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Chouksey G, Singh GP, Gupta V, Choure R, Dev A, Kumar B. Assessment of oral health-related quality of life outcomes: A preliminary study to compare conventional and digital impressions in obturator fabrication for patients with maxillectomy defects. J Dent 2025; 159:105852. [PMID: 40419079 DOI: 10.1016/j.jdent.2025.105852] [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: 10/01/2024] [Revised: 05/21/2025] [Accepted: 05/24/2025] [Indexed: 05/28/2025] Open
Abstract
OBJECTIVE The objective of this study was to compare oral health-related quality of life (OHRQoL) as measured by the University of Washington Quality of Life Scale Version 4 (UW-QOL v4) among patients with maxillectomy defects resulting from COVID-19-associated mucormycosis (CAM). The comparison focused on patients whose maxillary obturators were fabricated using conventional or digital impression techniques. METHODS Twenty patients with maxillary defects requiring oral rehabilitation with obturators were alternately assigned to two groups. Conventional impressions using stone models were taken for the Control Group, while digital impressions with 3D-printed models were used for the Test Group. For both groups, changes in OHRQoL were assessed using the UW-QOL v4 at baseline and three months post-prosthesis insertion. Nominal variables were summarised as counts and percentages, while numerical variables were expressed as means with standard deviations. The normality criterion was evaluated using the Shapiro-Wilk test. The distribution of variables and score comparisons between the digital and conventional methods were analysed using the Wilcoxon Rank Sum test for numerical variables and the Chi-square or Fisher's Exact test, as appropriate, for nominal variables. RESULTS Before rehabilitation, low scores were observed across all domains of the UW-QOL v4 in both participant groups. For the Control Group, the most affected domains were chewing [0.0 (0.0)], taste [6.0 (12.6)], and swallowing [9.0 (14.5)]. Meanwhile, in the Test Group, the most affected domains were taste [13.0 (23.6)] and speech [18.0 (15.5)]. Post-rehabilitation, significant improvements were noted across all domains of the UW-QOL v4, with mean scores exceeding 80 in most domains for both groups. Specifically, physical subscale scores increased from 22.5 (6.3) to 85.8 (8.9) in the Control Group, and from 29.5 (10.7) to 85.5 (14.0) in the Test Group. Similarly, social subscale scores rose from 37.3 (14.9) to 90.2 (12.4) in the Control Group, and from 33.1 (18.9) to 88.0 (10.7) in the Test Group. However, no statistically significant differences were found between the two groups in post-rehabilitation outcomes across all UW-QOL v4 domains (P > 0.05 for all comparisons). CONCLUSIONS Speech was the common domain of concern for both groups of participants before rehabilitation. A comparison between conventional and digital impressions for the fabrication of obturators in patients with maxillectomy defects due to CAM revealed no statistically significant differences in the distribution of scores across various domains of the UW-QOL v4 (P > 0.05 for all comparisons) CLINICAL SIGNIFICANCE: Obturators fabricated using digital impressions are equally effective as those made using conventional impressions for patients with maxillectomy defects. Regardless of the method used to create impressions of the defect, patients experienced significant improvements in clinical outcomes following rehabilitation.
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Affiliation(s)
- Gunjan Chouksey
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, India.
