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Sasani E, Pakdel F, Khodavaisy S, Salehi M, Salami A, Sohrabi M, Aminishakiba P, Amirafzali I, Salami Khaneshan A. Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review. Mycopathologia 2024; 189:10. [PMID: 38231407 DOI: 10.1007/s11046-023-00808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Mucormycosis and aspergillosis are angioinvasive infections mainly occurring in immunocompromised patients. However, mixed infection with mucormycosis and aspergillosis in post-COVID-19 patients is rare. In this report, we will report four cases and comprehensively review the published literature on COVID-19 associated mixed infection of aspergillosis and mucormycosis. METHOD Besides four of our cases, we searched for published articles using PubMed/MEDLINE, Scopus, and Web of Science databases from the beginning of 2020 until October 2023. RESULT During the COVID-19 pandemic, we analyzed 52 cases (4 from our research and 48 from other studies). The most common underlying disease (59.6%) was diabetes mellitus. However, 19.2% of COVID-19 patients had no underlying condition. Interestingly, rhino-orbital-cerebral mucormycosis featured prominently in India and Iran, while other countries primarily reported a higher prevalence of pulmonary cases. CONCLUSION In conclusion, this study highlights the presence of mixed aspergillosis and mucormycosis in COVID-19 patients who previously had common underlying diseases or even a healthy immune system. Therefore, managing COVID-19 patients should involve screening serum and respiratory samples using biomarkers to detect superinfections.
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Affiliation(s)
- Elahe Sasani
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzad Pakdel
- Department of Oculo-Facial Plastic Surgery, Farabi Eye Hospital, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Zoonoses Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Salami
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Sohrabi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouyan Aminishakiba
- Pathology Department, Cancer Institute Hospital, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Amirafzali
- Resident of Internal Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arezoo Salami Khaneshan
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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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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3
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Puri O, Bhatia M, Rekha US, Chakraborty D, Dua R, Dhar M, Chauhan U, Prasad A, Kalita D, Kaistha N. Post-COVID pulmonary fungal infections: An unanticipated predicament or a ticking time bomb? Clinico-microbiological profile of cases encountered during the second wave of COVID-19 pandemic at a teaching hospital in the Himalayas with a brief literature review. J Family Med Prim Care 2023; 12:3228-3235. [PMID: 38361892 PMCID: PMC10866219 DOI: 10.4103/jfmpc.jfmpc_1073_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: 06/28/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and mixed infections from the Himalayas and compares the micro-radio-clinical profile and outcomes of the affected patients. Materials and Methods A retrospective data analysis was conducted, where clinical profiles, microbiological and radiological reports, and outcomes of n = 16 patients of post-COVID pulmonary infections were compared. Results Of n = 16 patients, n = 7 had CAPA (n = 5 Aspergillus fumigatus, n = 1 Aspergillus flavus, and n = 1 Aspergillus niger), n = 5 CAPM (Rhizopus arrhizus), and n = 4 with mixed infections (n = 3 infected with Aspergillus fumigatus and Rhizopus spp. and n = 1 with Aspergillus flavus and Rhizopus arrhizus). Thick-walled cavitary lesions, air-fluid levels, and multiple centrilobular nodules were some of the common radiological findings reported among these patients. Conclusion The immuno-compromised state following COVID-19 infection and treatment might be responsible for the progression of regular exposure to the dense Himalayan vegetation into an invasive pulmonary fungal infection. Suspecting post-COVID pulmonary fungal infection is necessary for primary care physicians to ensure timely referral to higher centers. Mixed pulmonary fungal infections (coinfection with Aspergillus spp. and Rhizopus spp.) are also emerging as important sequelae of COVID-19.
