The global emergence of severe acute respiratory syndrome coronavirus 2 in human

Dexamethasone Induced Sino-Orbital Mucormycosis In a Patient Infected With COVID-19

BACKGROUND

The most common causes of immunodeficiency are iatrogenic and the result of the widespread use of therapies which modulates the immune system, whether they are planned or haphazardly. Mucormycosis is an invasive fungal disease which is usually secondary to immunosuppression, diabetic ketoacidosis, and long-term use of antibiotics, corticosteroids, and cytotoxic drugs. There are researches which show patients with coronavirus disease 2019 (COVID-19), especially severely ill or immunocompromised, are more likely to suffer from invasive fungal infections. Patients with diabetes are at a higher risk for severe COVID-19 outcomes. However, there has been no clear evidence on the relationship between pre-diabetes state and mucormycosis as a complication of SARS-CoV-2 infection so far.

CASE PRESENTATION

Here, we report a case of sino-orbital mucormycosis in a pre-diabetic 54-year-old female without any underlying diseases. The patient suffered from COVID-19 pneumonia. She received 8 mg dexamethasone for 12 days. Afterwards, she returned three days after her discharge with a complaint of pre-orbital cellulitis, unilateral facial numbness and decreased visual acuity. Therefore, after primary diagnostic imaging, she was regarded as a candidate for invasive surgical intervention and was consequently treated with a combination of liposomal amphotericin B, radical recurrent surgery and posaconazole.

CONCLUSION

It is very important to consider patients who are in the pre-diabetic state or possibly immunocompromised before prescribing steroids. The patients should be examined for invasive fungal infections in post-discharge period.

In silico docking analysis revealed the potential of phytochemicals present in Phyllanthus amarus and Andrographis paniculata, used in Ayurveda medicine in inhibiting SARS-CoV-2

The Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in outbreak of global pandemic, fatal pneumonia in human referred as Coronavirus Disease-2019 (Covid-19). Ayurveda, the age old practice of treating human ailments in India, can be considered against SARS-CoV-2. Attempt was made to provide preliminary evidences for interaction of 35 phytochemicals from two plants (Phyllanthus amarus and Andrographis paniculata used in Ayurveda) with SARS-CoV-2 proteins (open & closed state S protein, 3CLpro, PLpro and RdRp) through in silico docking analysis. The nucleotide analogue remdesivir, being used in treatment of SARS-CoV-2, was used as a positive control. The results revealed that 18 phytochemicals from P. amarus and 14 phytochemicals from A. paniculata shown binding energy affinity/dock score < - 6.0 kcal/mol, which is considered as minimum threshold for any compound to be used for drug development. Phytochemicals used for docking studies in the current study from P. amarus and A. paniculata showed binding affinity up to - 9.10 kcal/mol and - 10.60 kcal/mol, respectively. There was no significant difference in the binding affinities of these compounds with closed and open state S protein. Further, flavonoids (astragalin, kaempferol, quercetin, quercetin-3-O-glucoside and quercetin) and tannins (corilagin, furosin and geraniin) present in P. amarus have shown more binding affinity (up to - 10.60 kcal/mol) than remdesivir (up to - 9.50 kcal/mol). The pharmacokinetic predictions suggest that compounds from the two plants species studied in the current study are found to be non-carcinogenic, water soluble and biologically safe. The phytochemicals present in the extracts of P. amarus and A. paniculata might have synergistic effect with action on multiple target sites of SARS-CoV-2. The information generated here might serve as preliminary evidence for anti SARS-CoV-2 activity of phytochemicals present from P. amarus and A. paniculata and the potential of Ayurveda medicine in combating the virus.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13205-020-02578-7.