| | - Gurkaran Preet Singh
- Dental and Prosthetic Surgery, Tata Memorial Hospital, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Vikas Gupta
- Department of ENT-HNS, All India Institute of Medical Sciences, Bhopal, India
| | - Rupali Choure
- Department of Prosthodontics and Crown and Bridge, People's Dental Academy, Bhopal, India
| | - Aman Dev
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, India
| | - Bhimsen Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, India
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Kaur G, Kaur R, Sumanpreet, Kaur M. Association of COVID with Mycosis in General. Infect Disord Drug Targets 2024; 24:e190124225866. [PMID: 38251692 DOI: 10.2174/0118715265266815231130063931] [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: 07/30/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 is a respiratory disease which created havoc worldwide, was accompanied by another peculiar, otherwise rare, secondary fungal infection Mucormycosis which was observed at exceptionally high incidence in India during the second wave of COVID-19. The article explores possible links between the two infectious diseases to understand a higher-than-normal occurrence of Mucormycosis in COVID-19 patients. Coronavirus enters the patients through ACE-2 and many other receptors like- NRP-1, TfR, CD-126, and CD-26. Virus bind to cells possessing these receptors and affect their proper functioning, disturbing homeostatic metabolism and resulting in conditions like hyperglycemia, Diabetic Ketoacidosis (DKA), low serum pH, iron overload, anemia, hypoxia, and immunosuppression as explained in the article. All these outcomes provide a very supportive environment for the attack and spread of Mucormycosis fungi. The major receptor for Mucormycosis in humans is the GRP-78. Its expression is upregulated by coronavirus entry and by hyperferritinemia, hyperglycemia, and acidic conditions prevalent in COVID patients, thus providing an easy entry for the fungal species. Upregulation of GRP-78 furthermore damages pancreatic β-cells and intensifies hyperglycemia, showing quite a synergic relationship. Inordinate rise of Mucormycosis cases in India might be explained by facts like- India possessing a large proportion of diabetic patients, emergence of a very deadly strain of coronavirus- Delta strain, higher doses of steroids and antibodies used to treat patients against this strain, overburdened health care services, sudden much higher need of oxygen supply and use of industrial oxygen could explain the Mucormycosis outbreak observed in India during the second wave of COVID-19. OBJECTIVE The present review discusses the functional interdependence between COVID-19 and Mucormycosis and summarizes the possible synergic links between COVID and Mucormycosis. CONCLUSION The receptors and metabolic pathways affected by COVID-19 result in severe physiological conditions- hyperglycemia, DKA, anemia, iron overload, immunosuppression, and hypoxia. All these conditions not only increase the expression of GRP-78, the major receptor for entry of fungi but also play a crucial role in providing quality media for Mucormycosis fungus to establish and grow. Hence explains the fungal epidemic observed in India during the second wave of COVID-19 in India.
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Affiliation(s)
- Gurpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Rajinder Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Sumanpreet
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
| | - Manpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala, 147002, India
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Thakur (Rai) N, Misra M, Misra S, Misra S, Shukla DK, Singh AK, Dheer Y, Jaiswal V, Rai N. Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India. J Diabetes Metab Disord 2023; 22:1459-1469. [PMID: 37975119 PMCID: PMC10638341 DOI: 10.1007/s40200-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Introduction Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and methods An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.
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Affiliation(s)
- Neha Thakur (Rai)
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Maitreyi Misra
- Intern, Department Of Surgery, TSM Medical College, Lucknow, Uttar Pradesh India
| | - Samir Misra
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | | | - Devesh Kumar Shukla
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Arvind Kumar Singh
- Department of Social and Preventive Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Yadvendra Dheer
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Vaibhav Jaiswal
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Narendra Rai
- Department of Paediatrics, Chandan Hospital, Lucknow, Uttar Pradesh India
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Darazam IA, Babamahmoodi A, Ebrahimi MJ, Moafi M, Dilmaghani NA, Mardani M, Shokouhi S, Gharehbagh FJ, Chalmiani EM, Shabani M, Bidari F, Jamali E, Khoshsirat S, Shahriari M, Sabeti S, Rahmani Z, Mousavinejad SA, Ebrahimzadeh K, Hallajnejad M. Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021). IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2467-2473. [PMID: 38106820 PMCID: PMC10719695 DOI: 10.18502/ijph.v52i11.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 12/19/2023]
Abstract
Background Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection. Methods In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran. Results The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era. Conclusion The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased.
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Affiliation(s)
- Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Babamahmoodi
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Antimicrobial-Resistant Research Center, Mazandaran University of Medical Sciences, Ghaemshahr, Mazandaran, Iran
| | - Mohammad Javad Ebrahimi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Moafi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Mahmoudi Chalmiani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meinoosh Shabani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Jamali
- Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrokh Khoshsirat
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Rahmani
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mousavinejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hallajnejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Merad Y, Belmokhtar Z, Hadjazi O, Belkacemi M, Matmour D, Merad Z, Bassaid A, Megherbi O. Fungal contamination of medical masks among forensic healthcare workers in the COVID19 era. New Microbes New Infect 2023; 53:101134. [PMID: 37206638 PMCID: PMC10132829 DOI: 10.1016/j.nmni.2023.101134] [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: 10/20/2022] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Background Medical masks are widely used in health care settings to protect healthcare workers from respiratory infections, particularly in the context of the recent Covid-19 disease. Methods A cross-sectional study of 52 used masks collected from 52 forensic healthcare practitioners was conducted to culture for fungal isolation and identification. A study of fungal contamination was conducted by making an impression of the mouth mask cut piece on Sabouraud agar for selective isolation; each health worker completed a questionnaire, which included age, sex, type of mask, and duration of mask use. Results Twenty five of the 52 used masks tested positive for fungal contamination (48,08%). A total of 44% of the contaminated masks belong to health workers between the ages of 21-30 years. Surgical masks (80%), KN95 (8%), and N95 (4%) were the most contaminated protective devices. Usage duration of 1-2 h was associated with 4% of fungal contamination, while a usage duration of 5-6 h was associated with 36% of fungal contamination. Alternaria sp (32%), Penicillium sp (20%), Aspergillus sp (16%) were the most predominant isolated fungi discovered on the inside areas of the masks. Conclusion Because fungi are known to cause allergies and serious adverse health effects following recommendations to properly wear a medical mask is critical to preventing fungal contamination, especially among health care workers who are wearing the same mask for a long period during the pandemic.
