.9%). The overall concordance between the resistance genes detected by mNGS and the reported phenotypic resistance in 69 samples containing five clinically important pathogens (ie, K. pneumoniae, A. baumannii, S. aureus, P. aeruginosa and E. coli) that caused secondary infection was 85.5% (59/69). Conclusion mNGS can detect pathogens causing secondary infection and predict antimicrobial resistance for COVID19 patients. This is crucial for initiating targeted treatment and rapidly detect unsuspected spread of multidrug-resistant pathogens.
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Affiliation(s)
- Renke Chen
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Mengxiao Xie
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shenlong Wang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Fei Yu
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical in vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Dan Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical in vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Lingjun Yuan
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jieyuan Zheng
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jingchao Wang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jieting Zhou
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Binxiao Li
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shufa Zheng
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical in vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yongsheng Fan
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Dongsheng Han
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical in vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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22
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Mohamed Taha A, Adel Abdelkader Saed S, Hossam-Eldin Moawad M, Abd El-Tawab Moawad W, Al-Hejazi T, Mousa Y, Sharma R, Reiter RJ. Safety and efficacy of melatonin as an adjuvant therapy in COVID-19 patients: Systematic review and meta-analysis. Adv Med Sci 2023; 68:341-352. [PMID: 37742478 DOI: 10.1016/j.advms.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Melatonin might be beneficial to coronavirus disease 2019 (COVID-19) patients in terms of both prevention and treatment. We investigated how melatonin affected various clinical and laboratory results in COVID-19 patients. METHODS PubMed, Scopus, Cochrane Library and Web of Science databases were utilized for searching eligible articles fulfilling our inclusion criteria up to December 2022. We used random effect model in case of significant heterogeneity; in other cases, a fixed model was applied. RevMan was used for meta-analysis. RESULTS We included 11 studies in our review. Clinical improvement rate was found to be statistically significantly higher in patients taking melatonin than in the control group (OR: 5.09; 95% CI: 2.60-9.96, p < 0.001). Patients receiving melatonin showed a non-significant difference in mortality rate compared to the control group (OR: 0.37; 95% CI: 0.07-1.81, p = 0.22). However, in the randomized controlled trials subgroup, melatonin-treated patients showed significantly lower mortality than did the controls (OR: 0.17; 95% CI: 0.08-0.38, p < 0.001). CRP level was statistically significantly lower due to melatonin treatment (weighted mean difference [WMD] = -9.85; 95% CI: -18.54 to -1.16, p = 0.03). Length of hospital stay was statistically significantly shorter in patients taking melatonin compared to controls (WMD = -4.05; 95% CI: -5.39 to -2.7, p < 0.001). CONCLUSION Melatonin was found to have substantial effects on COVID-19 patients when used as adjuvant therapy, enhancing clinical improvement and decreasing time to recovery with a shorter length of hospital stay and a shorter duration of mechanical ventilation.
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Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
| | | | - Mostafa Hossam-Eldin Moawad
- Clinical Department, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Tala Al-Hejazi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Yosra Mousa
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
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23
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Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
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Abstract
COVID-19 can cause detrimental effects on health. Vaccines have helped in reducing disease severity and transmission but their long-term effects on health and effectiveness against future viral variants remain unknown. COVID-19 pathogenesis involves alteration in iron homeostasis. Thus, a contextual understanding of iron-related parameters would be very valuable for disease prognosis and therapeutics.Accordingly, we reviewed the status of iron and iron-related proteins in COVID-19. Iron-associated alterations in COVID-19 reported hitherto include anemia of inflammation, low levels of serum iron (hypoferremia), transferrin and transferrin saturation, and high levels of serum ferritin (hyperferritinemia), hepcidin, lipocalin-2, catalytic iron, and soluble transferrin receptor (in ICU patients). Hemoglobin levels can be low or normal, and compromised hemoglobin function has been proposed. Membrane-bound transferrin receptor may facilitate viral entry, so it acts as a potential target for antiviral therapy. Lactoferrin can provide natural defense by preventing viral entry and/or inhibiting viral replication. Serum iron and ferritin levels can predict COVID-19-related hospitalization, severity, and mortality. Serum hepcidin and ferritin/transferrin ratio can predict COVID-19 severity. Here, serum levels of these iron-related parameters are provided, caveats of iron chelation for therapy are discussed and the interplay of these iron-related parameters in COVID-19 is explained.This synopsis is crucial as it clearly presents the iron picture of COVID-19. The information may assist in disease prognosis and/or in formulating iron-related adjunctive strategies that can help reduce infection/inflammation and better manage COVID-19 caused by future variants. Indeed, the current picture will augment as more is revealed about these iron-related parameters in COVID-19.
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Affiliation(s)
- Erin Suriawinata
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kosha J Mehta
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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25
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Singh R, Malik P, Kumar M, Kumar R, Alam MS, Mukherjee TK. Secondary fungal infections in SARS-CoV-2 patients: pathological whereabouts, cautionary measures, and steadfast treatments. Pharmacol Rep 2023:10.1007/s43440-023-00506-z. [PMID: 37354313 DOI: 10.1007/s43440-023-00506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
The earliest documented COVID-19 case caused by the SARS-CoV-2 coronavirus occurred in Wuhan, China, in December 2019. Since then, several SARS-CoV-2 mutants have rapidly disseminated as exemplified by the community spread of the recent omicron variant. The disease already attained a pandemic status with ever-dwindling mortality even after two and half years of identification and considerable vaccination. Aspergillosis, candidiasis, cryptococcosis and mucormycosis are the prominent fungal infections experienced by the majority of SARS-CoV-2 high-risk patients. In its entirety, COVID-19's nexus with these fungal infections may worsen the intricacies in the already beleaguered high-risk patients, making this a topic of substantial clinical concern. Thus, thorough knowledge of the subject is necessary. This article focuses on the concomitant fungal infection(s) in COVID-19 patients, taking into account their underlying causes, the screening methods, manifested drug resistance, and long-term effects. The information and knowledge shared herein could be crucial for the management of critically ill, aged, and immunocompromised SARS-CoV-2 patients who have had secondary fungal infections (SFIs).