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Affiliation(s)
- Oshin Puri
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mohit Bhatia
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Udayakumar S. Rekha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Deepika Chakraborty
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ruchi Dua
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Udit Chauhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amber Prasad
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Deepjyoti Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Guwahati, India
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Faiyazuddin M, Sophia A, Ashique S, Gholap AD, Gowri S, Mohanto S, Karthikeyan C, Nag S, Hussain A, Akhtar MS, Bakht MA, Ahmed MG, Rustagi S, Rodriguez-Morales AJ, Salas-Matta LA, Mohanty A, Bonilla-Aldana DK, Sah R. Virulence traits and novel drug delivery strategies for mucormycosis post-COVID-19: a comprehensive review. Front Immunol 2023; 14:1264502. [PMID: 37818370 PMCID: PMC10561264 DOI: 10.3389/fimmu.2023.1264502] [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: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
The outbreak of a fatal black fungus infection after the resurgence of the cadaverous COVID-19 has exhorted scientists worldwide to develop a nutshell by repurposing or designing new formulations to address the crisis. Patients expressing COVID-19 are more susceptible to Mucormycosis (MCR) and thus fall easy prey to decease accounting for this global threat. Their mortality rates range around 32-70% depending on the organs affected and grow even higher despite the treatment. The many contemporary recommendations strongly advise using liposomal amphotericin B and surgery as first-line therapy whenever practicable. MCR is a dangerous infection that requires an antifungal drug administration on appropriate prescription, typically one of the following: Amphotericin B, Posaconazole, or Isavuconazole since the fungi that cause MCR are resistant to other medications like fluconazole, voriconazole, and echinocandins. Amphotericin B and Posaconazole are administered through veins (intravenously), and isavuconazole by mouth (orally). From last several years so many compounds are developed against invasive fungal disease but only few of them are able to induce effective treatment against the micorals. Adjuvant medicines, more particularly, are difficult to assess without prospective randomized controlled investigations, which are challenging to conduct given the lower incidence and higher mortality from Mucormycosis. The present analysis provides insight into pathogenesis, epidemiology, clinical manifestations, underlying fungal virulence, and growth mechanisms. In addition, current therapy for MCR in Post Covid-19 individuals includes conventional and novel nano-based advanced management systems for procuring against deadly fungal infection. The study urges involving nanomedicine to prevent fungal growth at the commencement of infection, delay the progression, and mitigate fatality risk.
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Affiliation(s)
- Md. Faiyazuddin
- School of Pharmacy, Al – Karim University, Katihar, Bihar, India
- Nano Drug Delivery®, Raleigh-Durham, NC, United States
| | - A. Sophia
- PG & Research Department of Physics, Cauvery College for Women (Autonomous), Tiruchirappalli, Tamil Nadu, India
| | - Sumel Ashique
- Department of Pharmaceutics, Pandaveswar School of Pharmacy, Pandaveswar, West Bengal, India
| | - Amol D. Gholap
- Department of Pharmaceutics, St. John Institute of Pharmacy and Research, Palghar, Maharashtra, India
| | - S. Gowri
- PG & Research Department of Physics, Cauvery College for Women (Autonomous), Tiruchirappalli, Tamil Nadu, India
| | - Sourav Mohanto
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - C. Karthikeyan
- Department of Chemical & Biochemical Engineering, Dongguk University, Seoul, Republic of Korea
| | - Sagnik Nag
- Department of Bio-Sciences, School of Biosciences & Technology (SBST), Vellore Institute of Technology (VIT), Tamil Nadu, India
| | - Arif Hussain
- School of Life Sciences, Manipal Academy of Higher Education, Dubai, United Arab Emirates
| | - Mohammad Shabib Akhtar
- Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Md. Afroz Bakht
- Chemistry Department, College of Science and Humanity Studies, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammed Gulzar Ahmed
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas—Institución Universitaria Visión de las Américas, Pereira, Colombia
- Faculties of Health Sciences and Environmental Sciences, Universidad Científica del Sur, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Luis Andres Salas-Matta
- Faculties of Health Sciences and Environmental Sciences, Universidad Científica del Sur, Lima, Peru
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, Maharashtra, India
- Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
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Prabhakar A, Bansal S, Vyas S, Bhatia V, Kumar A, Patro S, Singh U, Panda N, Singh P, Bhalla A, Puri GD, Ahuja CK. Clinicoradiological Profile of COVID-19-Associated Rhino-Orbital Cerebral Mucormycosis with a Focus on Computed Tomography: A Clinical Case Series and Review. Am J Trop Med Hyg 2023; 109:600-607. [PMID: 37487562 PMCID: PMC10484265 DOI: 10.4269/ajtmh.22-0298] [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: 04/30/2022] [Accepted: 05/09/2023] [Indexed: 07/26/2023] Open
Abstract