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Affiliation(s)
- Yassine Merad
- Central Laboratory, Parasitology-Mycology, Hassani Abdelkader Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
| | - Zoubir Belmokhtar
- Diilali Liabes University of Environmental Sciences, Sidi Bel Abbes, Algeria
| | - Omar Hadjazi
- Forensic Department, Hassani Abdelkader Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
| | - Malika Belkacemi
- Hemobiology Department, Hassani Abdelkader Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
| | - Derouicha Matmour
- Therapeutic Chemistry Department, Abdelkader Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
| | - Zakaria Merad
- Pathology Department, Hassani Abdelkader Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
| | - Adila Bassaid
- Parasitology-Mycology Department, Mustapha Bacha Hospital, University of Algiers, Algeria
| | - Ouziane Megherbi
- ENT Department, Hospital, Diilali Liabes University of Medicine, Sidi Bel Abbes, Algeria
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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: 0.5] [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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Ghasemi S, Dashti M, Fahimipour A, Daryakenari G, Mirzaei F, Akbari F, Khurshid Z. Onset of Mucormycosis in Patients with COVID-19: A Systematic Review on Patients' Characteristics. Eur J Dent 2022; 17:24-38. [PMID: 36049777 PMCID: PMC9949939 DOI: 10.1055/s-0042-1751003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Mucormycosis has a significant impact on patients' standard of living and, therefore, a high clinical suspicion, prediagnosis, and rapid treatment are critical in easing patients' suffering and fast recovery. Our focus is to conduct an organized review based on various variables on the patients' characteristics having mucormycosis in severe novel coronavirus disease 2019 (COVID-19). We examined Embase, PubMed-Medline, LitCovid, Web of Science, Scopus, and the reference lists of included case reports up to September 20, 2021, using the Medical Subject Heading (MeSH) phrases and other keywords related to this topic. Subsequently, we investigated associated comorbidities, patient characteristics, position of mucormycosis, steroids use, body involvements, and outcomes. Overall, 77 studies were conducted and among these, 72 studies mentioned that the patients' age to be 48.13±14.33 (mean±standard deviation [SD]) years. Diabetes mellitus (DM) was reported in 77.9% (n=60) of cases. Studies showed that central nervous system (CNS) and bone involvement were reported in 62.3 (n=48) and 53.2% (n=41), respectively. More fatalities were observed in patients with mucormycosis with the active form of COVID-19. Also, men infected with mucormycosis significantly affected by COVID-19. In the end, mortality was higher in males with mucormycosis. As a result, a solid investigation into the root cause of mucormycosis, especially in COVID-19, should be included in the study plan. If the patient is COVID-19-positive and immunosuppressed, this opportunistic pathogen diagnostic test should not be overlooked.