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Affiliation(s)
- Raj Singh
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to Be University), Mullana, Ambala, Haryana, 133207, India
| | - Parth Malik
- School of Chemical Sciences, Central University of Gujarat, Gandhinagar, Gujarat, India
| | - Mukesh Kumar
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to Be University), Mullana, Ambala, Haryana, 133207, India
| | - Raman Kumar
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to Be University), Mullana, Ambala, Haryana, 133207, India
| | - Md Shamshir Alam
- Department of Pharmacy Practice, College of Pharmacy, National University of Science and Technology, PO Box 620, 130, Bosher-Muscat, Sultanate of Oman
| | - Tapan Kumar Mukherjee
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida, UP, India.
- Department of Biotechnology, Amity University, Major Arterial Road, Action Area II, Rajarhat, New Town, Kolkata, West Bengal, 700135, India.
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26
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Tazeem S, Nagaraju A, Begum H, Tommi JA, Sudarshan Reddy L, Vijay Kumar M. COVID-19 Associated Mucormycosis. Indian J Otolaryngol Head Neck Surg 2023:1-9. [PMID: 37362123 PMCID: PMC10257165 DOI: 10.1007/s12070-023-03676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is a life-threatening opportunistic fungal infection seen in immunocompromised states. Rising incidence of mucormycosis among Coronavirus Disease-2019 infected individuals is an increasing concern in India. The disease which was endemic has blown out to become an epidemic. The purpose of this research is to study the epidemiology, management and outcome of Coronavirus Disease-2019 Associated Mucormycosis (CAM) cases. Additionally, the role of diabetes and steroids in the causation of CAM was determined. A hospital-based observational study was conducted at a tertiary care centre involving cases with rhino-orbital mucormycosis with recent history of COVID-19 infection. Out of 205,166(81%) cases had Diabetes Mellitus as a comorbid condition. Among them, 75(36.6%) cases were diagnosed with diabetes during COVID-19 treatment. 161/205(78.5%) cases received corticosteroids during COVID-19 treatment. Corticosteroids were notindicated in 43(26.7%) cases. 177/205(85.4%) cases were alive at the end of 12 weeks. 8 out of 10 deaths were seen in cases having diabetes. As the incidence of mucormycosis is increasing, better awareness among general population about the disease, early diagnosis and multidisciplinary approach is required to improve prognosis.
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Affiliation(s)
| | - A. Nagaraju
- Department of ENT, Osmania Medical College, Hyderabad, India
| | | | | | | | - M. Vijay Kumar
- Department of Community Medicine, Gandhi Medical College, Secunderabad, India
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27
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Patel VB, Patel A, Mishra G, Shah N, Shinde MK, Musa RK. Imaging spectrum, associations and outcomes in acute invasive fungal rhino-ocular-cerebral sinusitis in patients with COVID-19 pneumonia. J Family Med Prim Care 2023; 12:1055-1062. [PMID: 37636178 PMCID: PMC10451586 DOI: 10.4103/jfmpc.jfmpc_1189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has been speculated to enhance mucormycosis infection due to its immune-altering pathophysiology. Early identification of high-morbidity conditions is crucial for optimal treatment and improved outcomes. Methods A retrospective study was conducted on 63 patients with clinical and microbiological evidence of rhino-ocular-cerebral mucormycosis, who had a history of COVID-19 infection. The clinical, demographic, and imaging data were retrieved and analyzed. Descriptive statistics (mean [SD] and frequency [%]) were used to describe important characteristics across audit cycles. Results Out of 63 patients, 54 (85.71%) patients had associated comorbidities, with diabetes mellitus being common comorbidity and all patients had received injectable and/or oral corticosteroids. Imaging showed nasal and paranasal sinus, perisinus, maxillary alveolar arch, and hard palate involvement in 62 (98.41%), 33 (52.38%), 5 (7.94%) and 5 (7.94%) patients, respectively. Orbital involvement was seen in 24 (38.10%) patients. Skull base involvement was seen in 11 (17.46%) patients, and intracranial extension of disease was present in 11 (17.46%) patients. A total of 16 patients were on mechanical ventilation, of whom 3 succumbed. The mean (standard deviation [SD]) intensive care unit (ICU) stay was 13.2 days (6.8) for 5 patients who succumbed and 6.4 days (4.6) for 30 patients who survived (P value = 0.008). Conclusion Cross-sectional imaging not only provides the extent of disease spread but also plays a vital role in providing a surgical roadmap to treating surgeons and in predicting prognosis in patients with invasive fungal infections.
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Affiliation(s)
- Viral B. Patel
- Department of Radio Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Aashvi Patel
- Department of Otolaryngology, Medical Officer, IRIS Hospital, Anand Gujarat, India
| | - Girish Mishra
- Department of Otolaryngology, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Nilay Shah
- ENT and Head – Neck Surgeon, IRIS Hospital, Anand, Gujarat, India
| | - Mayur K. Shinde
- Department of Biostatistics, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Raish K. Musa
- Department of Radio Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
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Aboutalebian S, Erami M, Momen-Heravi M, Charsizadeh A, Hezaveh SJH, Matini AH, Ahsaniarani AH, Fakhrehi M, Mirhendi H. A case of COVID-19-associated mucormycosis due to Lichtheimia ramosa. J Clin Lab Anal 2023:e24895. [PMID: 37183276 DOI: 10.1002/jcla.24895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/25/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening invasive fungal infection in immunocompromised and COVID-19 patients. CASE REPORT Here, we report a fatal rhino-orbito-cerebral mucormycosis caused by Lichtheimia ramosa, in a 79-year-old diabetic female. She was initially admitted to the hospital for COVID-19 infection and received broad-spectrum antibiotics and corticosteroids. After 1 month, she was admitted again because of persistent headaches and decreased right eye movement when the computed tomography scan showed mucosal thickening and opacification of paranasal sinuses. Microbiological investigations, including culture and direct microscopy, and histopathological findings confirmed the diagnosis of proven mucormycosis. The isolated causal agent was identified as Lichtheimia ramosa by sequencing the entire ITS region of nuclear ribosomal DNA. Despite surgical debridement and administration of liposomal amphotericin B 5 mg/kg/day, the patient's level of consciousness suddenly deteriorated; she was intubated and mechanically ventilated in the ICU and died on the same day. CONCLUSION To our knowledge, this is the first worldwide case of COVID-19-associated rhino-orbito-cerebral mucormycosis due to Lichtheimia ramosa.