COVID-19-associated rhino-orbital cerebral mucormycosis (ROCM) has a rapidly evolving course with high morbidity and mortality. We describe imaging features of COVID-19-associated ROCM based on noncontrast computed tomography (NCCT). This retrospective single-center observational study included 50 patients with COVID-19 from January 1, 2021 to June 30, 2021 who subsequently developed ROCM confirmed by fungal culture studies. All patients underwent NCCT of the paranasal sinuses as the diagnostic workup. The involvement of the nasal cavity, paranasal sinuses, orbits, and intracranial cavity was identified and graded. The ethmoid sinuses were most commonly involved [right (n = 46 of 50) > left (n = 45 of 50)], followed by the maxillary, sphenoid, and frontal sinuses. Thinning and erosions of the hard palate were noted in 18% of patients (n = 9), whereas 34% (n = 17) showed dehiscence of the lamina papyracea. Retromaxillary fat stranding was noted in 68% of patients (n = 34). Severe ethmoid sinusitis was associated significantly with ipsilateral pterygopalatine fossa involvement. The extraocular muscles were involved in 64% of patients (n = 32), with 84% (n = 42) showing orbital fat stranding. Proptosis of the affected eye was seen in 66% of patients, optic nerve involvement in 52%, and irregularity of globe contour in 12% (n = 6). The cavernous sinuses were affected in 10% of patients (n = 5), with three of them having temporal infarcts. COVID-19-associated ROCM is an acute, invasive fungal disease characterized by multisinus involvement, often with orbital and intracranial extension. Bilateral involvement with rapid progression should alert one to underlying COVID-19 disease.
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Affiliation(s)
- Anuj Prabhakar
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha Patro
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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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Fang W, Wu J, Cheng M, Zhu X, Du M, Chen C, Liao W, Zhi K, Pan W. Diagnosis of invasive fungal infections: challenges and recent developments. J Biomed Sci 2023; 30:42. [PMID: 37337179 DOI: 10.1186/s12929-023-00926-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The global burden of invasive fungal infections (IFIs) has shown an upsurge in recent years due to the higher load of immunocompromised patients suffering from various diseases. The role of early and accurate diagnosis in the aggressive containment of the fungal infection at the initial stages becomes crucial thus, preventing the development of a life-threatening situation. With the changing demands of clinical mycology, the field of fungal diagnostics has evolved and come a long way from traditional methods of microscopy and culturing to more advanced non-culture-based tools. With the advent of more powerful approaches such as novel PCR assays, T2 Candida, microfluidic chip technology, next generation sequencing, new generation biosensors, nanotechnology-based tools, artificial intelligence-based models, the face of fungal diagnostics is constantly changing for the better. All these advances have been reviewed here giving the latest update to our readers in the most orderly flow. MAIN TEXT A detailed literature survey was conducted by the team followed by data collection, pertinent data extraction, in-depth analysis, and composing the various sub-sections and the final review. The review is unique in its kind as it discusses the advances in molecular methods; advances in serology-based methods; advances in biosensor technology; and advances in machine learning-based models, all under one roof. To the best of our knowledge, there has been no review covering all of these fields (especially biosensor technology and machine learning using artificial intelligence) with relevance to invasive fungal infections. CONCLUSION The review will undoubtedly assist in updating the scientific community's understanding of the most recent advancements that are on the horizon and that may be implemented as adjuncts to the traditional diagnostic algorithms.
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Affiliation(s)
- Wenjie Fang
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, 200433, China
| | - Mingrong Cheng
- Department of Anorectal Surgery, The Third Affiliated Hospital of Guizhou Medical University, Guizhou, 558000, China
| | - Xinlin Zhu
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Mingwei Du
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, 200433, China
| | - Wanqing Liao
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Kangkang Zhi
- Department of Vascular and Endovascular Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
| | - Weihua Pan
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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8
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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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9
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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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10
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Eker C, Tarkan O, Surmelioglu O, Dagkiran M, Tanrisever I, Yucel Karakaya SP, Ulas B, Onan E, Uguz AH, Ozdemir S. Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients. Eur Arch Otorhinolaryngol 2023; 280:219-226. [PMID: 35768700 PMCID: PMC9244150 DOI: 10.1007/s00405-022-07526-0] [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: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19. MATERIALS AND METHODS A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared. RESULTS Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741). CONCLUSIONS With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.