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Affiliation(s)
- Shohreh Ghasemi
- Department of Oral and Maxillofacial Surgery, The Dental College of Georgia at Augusta University, Augusta, GA, USA,Department of Craniofacial Reconstruction and Trauma Queen Marry, University of London, London, UK
| | - Mahmood Dashti
- Department of Orthodontics, Georgia School of Orthodontics, Atlanta, Georgia, USA,Address for correspondence Mahmood Dashti, DDS Department of Orthodontics, Georgia School of OrthodonticsAtlanta, GeorgiaUSA
| | - Amir Fahimipour
- Department of Oral Surgery, Medicine and Diagnostics, School of Dentistry, Faculty of Medicine and Health, Westmead Centre for Oral Health, The University of Sydney, Sydney, Australia
| | - Ghazaleh Daryakenari
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Mirzaei
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Akbari
- Department of Dentistry, Mazandaran University of Medical Science, Mazandaran, Iran
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
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8
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Tiwari S, Vakil Z. Adverse Drug Reactions with Antifungals Used in the Management of COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221105759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Amidst the second wave of the coronavirus disease 2019 (COVID-19) pandemic in India, there was a sharp increase in the number of cases of Rhino-orbito-cerebral mucormycosis (ROCM) leading to increased use of systemic antifungal agents namely Amphotericin B Deoxycholate, Liposomal Amphotericin B, and Posaconazole thereby causing an increase in associated adverse drug reactions. This study aimed to determine the incidence and frequency of adverse drug reactions (ADRs), to study any factors contributing to the same, while also exploring the use of Amphotericin B Deoxycholate as a cheaper, safe alternative to Liposomal Amphotericin B. Materials and Methods: It was a cross-sectional observational study, with a study population of 50 conducted over three months after ethics approval. All adult patients admitted to a tertiary care center, in a metropolitan city of Maharashtra, diagnosed with Rhino-orbito-cerebral mucormycosis, with a history of previous COVID-19 infection and receiving antifungals for the treatment of the same were included in the study. Central drug standard control organization (CDSCO) ADR reporting forms were used to collect data. Results: Electrolyte disturbances mainly hypokalemia were the most frequently encountered ADR with both Amphotericin formulations (39/50; 20.31%) followed by pain at the injection site (33/50; 17.19%). Nephrotoxicity occurred slightly more frequently with Amphotericin B Deoxycholate (19/29; 65%), compared to Liposomal Amphotericin B (11/19; 57%), while Posaconazole was mainly associated with gastrointestinal (GI) disturbances and hepatotoxicity. Conclusion: Amphotericin B Deoxycholate was associated most with ADRs, hypokalemia, and pain at the injection site being the most frequent. However, concerning nephrotoxicity, both Amphotericin formulations showed only a modest difference. Posaconazole was associated with the least number of ADRs and had a favorable safety profile.
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Affiliation(s)
- Smrati Tiwari
- Department of General Medicine, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Zahaan Vakil
- Department of General Medicine, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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García-Carnero LC, Mora-Montes HM. Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis. J Fungi (Basel) 2022; 8:445. [PMID: 35628701 PMCID: PMC9144279 DOI: 10.3390/jof8050445] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
The ongoing COVID-19 pandemic has quickly become a health threat worldwide, with high mortality and morbidity among patients with comorbidities. This viral infection promotes the perfect setting in patients for the development of opportunistic infections, such as those caused by fungi. Mucormycosis, a rare but deadly fungal infection, has recently increased its incidence, especially in endemic areas, since the onset of the pandemic. COVID-19-associated mucormycosis is an important complication of the pandemic because it is a mycosis hard to diagnose and treat, causing concern among COVID-19-infected patients and even in the already recovered population. The risk factors for the development of mucormycosis in these patients are related to the damage caused by the SARS-CoV-2 itself, the patient's overstimulated immune response, and the therapy used to treat COVID-19, causing alterations such as hyperglycemia, acidosis, endothelial and lung damage, and immunosuppression. In this review, the molecular aspects of mucormycosis and the main risk factors for the development of COVID-19-associated mucormycosis are explained to understand this virus-fungi-host interaction and highlight the importance of this neglected mycosis.
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Affiliation(s)
- Laura C. García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Mexico
| | - Héctor M. Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Mexico
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Risks of mucormycosis in the current Covid-19 pandemic: a clinical challenge in both immunocompromised and immunocompetent patients. Mol Biol Rep 2022; 49:4977-4988. [PMID: 35107737 PMCID: PMC8808276 DOI: 10.1007/s11033-022-07160-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
Mucormycosis, also called "Black Fungus", is a new cause for worry in the current Coronavirus disease 2019 (covid-19) pandemic. Mucormycosis is devasting due to its high rate of morbidity and mortality which is a great cause of concern. Mucormycosis, in general, affects immunocompromised patients including diabetic, people with malignancies, organ and stem cell transplants and people affected with pandemic diseases like covid-19. Diagnosis of Mucormycosis is often delayed either due to clinical complications or misdiagnosed as symptoms of other diseases, especially covid-19. This could delay the treatment protocol which results in the failure of treatment. Mortality rate due to secondary infections in covid-19 patients with uncontrolled diabetics and who are on steroid therapy can soon reach 100% if diagnosis and treatment doesn't happen on timely basis. Risk of Mucormycosis is not just in immunosuppressed patients, but immunocompetent people with late diagnosis are also prone to infection. In view of this, we present a comprehensive review on risks of Mucormycosis in immunocompromised and immunocompetent patients highlighting the epidemiology, forms of Mucormycosis, immune response against Mucorales, difficulties in diagnosis and challenges in treatment of Mucormycosis, with emphasis on covid-19 associated Mucormycosis. Importantly, we have discussed the precautions and care to effectively manage Mucormycosis in immunocompromised and immunocompetent patients. Thus, current review helps clinicians in understanding various risk factors in both immunocompromised (especially covid-19 patients) and immunocompetent patients which is critical in managing Mucormycosis in current covid-19 pandemic.