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Affiliation(s)
- Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahzad Erami
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Fakhrehi
- Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
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Lahiri S, Kundu AK, Ray M. Anaesthetic concerns in post-COVID mucormycosis at a tertiary care hospital in India: An observational study. Indian J Anaesth 2023; 67:471-474. [PMID: 37333699 PMCID: PMC10269986 DOI: 10.4103/ija.ija_695_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/20/2023] Open
Abstract
Administration of anaesthesia in post-COVID mucormycosis patients is a real challenge due to complications such as dyselectrolytemia, renal failure, multi-organ failure, and sepsis. The aim of this study was to evaluate the challenges and perioperative complications of administration of anaesthesia in terms of morbidity and mortality in patients undergoing surgical resection of post-COVID rhino-orbito-cerebral mucormycosis (ROCM). The present study was a case series, which was carried out on 30 post-COVID, biopsy-proven mucormycosis patients enrolled for ROCM resection under general anaesthesia, and all data were collected retrospectively for this series. The post-COVID mucormycosis patients had diabetes mellitus as the most common comorbidity (96.6%), and difficult airway was a common feature (60%) among them. Anaesthetic management of post-COVID mucormycosis patients is a real challenge due to associated comorbidities.
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Affiliation(s)
- Swati Lahiri
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Asim Kumar Kundu
- Department of Critical Care Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Manjushree Ray
- Department of Anaesthesiology, Agartala Government Medical College, Agartala, Tripura, India
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30
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Kaushik N, Rani D, Agarwal P, Kumar H, Kumar L, Singh AP. Clinicopathological profile of post-COVID-19 mucormycosis cases: A report from a tertiary care center. Natl J Maxillofac Surg 2023; 14:264-270. [PMID: 37661969 PMCID: PMC10474536 DOI: 10.4103/njms.njms_482_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 09/05/2023] Open
Abstract
Introduction Mucormycosis is a fatal fungal infection, which is rare but commonly affects immunocompromised patients. Coronavirus disease 2019 (COVID-19) patients who were immunocompromised, due to comorbid conditions, such as hematological malignancy and diabetes mellitus (DM), and patients on immunosuppressive therapy such as steroid therapy were the important host for mucormycosis infection. Aim This study aimed to study the clinicopathological correlation of mucormycosis in post-COVID-19 patients. Material and Methods The study was a retrospective study conducted in the Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over four months from April 2021 to July 2021, and clinically diagnosed mucormycosis cases were included in this study. Clinical details, histology slides, and blocks were reviewed, and the data were analyzed. Three- to four-micrometer sections were taken from the blocks and stained with hematoxylin and eosin, and two more slides were made for each case for periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) staining. Result In this study, the maximum cases were above the fifth decade of life. Males were more commonly affected than females with a male-to-female ratio of 2.09:1. Of the total of 65 cases, 46 (70.77%) cases were positive for mucormycosis and 19 (29.23%) cases were negative on histopathological examination and special stain PAS and GMS. A significant correlation was found between mucormycosis-positive cases on steroid therapy and oxygen supply during the treatment for COVID-19 with P- values of 0.001 and 0.027, respectively. Conclusion For COVID-19 patients with altered glycemic control, receiving steroid therapy and oxygen supply poses a significant threat to the development of mucormycosis.
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Affiliation(s)
- Nupur Kaushik
- Department of Pathology, S.N. Medical College Agra, Uttar Pradesh, India
| | - Deepa Rani
- Department of Pathology, S.N. Medical College Agra, Uttar Pradesh, India
| | - Pooja Agarwal
- Department of Pathology, S.N. Medical College Agra, Uttar Pradesh, India
| | - Harendra Kumar
- Department of Pathology, S.N. Medical College Agra, Uttar Pradesh, India
| | - Lalit Kumar
- Department of Pathology, S.N. Medical College Agra, Uttar Pradesh, India
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Khade S, Nalwa A, Rao M, Aggarwal D, Sharma V, Chugh A. Mucormycosis: An Epidemic Complicating the COVID-19 Pandemic. Oman Med J 2023; 38:e511. [PMID: 37313250 PMCID: PMC10259156 DOI: 10.5001/omj.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/24/2021] [Indexed: 08/30/2023] Open
Abstract
COVID-19 is a relatively new disease whose complete pathogenesis and complications have not been elucidated. Apart from the morbidity and mortality caused by the virus itself, it is noted that patients affected with this virus have a higher susceptibility to bacterial and fungal co-infections. Mucormycosis is a rare and life-threatening fungal infection generally associated with uncontrolled diabetes mellitus and immunosuppression. It tends to rapid disease progression and poor prognosis if not diagnosed and managed promptly. There has been a sudden increase in the number of mucormycosis cases in patients with moderate to severe COVID-19 infection in the past few months. Herein, we present a series of 10 mucormycosis cases diagnosed over one week.
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Affiliation(s)
- Shalaka Khade
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
| | - Aasma Nalwa
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
| | - Divya Aggarwal
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
| | - Vidhu Sharma
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
| | - Ankita Chugh
- Department of Pathology, All India Institute of Medical Sciences, Rajasthan, India
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Negm EM, Mohamed MS, Rabie RA, Fouad WS, Beniamen A, Mosallem A, Tawfik AE, Salama HM. Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country. BMC Infect Dis 2023; 23:246. [PMID: 37072718 PMCID: PMC10111294 DOI: 10.1186/s12879-023-08226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). METHODS A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. RESULTS Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43-30.39), 14.1 (5.67-35.10), 14.57 (5.83-33.78), and 4.57 (1.83-14.88), respectively]. CONCLUSION Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.