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Affiliation(s)
- Caglar Eker
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Tarkan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ozgur Surmelioglu
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Muhammed Dagkiran
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Ilda Tanrisever
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Sevinc Puren Yucel Karakaya
- grid.98622.370000 0001 2271 3229Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Burak Ulas
- grid.98622.370000 0001 2271 3229Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Elvan Onan
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
| | - Aysun Hatice Uguz
- grid.98622.370000 0001 2271 3229Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Suleyman Ozdemir
- grid.98622.370000 0001 2271 3229Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330 Adana, Turkey
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11
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Dual Fungal Infection of Aspergillosis and Mucormycosis in a COVID-19 Patient: A Rare Case Report. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) infections can be related to vast spectrum of co-existent bacterial and fungal infections. A 49-year-old diabetic male was admitted with a history of fever, cough and breathlessness since 5 days. He developed persistent headache with right sided purulent nasal discharge. Relevant histo-pathological, biochemical, microbiological and imaging studies were performed which proved it to be a dual infection of Aspergillosis and Mucormycosis. We present one such case in a COVID-19 patient to highlight its unusual clinical features along with the diagnostic and therapeutic challenges.
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12
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Alkhamiss AS, Ahmed AA, Rasheed Z, Alghsham R, Shariq A, Alsaeed T, Althwab SA, Alsagaby S, Aljohani ASM, Alhumaydhi FA, Alduraibi SK, Alduraibi AK, Alhomaidan HT, Allemailem KS, Alharbi RA, Alamro SA, Alqusayer AM, Alharbi SA, Alharby TA, Almujaydil MS, Mousa AM, Alghaniam SA, Alghunaim AA, Alghamdi R, Fernández N, Al Abdulmonem W. Mucormycosis co-infection in COVID-19 patients: An update. Open Life Sci 2022; 17:917-937. [PMID: 36045713 PMCID: PMC9372758 DOI: 10.1515/biol-2022-0085] [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: 03/02/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.
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Affiliation(s)
- Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmed A Ahmed
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ruqaih Alghsham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Departments of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thamir Alsaeed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sami A Althwab
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Suliman Alsagaby
- Department of Medical Laboratories Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Raya A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Samar A Alamro
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Arwa M Alqusayer
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sahim A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thekra A Alharby
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Mona S Almujaydil
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ayman M Mousa
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sultan A Alghaniam
- Department of Clinical Nutrition, Qassim Health Affairs, Ministry of Health, Buraidah, Saudi Arabia
| | | | - Rana Alghamdi
- Department of Chemistry, Science and Arts College, Rabigh Campus, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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13
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Mina S, Yaakoub H, Annweiler C, Dubée V, Papon N. COVID-19 and Fungal Infections: A Double Debacle. Microbes Infect 2022; 24:105039. [PMID: 36030024 PMCID: PMC9400371 DOI: 10.1016/j.micinf.2022.105039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
Fungal infections remain hardly treatable because of unstandardized diagnostic tests, limited antifungal armamentarium, and more specifically, potential toxic interactions between antifungals and immunosuppressants used during anti-inflammatory therapies, such as those set up in critically ill COVID-19 patients. Taking into account pre-existing difficulties in treating vulnerable COVID-19 patients, any co-occurrence of infectious diseases like fungal infections constitutes a double debacle for patients, healthcare experts, and the public economy. Since the first appearance of SARS-CoV-2, a significant rise in threatening fungal co-infections in COVID-19 patients has been testified in the scientific literature. Better management of fungal infections in COVID-19 patients is, therefore, a priority and requires highlighting common risk factors, relationships with immunosuppression, as well as challenges in fungal diagnosis and treatment. The present review attempts to highlight these aspects in the three most identified causative agents of fungal co-infections in COVID-19 patients: Aspergillus, Candida, and Mucorales species.