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Mucormycosis in Mainland China: A Systematic Review of Case Reports. Mycopathologia 2021; 187:1-14. [PMID: 34855101 PMCID: PMC8637510 DOI: 10.1007/s11046-021-00607-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022]
Abstract
Background Mucormycosis is a lethal fungal infection with increasing incidence. The epidemiology of mucormycosis in current mainland China has not been fully elucidated.
Objectives To investigate the epidemiology, risk factors, manifestations, diagnosis, treatment and prognosis of mucormycosis in mainland China.
Methods We searched for published mucormycosis case reports/series in mainland China in the PubMed, WanFang and China National Knowledge Infrastructure databases from January 2001 to July 2020. Cases of proven/probable mucormycosis were included. Results A total of 390 cases were included in this review. Most of the patients were male (61.3%), and diabetes was the most common predisposing factor (37.2%). Pulmonary mucormycosis (42.1%) was the most common form followed by cutaneous infection (21.0%). Of 390 patients, 24 died before therapy. Among the remaining 366 patients, 208 (56.8%) received antifungal drugs alone, 16 (4.4%) received surgery alone, and 142 (38.8%) received a combination of drugs and surgery, the mortality of the last group is much lower (34/142, 23.9%). The overall mortality was 37.2%. A multivariate analysis indicated that factors associated with increased mortality included corticosteroid use alone as immunosuppressive therapy, rhino-orbito-cerebral or disseminated mucormycosis (compared with pulmonary mucormycosis), and drug administration other than amphotericin B (AmB), posaconazole (POS) and itraconazole (ITR) (compared with the use of conventional AmB), while factors associated with decreased mortality included cutaneous mucormycosis and surgical therapy. Combination or sequential antifungal therapy of AmB and POS or ITR did not reduce mortality compared with conventional AmB monotherapy. Conclusion In mainland China, mucormycosis is a serious fungal infection with high mortality. Corticosteroid use, rhino-orbito-cerebral and disseminated mucormycosis were adverse prognostic factors. Antifungal therapy combined with surgery could improve the prognosis. Supplementary Information The online version contains supplementary material available at 10.1007/s11046-021-00607-4.
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Dhasarathan P, AlSalhi MS, Devanesan S, Subbiah J, Ranjitsingh AJA, Binsalah M, Alfuraydi AA. Drug resistance in Candida albicans isolates and related changes in the structural domain of Mdr1 protein. J Infect Public Health 2021; 14:1848-1853. [PMID: 34794907 DOI: 10.1016/j.jiph.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The increasing azole drug resistance in fungal pathogens poses a pressing threat to global health care. The coexistence of drug-resistant Candida albicans with tuberculosis patients and the failure of several drugs to treat C. albicans infection extend hospital stay, economic burden, and death. The misuse or abuse of azole-derived antifungals, chronic use of TB drugs, different immune-suppressive drugs, and diseases like HIV, COVID-19, etc., have aggravated the situation. So it is vital to understand the molecular changes in drug-resistant genes to modify the treatment to design an alternative mechanism. METHOD C. albicans isolated from chronic tuberculosis patients were screened for antifungal sensitivity studies using disk diffusion assay. The multidrug-resistant C. albicans were further screened for molecular-level changes in drug resistance using MDR1 gene sequencing and compared with Gen bank data of similar species using the BLAST tool. RESULTS The investigation proved that the isolated C. albicans from TB patients are significantly resistant to the action of six drugs. The molecular changes in MDR1 genes showed differences in seven nucleotide base pairs that interfered with the efflux pump.
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Affiliation(s)
- P Dhasarathan
- Department of Biotechnology, Prathyusha Engineering College, Thiruvallur 602 025, Tamil Nadu, India
| | - Mohamad S AlSalhi
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh, 11451, Saudi Arabia.
| | - Sandhanasamy Devanesan
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh, 11451, Saudi Arabia
| | - Jeeva Subbiah
- Department Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - A J A Ranjitsingh
- Department of Biotechnology, Prathyusha Engineering College, Thiruvallur 602 025, Tamil Nadu, India.
| | - Mohammed Binsalah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Akram A Alfuraydi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box-2455, Riyadh, 11451, Saudi Arabia
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