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Affiliation(s)
- Essamedin M Negm
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt.
| | - Mohamed Sorour Mohamed
- Internal Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Rehab A Rabie
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Walaa S Fouad
- Family Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Ahmed Beniamen
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Ahmed Mosallem
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | | | - Hussein M Salama
- Internal Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
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Banerjee A, Das M, Verma P, Chatterjee A, Ramalingam K, Srivastava KC. COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review. Cureus 2023; 15:e37984. [PMID: 37223184 PMCID: PMC10202344 DOI: 10.7759/cureus.37984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
During the second wave of coronavirus disease, or COVID-19, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the year 2021 around the globe, there is a surge in the number of cases of mucormycosis or "Black Fungus" that is directly/indirectly associated with COVID-19. In this review article, mucormycosis of the orofacial region has gained importance from the maximum published literature (45 articles) from various databases like PubMed, Google Scholar, Scopus, Web of Science, and Embase. Rhino-orbital cerebral mucormycosis (ROCM) is a fatal condition associated with COVID-19 among categories of mucormycosis such as pulmonary, oral, gastrointestinal, cutaneous, and disseminated. ROCM targets the maxillary sinus, also involving teeth of the maxilla, orbits, and ethmoidal sinus. These are of particular interest to dentists and oral pathologists for proper diagnosis and identification. Co-morbid conditions, especially diabetes mellitus type II, have to be monitored carefully in COVID-19 patients as they have a higher risk of developing mucormycosis. In this review article, various presentations of COVID-19-linked mucormycosis are mentioned having particular emphasis on pathogenesis, signs and symptoms, clinical presentation, various diagnostic modalities including histopathology, radiology like CT and MRI, serology, tissue culture, various laboratory investigations, treatment protocols, management with prognosis, and so on. Any suspected case of mucormycosis needs quick detection and treatment since it progresses quickly due to the destructive course of infection. Long-term follow-up along with proper care is a must to detect any kind of recurrence.
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Affiliation(s)
- Abhisek Banerjee
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Moumalini Das
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Pooja Verma
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Abhishek Chatterjee
- Dentistry, Rampurhat Government Medical College and Hospital, Rampurhat, IND
| | - Karthikeyan Ramalingam
- Oral pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Muthu S, Jeyaraman M, Selvaraj P, Jeyaraman N, Potty AG, Gupta A. Dose–Response Meta-Analysis of Corticosteroid Effects in SARS Outbreak: A Model for Risk Stratification and Screening Strategy for Osteonecrosis of Femoral Head Post-Corticosteroid Therapy for COVID-19. Life (Basel) 2023; 13:life13040907. [PMID: 37109436 PMCID: PMC10143798 DOI: 10.3390/life13040907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Corticosteroids (CS) have been used in the management regimens for COVID-19 disease to mitigate the cytokine storm and ill effects of the pulmonary inflammatory cascade. With the rampant use of CS, clinicians started reporting the occurrence of osteonecrosis of the femoral head (OFH). In this systematic review, we aim to analyze the literature and identify the definitive cumulative dose and duration of CS needed for the development of OFH based on the SARS model and generate a risk-based screening recommendation for OFH in convalescent COVID-19 patients to facilitate early identification and management. An electronic database search was conducted until December 2022 in PubMed, Web of Science, Embase, and CNKI (China Knowledge Resource Integrated Database). Studies involving CS therapy and osteonecrosis data in SARS patients were included. Three authors independently extracted the data from the included studies and a dose–response meta-analysis was performed for various doses and duration of CS utilized in the included studies. We selected 12 articles with 1728 patients in the analysis. The mean age was 33.41 (±4.93) years. The mean dosage of CS administered was 4.64 (±4.7) g which was administered for a mean duration of 29.91 (±12.3) days. The risk of osteonecrosis increases at pooled OR of 1.16 (95% CI 1.09–1.23, p < 0.001) per 2.0 g increase in the cumulative dose of CS usage. Similarly, the risk increases at pooled OR of 1.02 (95% CI 1.01–1.03, p < 0.001) per 5 days of increase in the cumulative duration of CS usage. A cumulative dosage of 4 g and a duration of 15 days were determined as the critical cut-off for the non-linear dose–response relationship observed. Appropriate and frequent screening of these individuals at regular intervals would help in the identification of the disease at an early stage in order to treat them appropriately.
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Gupta I, Baranwal P, Singh G, Gupta V. Mucormycosis, past and present: a comprehensive review. Future Microbiol 2023; 18:217-234. [PMID: 36970978 DOI: 10.2217/fmb-2022-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Mucormycosis is an emerging opportunistic angioinvasive fungal infection. Predisposing factors such as diabetes, neutropenia, long-term corticosteroid therapy, solid organ transplantation and immunosuppression contribute to its occurrence. This disease was not of significant concern prior to the COVID-19 pandemic, but gained prominence due to infections in COVID-19 patients. Mucormycosis needs special attention and coordinated efforts of the scientific community and medical professionals to reduce morbidity and mortality. Here we present an overview of the epidemiology and prevalence of mucormycosis in the pre- and post-COVID-19 eras, the factors that contributed to the abrupt increase in COVID-19-associated mucormycosis (CAM), the actions taken by the regulatory agencies (including Code Mucor and CAM registry), the existing diagnostic tools and CAM management strategies.