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Affiliation(s)
- Sara Mina
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.
| | - Hajar Yaakoub
- Univ Angers, Univ Brest, IRF, SFR ICAT, F-49000, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France; Univ Angers, Université de Nantes, LPPL, SFR CONFLUENCES, F-49000 Angers, France
| | - Vincent Dubée
- Univ Angers, Université de Nantes, Inserm, CRCINA, INCIT, SFR ICAT, F-49000 Angers, France; Infectious Diseases Department, Angers University Hospital, Angers, France
| | - Nicolas Papon
- Univ Angers, Univ Brest, IRF, SFR ICAT, F-49000, Angers, France.
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14
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Domán M, Bányai K. COVID-19-Associated Fungal Infections: An Urgent Need for Alternative Therapeutic Approach? Front Microbiol 2022; 13:919501. [PMID: 35756020 PMCID: PMC9218862 DOI: 10.3389/fmicb.2022.919501] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/19/2022] [Indexed: 12/19/2022] Open
Abstract
Secondary fungal infections may complicate the clinical course of patients affected by viral respiratory diseases, especially those admitted to intensive care unit. Hospitalized COVID-19 patients are at increased risk of fungal co-infections exacerbating the prognosis of disease due to misdiagnosis that often result in treatment failure and high mortality rate. COVID-19-associated fungal infections caused by predominantly Aspergillus and Candida species, and fungi of the order Mucorales have been reported from several countries to become significant challenge for healthcare system. Early diagnosis and adequate antifungal therapy is essential to improve clinical outcomes, however, drug resistance shows a rising trend highlighting the need for alternative therapeutic agents. The purpose of this review is to summarize the current knowledge on COVID-19-associated mycoses, treatment strategies and the most recent advancements in antifungal drug development focusing on peptides with antifungal activity.
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Affiliation(s)
- Marianna Domán
- Veterinary Medical Research Institute, Budapest, Hungary
| | - Krisztián Bányai
- Veterinary Medical Research Institute, Budapest, Hungary.,Department of Pharmacology and Toxicology, University of Veterinary Medicine, Budapest, Hungary
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15
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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:jof8050445. [PMID: 35628701 PMCID: PMC9144279 DOI: 10.3390/jof8050445] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [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)
| | - Héctor M. Mora-Montes
- Correspondence: (L.C.G.-C.); (H.M.M.-M.); Tel.: +52-473-7320006 (ext. 8193) (H.M.M.-M.)
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16
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An overview of COVID-19 related to fungal infections: what do we know after the first year of pandemic? Braz J Microbiol 2022; 53:759-775. [PMID: 35315001 PMCID: PMC8936386 DOI: 10.1007/s42770-022-00704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
In 2019, severe acute respiratory syndrome caused by CoV-2 virus became a pandemic worldwide, being the fast spread of the disease due to the movement of infected people from one country to another, from one continent to another, or within the same country. Associated comorbidities are important factors that predispose to any fungal coinfections. Because of the importance of fungal infections in COVID-19 patients, the aim of this work was to collect data of the more encountered mycoses related to patients undergoing this disease. Aspergillosis was the first COVID-19-related fungal infection reported, being A. fumigatus the most frequent species for CAPA. Other fungal infections related include mainly candidiasis and mucormycosis, being Rhizopus spp. the more prevalent species found. Influenza-associated pulmonary aspergillosis is well documented; thus, similar complications are expected in severe forms of COVID-19 pneumonia. Therefore, in patients with COVID-19, it is important to take special attention to the surveillance and suspicion of fungal coinfections that might worsen the patient's prognosis.