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Erami M, Mirhendi H, Momen-Heravi M, Sharif A, Hashemi Hezaveh SJ, Matini AH, Ahsaniarani AH, Aboutalebian S. Case report: COVID-19-associated mucormycosis co-infection with Lomentospora prolificans: The first case and review on multiple fungal co-infections during COVID-19 pandemic. Front Med (Lausanne) 2023; 10:1078970. [PMID: 37007774 PMCID: PMC10061085 DOI: 10.3389/fmed.2023.1078970] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Along with the pandemic COVID-19 spreads, new clinical challenges have emerged in the health care settings, among which there is a high risk of secondary invasive fungal infections with significant mortality. Here, we report a case of invasive fungal rhino orbital sinusitis due to the simultaneous co-infection by Rhizopus oryzae and Lomentospora prolificans, both identified by sequencing, in a 70-year-old Afghanistanian female with COVID-19. The patient was subjected to surgical debridement as well as taking liposomal amphotericin B, voriconazole, and on discharge, her condition was good. As far as we know, this is the first case of co-infection of COVID-19-associated mucormycosis (CAM) and Lomentospora prolificans infection. Multiple fungal co-infections in COVID-19 patients are reviewed.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Diseases, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Sharif
- Department of Infectious Diseases, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Shima Aboutalebian,
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Chopra S, Setiya S, Waknis PP, Kale L, Tidke S. Various Treatment Modalities in COVID-19 Associated Facial Mucormycosis and the Need for its Surgical Management: A Systematic Review. J Maxillofac Oral Surg 2023:1-22. [PMID: 37362874 PMCID: PMC10008719 DOI: 10.1007/s12663-023-01878-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction Mucormycosis emerged as a wildfire in post-covid-19 infected patients. Most frequently involved sites of mucormycosis are rhino-orbital, rhino-sinusal and rhino-orbito-cerebral. The hallmark sign of mucormycosis is tissue necrosis, which is often a late sign. The fatality rate of mucormycosis is 46% globally. Despite early aggressive combined surgical and medical therapy, the prognosis of mucormycosis is poor. Methods We searched the electronic database of PubMed, web of science, Embase, Scopus and Google Scholar from Jan 2020 until December 2021 using keywords. We retrieved all the granular details of original research articles, case reports/series of patients with rhino-orbito-cerebral mucormycosis (ROCM), and COVID-19 reported worldwide. Subsequently, we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, treatment given and its outcome in people with COVID-19. (Prospero registration-CRD42021256830, June 4, 2021). Results Overall, 544 rhino-orbito-cerebral mucormycosis patients were included in our review with a history of Covid-19 infection. Out of which 410 patients had diabetes mellitus which has proven to be major contributing immunocompromised disease. Other diseases like hypertension, chronic kidney diseases, hypothyroidism, etc., were also attributed as an immunocompromised disease causing increased number of covid associated mucormycosis cases. We found out that total number of patients alive after taking only antifungal drug treatment were 25 in number, whereas total number of patients alive when antifungal drugs were combined with surgical intervention were 428 which was significantly higher. Conclusion Our systematic review concluded that surgical debridement should be performed whenever feasible in parallel to antifungal treatment in order to reduce the mortality rate of COVID-19 associated rhino-orbito-cerebral mucormycosis patients.
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Affiliation(s)
- Shivya Chopra
- Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sneha Setiya
- Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Pushkar P. Waknis
- Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Luke Kale
- Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sanika Tidke
- Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
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COVID-19-associated mucormycosis: A systematic review and meta-analysis of 958 cases. Clin Microbiol Infect 2023:S1198-743X(23)00122-2. [PMID: 36921716 PMCID: PMC10008766 DOI: 10.1016/j.cmi.2023.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases during the COVID-19 pandemic. OBJECTIVES To provide a comprehensive insight into the characteristics of COVID-19-associated mucormycosis (CAM), through a systematic review and meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science, Cochrane, CINAHL, Ovid MEDLINE, and FungiSCOPE. STUDY ELIGIBILITY CRITERIA Studies reporting individual-level information in adult CAM patients between January 1, 2020 and December 28, 2022. PARTICIPANTS Adults who developed mucormycosis during or after COVID-19. ASSESSMENT OF RISK OF BIAS Quality assessment was performed based on the National Institutes of Health Quality Assessment Tool for Case Series Studies. METHODS OF DATA SYNTHESIS Demographic information and clinical features were documented for each patient. Logistic regression analysis was used to predict the risk of mortality. RESULTS 958 individual cases reported from forty-five countries were eligible. 88.1% (844/958) were reported from low- or middle-income countries (LMIC). Corticosteroid use for COVID-19 (78.5%, 619/789) and diabetes (77.9%, 738/948) were common. Diabetic ketoacidosis (p<0.001), history of malignancy (p<0.001), underlying pulmonary (p=0.017) or renal disease (p<0.001), obesity (p<0.001), hypertension (p=0.040), age (>65 years) (p=0.001), Aspergillus co-infection (p=0.037), and tocilizumab use during COVID-19 (p=0.018) increased the mortality. CAM occurred on average 22 days after COVID-19 and 8 days after hospitalization. Diagnosis of mucormycosis in patients with Aspergillus co-infection and pulmonary mucormycosis was made on average 15.4 days (range 0-35) and 14.0 days (range 0-53) after hospitalization, respectively. Cutaneous mucormycosis accounted for <1% of cases. The overall mortality rate was 38.9% (303/780). CONCLUSION Mortality of CAM was high, and most reports were from LMIC countries. We detected novel risk factors for CAM such as older age, specific comorbidities, Aspergillus co-infection and tocilizumab use, in addition to previously identified factors.
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Erami M, Aboutalebian S, Hezaveh SJH, Ghazvini RD, Momen-Heravi M, Jafari Y, Ahsaniarani AH, Basirpour B, Matini AH, Mirhendi H. Microbial and clinical epidemiology of invasive fungal rhinosinusitis in hospitalized COVID-19 patients, the divergent causative agents. Med Mycol 2023; 61:myad020. [PMID: 36906282 DOI: 10.1093/mmy/myad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023] Open
Abstract
Since COVID-19 spread worldwide, invasive fungal rhinosinusitis (IFRS) has emerged in immunocompromised patients as a new clinical challenge. In this study, clinical specimens of 89 COVID-19 patients who presented clinical and radiological evidence suggestive of IFRS were examined by direct microscopy, histopathology, and culture, and the isolated colonies were identified through DNA sequence analysis. Fungal elements were microscopically observed in 84.27% of the patients. Males (53.9%) and patients over 40 (95.5%) were more commonly affected than others. Headache (94.4%) and retro-orbital pain (87.6%) were the most common symptoms, followed by ptosis/proptosis/eyelid swelling (52.8%), and 74 patients underwent surgery and debridement. The most common predisposing factors were steroid therapy (n = 83, 93.3%), diabetes mellitus (n = 63, 70.8%), and hypertension (n = 42, 47.2%). The culture was positive for 60.67% of the confirmed cases, and Mucorales were the most prevalent (48.14%) causative fungal agents. Different species of Aspergillus (29.63%) and Fusarium (3.7%) and a mix of two filamentous fungi (16.67%) were other causative agents. For 21 patients, no growth was seen in culture despite a positive result on microscopic examinations. In PCR-sequencing of 53 isolates, divergent fungal taxons, including 8 genera and 17 species, were identified as followed: Rhizopus oryzae (n = 22), Aspergillus flavus (n = 10), A. fumigatus (n = 4), A. niger (n = 3), R. microsporus (n = 2), Mucor circinelloides, Lichtheimia ramosa, Apophysomyces variabilis, A. tubingensis, A. alliaceus, A. nidulans, A. calidoustus, Fusarium fujikuroi/proliferatum, F. oxysporum, F. solani, Lomentospora prolificans, and Candida albicans (each n = 1). In conclusion, a diverse set of species involved in COVID-19-associated IFRS was observed in this study. Our data encourage specialist physicians to consider the possibility of involving various species in IFRS in immunocompromised and COVID-19 patients. In light of utilizing molecular identification approaches, the current knowledge of microbial epidemiology of invasive fungal infections, especially IFRS, may change dramatically.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Yazdan Jafari
- Department of Internal Medicine, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Bahare Basirpour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
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Keerthika R, Narwal A, Kamboj M, Devi A, Anand R, N S, Singh V, Agarwal V, Gupta A. Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study. Med Oral Patol Oral Cir Bucal 2023; 28:e99-e107. [PMID: 36806020 PMCID: PMC9985935 DOI: 10.4317/medoral.25130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/10/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). MATERIAL AND METHODS Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. RESULTS 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. CONCLUSIONS The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.
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Affiliation(s)
- R Keerthika
- Department of Oral and Maxillofacial Pathology and Microbiology Pt. Bhagwat Dayal Sharma University of Health Sciences Post Graduate Institute of Dental Sciences (PGIDS) Rohtak, Haryana-124001, India
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Madan S, Shelly S, Yadav R, Rohatgi J, Bajaj I, Tadu N, Rahul S, Das GK, Sahu PK, Gupta N. A Study on the Impact of Diabetes Mellitus on the Severity of COVID-19-Associated Mucormycosis. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2023. [DOI: 10.1055/s-0042-1759890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Abstract
Objectives: Diabetes mellitus (DM) seems the most common predisposing factor for rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to study the impact of DM on the severity of COVID-19-associated ROCM (CAM).
Methods: This was a retrospective analytical study performed over a period of 3 months to assess the impact of DM on the severity of CAM in 100 patients and association of clinical correlates of DM with severity of CAM.
Statistical analysis: The data collected using the study tools were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised a descriptive analysis that involved calculating means, standard deviations, and proportions. For calculating the significance of the difference of mean between two groups, Student's t-test was applied. In addition, chi-square test (or Fisher's t-test if applicable) was applied to study the significance of association of clinical correlates of DM with severity of CAM for categorical variables and t-test for continuous variables.
Results: The prevalence of DM was 67%. The average presenting blood sugar level was 245.9 ± 99.86 mg%. Glycated hemoglobin level between 4.5 and 6.5% was observed in 57 patients and over 6.5% in 43 subjects. A high body mass index (BMI) of 25 and above was noted in 52 patients. A significantly higher level of presenting blood sugar and a longer duration of hospital stay was noted in patients having stage 3b or higher (p < 0.05) when compared with those having stage 3a or below. No significant correlation was observed in patients in stage 3a or below and those presenting with stage 3b or higher in terms of BMI, waist to hip ratio, or total cholesterol levels. There was a strong correlation between blood sugar level at presentation, severity of DM with the severity of ROCM, and a strong inverse correlation noted between HDL level and severity of ROCM.
Conclusion: A poor metabolic control is associated with a higher risk of a severe disease with intracranial involvement.
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Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Shelly Shelly
- Department of Medicine, University College of Medical Sciences and Associated GTB Hospital, India
| | - Rekha Yadav
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Ishita Bajaj
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Nampi Tadu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Sharma Rahul
- Department of Community Medicine, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Gopal Krushna Das
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Pramod Kumar Sahu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Neelima Gupta
- Department of ENT, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
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Gulabani M, Chauhan R, Gaur D, Das S, Bajaj M, Saxena AK. Health Literacy and Clinic-Epidemiological Profile of Patients with COVID-19-Associated Mucormycosis: A Questionnaire-Based Study. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2023. [DOI: 10.1055/s-0042-1760288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Abstract
Background The patient partnership is desirable for the optimal management of comorbidities. This became significant more so during the coronavirus disease 2019 (COVID-19) crisis wherein health infrastructure was overburdened.
Objectives The aim of this study was to estimate the clinicoepidemiological profile, health literacy regarding predisposing risk factors, and disease management in patients with COVID-19-associated mucormycosis (CAMCR).
Materials and Methods A structured questionnaire-based study on randomly chosen 100 microbiologically proven patients of CAMCR, consisting of 38 multiple choice questions, was designed with each answer having a patient and assessor response to it.
Results A male predilection was seen (68%) with rhino-orbital (73%) being the commonest anatomic site. Forty-nine percent of the study participants had pre-existing diabetes of which 62% did not carry out regular blood sugar monitoring and in 18%, blood sugars were controlled prior to COVID-19. Thirty-five percent of patients with mild COVID-19 illness were treated with unwarranted steroids and 56% of patients had fluctuating blood sugar levels, during COVID-19 illness.Seventy-nine percent of patients were not vaccinated against COVID-19, 16% only partially vaccinated. Seventy-one percent of patients were not aware of red flag signs and of mucormycosis with 8% presenting early, on noticing nasal symptoms.
Conclusion This study observed diabetes as the most common comorbidity in patients with CAMCR. A lacuna in the health literacy of diabetics presenting with CAMCR was found. Additionally, knowledge regarding glycemic control during COVID-19 illness with or without the use of steroids and awareness of the “red flag” signs of CAMCR were mostly lacking. Interventions to improve awareness amongst patients with diabetes should help in optimal glycemic control, and avoid potential complications like severe COVID-19 illness, and mucormycosis.