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17
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A Clustered Case Series of Mucorales Detection in Respiratory Samples from COVID-19 Patients in Intensive Care, France, August to September 2021. J Fungi (Basel) 2022; 8:jof8030258. [PMID: 35330260 PMCID: PMC8948870 DOI: 10.3390/jof8030258] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/15/2022] Open
Abstract
While COVID-19-associated pulmonary aspergillosis is now well described in developed countries, COVID-19-associated mucormycosis (CAM) has seemed to remain quite rare in Europe. A retrospective study was performed between March 2020 to September 2021 among COVID-19 adult patients in the intensive care unit (ICU) at Toulouse Hospital (Southern France). PCR screening on respiratory samples, which target Aspergillus or Mucorales DNA, were performed, and the number of fungal detections was evaluated monthly during the study period. During the 19 months of the study, 44 (20.3%) COVID-19 ICU patients had a positive PCR for Aspergillus, an overall rate in keeping with the incidence of ICU COVID-19 patients. Ten patients (7.1%) had a positive Mucorales PCR over the same period. Surprisingly, 9/10 had a positive Mucor/Rhizopus PCR in August-September 2021, during the fourth Delta SARS-CoV-2 variant wave. Epidemic investigations have identified a probable environmental cause linked to construction works in the vicinity of the ICU (high levels of airborne spores due to the mistaken interruption of preventive humidification and summer temperature). Even if CAM are apparently rare in Europe, a cluster can also develop in industrialised countries when environmental conditions (especially during construction work) are associated with a high number of COVID-19 patients in the ICU.
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18
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Dravid A, Kashiva R, Khan Z, Bande B, Memon D, Kodre A, Mane M, Pawar V, Patil D, Kalyani S, Raut P, Bapte M, Saldanha C, Chandak D, Patil T, Reddy MS, Bhayani K, Laxmi SS, Vishnu PD, Srivastava S, Khandelwal S, More S, Shakeel A, Pawar M, Nande P, Harshe A, Kadam S, Hallikar S, Kamal N, Andrabi D, Bodhale S, Raut A, Chandrashekhar S, Raman C, Mahajan U, Joshi G, Mane D. Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single center experience from Pune, Western India. Mycoses 2022; 65:526-540. [PMID: 35212032 PMCID: PMC9115310 DOI: 10.1111/myc.13435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Background The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM). Methods This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM. Results 59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. Conclusions CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.
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Affiliation(s)
- Ameet Dravid
- Department of Infectious diseases and HIV/AIDS, Noble hospitals and Research Centre, Pune, Maharashtra, India
| | - Reema Kashiva
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Zafer Khan
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Balasaheb Bande
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Danish Memon
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Aparna Kodre
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Milind Mane
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Vishal Pawar
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Dattatraya Patil
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Suraj Kalyani
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Prathamesh Raut
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Madhura Bapte
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Charlotte Saldanha
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Dinesh Chandak
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Teerthagouda Patil
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - M Sateesh Reddy
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Krushnadas Bhayani
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - S S Laxmi
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - P D Vishnu
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shipra Srivastava
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shubham Khandelwal
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sailee More
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Atif Shakeel
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Mohit Pawar
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Pranava Nande
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Amol Harshe
- Department of Pathology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sagar Kadam
- Department of Radiology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sudhir Hallikar
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Nudrat Kamal
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Danish Andrabi
- Department of Otorhinolaryngology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sachin Bodhale
- Department of Ophthalmology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Akshay Raut
- Department of Maxillo-facial surgery, Noble hospital and Research Centre, Pune, Maharashtra, India
| | | | - Chandrashekhar Raman
- Department of Neurosurgery, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Uma Mahajan
- Statistician, VMK Diagnostics private limited, Pune, Maharashtra, India
| | - Gaurav Joshi
- Independent statistical consultant, Chicago, USA
| | - Dilip Mane
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
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19