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Affiliation(s)
- Michell Gulabani
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
| | - Richa Chauhan
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
| | - Diksha Gaur
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
| | - Swati Das
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
| | - Megha Bajaj
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
| | - Ashok Kumar Saxena
- Department of Anaesthesia and Critical Care, University College of Medical Sciences, Delhi, India
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Li CX, Gong ZC, Pataer P, Shao B, Fang C. A retrospective analysis for the management of oromaxillofacial invasive mucormycosis and systematic literature review. BMC Oral Health 2023; 23:115. [PMID: 36810012 PMCID: PMC9942087 DOI: 10.1186/s12903-023-02823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Mucormycosis is a type of fatal infectious disease, rarely involved in the oromaxillofacial region. This study aimed to describe a series of 7 cases with oromaxillofacial mucormycosis and to discuss the epidemiology, clinical features, and treatment algorithm thereof. METHODOLOGY Seven patients in the author's affiliation have been treated. They were assessed and presented as per their diagnostic criteria, surgical approach, and mortality rates. Reported cases of mucormycosis originally happened in craniomaxillofacial region were synthesized through a systematic review so as to better discuss its pathogenesis, epidemiology, and management. RESULTS Six patients had a primary metabolic disorder, and one immunocompromised patient had a history of aplastic anemia. The criteria for a positive diagnosis of invasive mucormycosis were based on clinical presentation of signs and symptoms, and a biopsy for microbiological culture and histopathologic analysis. Each patient used antifungal drugs and five of them also underwent surgical resection at the same time. Four patients died due to the unregulated spread of mucormycosis, and one patient died owing to her main disease. CONCLUSIONS Although uncommon in clinical practice setting, mucormycosis should be of great concern in oral and maxillofacial surgery, due to the life-threatening possibility of this disease. The knowledge of early diagnosis and prompt treatment is of utmost importance for saving lives.
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Affiliation(s)
- Chen-xi Li
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China ,grid.33199.310000 0004 0368 7223Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022 People’s Republic of China
| | - Zhong-cheng Gong
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Parekejiang Pataer
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Bo Shao
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Chang Fang
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
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Sharma A, Bedi M, Patel P, Singh Arora A. Black fungus outbreak in India - A direct consequence of COVID-19 surge: A myth or reality. GONDWANA RESEARCH : INTERNATIONAL GEOSCIENCE JOURNAL 2023; 114:117-123. [PMID: 35153531 PMCID: PMC8816797 DOI: 10.1016/j.gr.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 05/06/2023]
Abstract
The deadly second wave of COVID-19 has seen an unprecedented surge in mucormycosis associated mortality in India, overwhelming the heath authorities with challenges beyond measure. Also known as black fungus, this life-threatening fungal infection usually manifests in the nose, spreads to the eyes, and in some cases also to the brain. Immune suppression, pre-existing conditions, prolonged and indiscriminate use of steroids, and unhygienic environments are some of the widely recognized risk factors for contracting black fungus in individuals recovered from COVID-19. However, diagnosis of the infection remains insufficient due to the lack a holistic understanding of the possible risks, symptoms, and exposure pathways and therefore no definite protocol exists for managing this fatal infection. Here, we synthesize the current state of knowledge on black fungus outbreak in India and identify key gaps in its understanding with respect to potential risk factors leading to the widespread infection. We looked at 3354 black fungus cases in India, enlisting ailment history (particularly diabetes) and steroid usage in COVID-19 patients as the key factors responsible for exacerbating risks associated with the disease. However, we also press on the possibilities that other less studied non-traditional risk factors may also have a role in causing the infection. Black fungus is therefore a reality of COVID-19, with or without diabetes or steroid use needs to be investigated. We believe such a review is imperative for making informed decisions specially around timely diagnosis and channelizing efforts in controlling the spread of COVID-19 associated mucormycosis.
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Affiliation(s)
- Archana Sharma
- Department of Environmental Science and Engineering, Marwadi University, Rajkot 36004, Gujarat, India
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh 15261, PA, USA
| | - Prachi Patel
- Department of Environmental Engineering, University of Ottawa, Ontario, Canada
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N Al‐Rasheedi A, D Alotaibi A, Alshalan A, Muteb Alshalan K, Muharib R Alruwaili K, Hamdan R Alruwaili A, Talal Alruwaili A, Abdulhamid Alanazi A, Khalid Alshalan M, Fahid ALtimani A. Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review. J Asthma Allergy 2023; 16:201-211. [PMID: 36733455 PMCID: PMC9888400 DOI: 10.2147/jaa.s398686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Sinusitis is a common condition with various forms and different etiologies. In the era of COVID-19, a large number of studies covered the association between sinusitis and COVID-19, while others reported the impact of COVID-19 on the development of acute invasive fungal rhinosinusitis (AIFR), together with the most commonly associated predisposing factors. Fungal sinusitis, particularly AIFR, can be life-threatening. It is important to dissect this association and improve current evidence and management. Therefore, we conducted this literature review to highlight the association between COVID-19 and sinusitis based on evidence from the available studies in the literature. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed. On the other hand, COVID-19 can also cause olfactory dysfunction, which is usually temporary. In addition, we found several studies that indicated the association between COVID-19 and AIFR. The condition is usually associated with severe morbidities, as affected patients are usually immunocompromised, including those with uncontrolled diabetes, malignancy, immunosuppression, AIDS, the administration of chemotherapy and other immunosuppressive drugs, and COVID-19.
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Affiliation(s)
- Abdullah N Al‐Rasheedi
- Department of Otolaryngology, Head & Neck Surgery, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia,Correspondence: Abdullah N Al‐Rasheedi, Saudi Board (Otolaryngology-Head & Neck Surgery), College of Medicine, Jouf University, Sakaka, Aljouf, 72388, Saudi Arabia, Tel +966591009005, Email
| | - Abdullah D Alotaibi
- Department of Otolaryngology, Head & Neck Surgery, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Afrah Alshalan
- Department of Otolaryngology, Head & Neck Surgery, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia
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Pathak L, Tripathi A, Nayyar SS, Kurkure R, Yadav A, Mishra J, Das B, Tiwari S. Management of post-COVID mucormycosis at a tertiary care center in Northern India. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2023. [PMCID: PMC9869295 DOI: 10.1186/s43163-023-00388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abstract
Purpose
Our study aims to compile data on the clinical presentation, pathological and radiological findings in cases of post-COVID mucormycosis, and present the management strategy used in our center.
Methods
This is a retrospective cohort observational study based at a tertiary healthcare institution in Northern India. All COVID-positive patients presenting with clinical features of mucormycosis were included in the study. They underwent complete otorhinolaryngeal, medical, and ophthalmological examination after thorough history taking. Biochemical tests, biopsy and imaging studies were done for all the patients. The treatment strategy included a multidisciplinary team approach, that is, intravenous antifungals as well as surgical debridement of necrotic tissue via Modified Denker’s approach or open maxillectomy, and orbital exenteration, if required. Patients were followed up for six months to look for recurrence.
Results
Twenty-three patients were studied, out of which 14 were males and 9 were females. Pathological findings of 13 out of 15 patients, who underwent surgical debridement revealed mucormycosis as a causative agent, received Amphotericin. Aspergillus was found in two cases which received Voriconazole. Eleven out of 20 patients who were treated in our hospital survived. Three patients were lost to follow up. The average hospital stay of discharged patients was 14 days.
Conclusion
Post-COVID mucormycosis was reported at an alarming rate after the second COVID wave in India especially after steroid therapies in diabetic patients. Thus a timely, aggressive, team approach using Modified Denkers or open maxillectomy along with proper intravenous antifungals is the key to survival in such patients.
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Chaurpagar R, Chiplunkar B, Doifode P, Athawale N. Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2023; 75:867-874. [PMID: 36684821 PMCID: PMC9838433 DOI: 10.1007/s12070-022-03430-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60 years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.
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Affiliation(s)
| | | | - Parag Doifode
- Department of ENT, Government Medical College, Akola, Maharashtra India
| | - Neha Athawale
- Department of ENT, Government Medical College, Akola, Maharashtra India
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The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis. CURRENT FUNGAL INFECTION REPORTS 2023; 17:54-70. [PMID: 36852004 PMCID: PMC9947451 DOI: 10.1007/s12281-023-00456-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/25/2023]
Abstract
Purpose of Review Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different fungal diseases. Recent Findings Corticosteroids are a risk factor of aspergillosis for patients who have COVID-19, and they also led to a worse outcome. Similarity, corticosteroids are a risk factor for candidemia and mucormycosis. Some researchers reported that using topical corticosteroid in keratitis was associated with worse visual outcome if fungal keratitis. Some studies showed that corticosteroids are linked to a negative outcome for non-HIV patients with Pneumocystis jirovecii pneumonia (PCP), in contrast to those with HIV and PCP. Summary In 59 references, we found that corticosteroid therapy showed a worse clinical outcome in invasive aspergillosis (IA) (HR: 2.50, 95%CI: 1.89-3.31, p < 0.001) and chronic pulmonary aspergillosis (CPA) (HR: 2.74, 95%CI: 1.48-5.06, p = 0.001), PCP without HIV infection (OR: 1.29, 95%CI: 1.09-1.53, p = 0.003), invasive candidiasis and candidaemia (OR: 2.13, 95%CI: 1.85-2.46, p < 0.001), mucormycosis (OR: 4.19, 95%CI: 1.74-10.05, p = 0.001) and early in the course of fungal keratitis (OR: 2.99, 95%CI: 1.14-7.84, p = 0.026). There was equivocal outcome in cryptococcal meningoencephalitis in AIDS and primary coccidioidomycosis, while corticosteroid therapy showed a better outcome in PCP in HIV-infected patients (RR: 0.62, 95%CI: 0.46-0.83, p=0.001) and fungal keratitis patients after keratoplasty surgery (OR: 0.01, 95%CI: 0.00-0.41, p = 0.041) and probably in cryptococcal meningoencephalitis in non-immunocompromised patients. A sub-analysis in invasive aspergillosis and CPA showed that use of more than 2 mg/kg/day of prednisolone equivalents per day is a significant factor in increasing mortality (HR: 2.94, 95%CI: 2.13-4.05, p < 0.001). Corticosteroid therapy during invasive fungal disease was usually associated with a slightly or greatly increased mortality or worse visual outcome (in fungal keratitis), with two disease exceptions. Avoiding the addition of corticosteroids, or minimising dose and duration in those who require them, is likely to improve the outcome of most life- and vision-threatening fungal diseases. This review provides a cornerstone for further research in exploring the accuracy of suitable dose and duration of corticosteroids treatment in fungal diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s12281-023-00456-2.
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Panta P, Reddy P, Andhavarapu A, Patil S. Can Nasal Irrigation Serve as a Complementary Strategy for Preventing COVID-associated Mucormycosis? J Contemp Dent Pract 2023; 24:1-3. [PMID: 37189004 DOI: 10.5005/jp-journals-10024-3477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, Malla Reddy Institute of Dental Sciences, Suraram X Roads, Jeedimetla, Quthbullapur, Hyderabad, Telangana, India, Phone: +91 9701806830, e-mail:
| | - Prashanthi Reddy
- Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Archana Andhavarapu
- Department of Pulmonary Medicine, Malla Reddy Medical College for Women, Hyderabad, Telangana, India
| | - Shankargouda Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America
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Thakur B, Ahuja S, Acharya S, Kaushik S. A retrospective clinicopathological analysis of rhino-orbital mucormycosis in second wave of COVID-19. INDIAN J PATHOL MICR 2023; 66:411-414. [PMID: 37077099 DOI: 10.4103/ijpm.ijpm_732_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background During the present surge of COVID-19 positive cases, concurrent multifold increase in the incidence of mucormycosis cases has resulted into significant morbidity and mortality. We retrospectively evaluated the clinicopathological features along with microbiological examination findings in histologically diagnosed cases of rhino-orbital mucormycosis. Material and Methods All the H and E and special stained slides of included mucormycosis cases were retrieved from the records and were evaluated with microbiological findings including screening KOH mount examination and culture results. Results Out of 16 cases with available details, 10 cases had the previous history of diabetes mellitus. The most frequent single site of involvement was maxillary sinus (7/25) followed by nasal cavity, orbit, ethmoid and sphenoid sinuses. While comparing the histological diagnosis with KOH mount findings and culture results, 15 cases revealed consistent results. Conclusion A high clinical suspicion, monitoring, early diagnosis, and timely management can improve the morbidity and mortality of this life-threatening complication.
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