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Busca A, Marchesi F, Cattaneo C, Trecarichi EM, Delia M, Del Principe MI, Candoni A, Pagano L. When Viruses Meet Fungi: Tackling the Enemies in Hematology. J Fungi (Basel) 2022; 8:jof8020184. [PMID: 35205938 PMCID: PMC8875273 DOI: 10.3390/jof8020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Unit, AOU Citta’ della Salute e della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, University “Magna Graecia”—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy;
| | | | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University of Udine-ASUFC, 33100 Udine, Italy;
| | - Livio Pagano
- Unità di Ematologia Geriatrica ed Emopatie Rare, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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20
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Nagalli S, Kikkeri NS. Mucormycosis in COVID-19: A systematic review of literature. LE INFEZIONI IN MEDICINA 2022; 29:504-512. [PMID: 35146358 DOI: 10.53854/liim-2904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an acute viral illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Opportunistic infections such as mucormycosis have been reported among COVID-19 patients particularly in South Asian countries during the second wave of this pandemic. It is necessary to re-evaluate any changes in traditional risk factors associated with mucormycosis such as diabetes mellitus, organ transplant, etc in the precedent of ongoing COVID-19 pandemic. We conducted a systematic review using electronic databases. A total of 115 COVID-19 patients who were diagnosed with mucormycosis were included in this study. Diabetes mellitus was the most common co-morbidity with 77.1%, followed by hypertension (29.5%) and renal disease (14.3%). 55.2% of the patients had received dexamethasone for COVID-19 infection. Ten patients (11.5%) had received tocilizumab. Sinuses were the most common site of mucormycosis among COVID-19 patients at 79.4% with maxillary sinus (47.4%) being most commonly infected. Orbits were the second most prevalent site at 56.7% and lungs were infected with mucor at 11.3%. The mean duration between the diagnosis of COVID-19 infection and mucormycosis was 16.15 days (range 2-90 days). Cavernous sinus was either infiltrated or encased in 14 patients (14.4%). Cerebral involvement was seen in terms of abscess, infarcts, or edema in 12 patients (12.4%). Only 76 patients had data on the outcomes, out of which 37 (48.7%) patients had died. Diabetes mellitus is still the most common co-morbidity similar to non-COVID-19 patients. More than 90% of the patients with COVID-19 infection had received steroids. Complications such as cavernous sinus thrombosis, cerebral infarcts, abscesses were common. Indiscriminate use of steroids in patients needs to be avoided and focus needs to be put on tight blood sugar control in diabetic patients. Studies are needed to confirm the role of the SARS-CoV-2 virus in causing immune dysfunction and mucormycosis.
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Affiliation(s)
- Shivaraj Nagalli
- Department of Internal Medicine, Brookwood Baptist Health, Alabaster, USA
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21
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Danion F, Letscher-Bru V, Guitard J, Sitbon K, Dellière S, Angoulvant A, Desoubeaux G, Botterel F, Bellanger AP, Gargala G, Uhel F, Bougnoux ME, Gerber V, Michel J, Cornu M, Bretagne S, Lanternier F. Coronavirus Disease 2019-Associated Mucormycosis in France: A Rare but Deadly Complication. Open Forum Infect Dis 2022; 9:ofab566. [PMID: 35071681 PMCID: PMC8773954 DOI: 10.1093/ofid/ofab566] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Abstract
We studied COVID-19 associated mucormycosis based on 17 cases reported nationwide and assessed the differences with India. They differed by frequencies of diabetes mellitus (47% in France versus up to 95% in India), hematological malignancies (35% versus 1%), anatomical sites (12% versus >80% rhino-orbito-cerebral) and prognosis (88% mortality versus <50%).
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Affiliation(s)
- François Danion
- Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Service de Maladies Infectieuses et Tropicales, Strasbourg, France.,Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM Unité Mixte de Recherche_S 1109, Strasbourg, France
| | - Valérie Letscher-Bru
- Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Laboratoire de Mycologie-Parasitologie, Strasbourg, France
| | - Juliette Guitard
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Karine Sitbon
- Institut Pasteur, CNRS, Université de Paris, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et des Antifongiques, Paris, France
| | - Sarah Dellière
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Laboratoire de Mycologie-Parasitologie, Paris, France
| | - Adela Angoulvant
- Université Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service des Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre, France.,Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre National de Recherche Scientifique, AgroParisTech, GQE-Le Moulon, Gif-sur-Yvette, France
| | - Guillaume Desoubeaux
- Centre Hospitalier Universitaire de Tours, Laboratoire de Mycologie-Parasitologie, Tours, France
| | - Francoise Botterel
- Assistance Publique-Hôpitaux de Paris, CHU Henri-Mondor, Laboratoire de Mycologie-Parasitologie, Créteil, France
| | | | - Gilles Gargala
- CHU de Rouen, Laboratoire de Mycologie-Parasitologie, Rouen, France
| | - Fabrice Uhel
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis-Mourier, Service de Médecine Intensive et Réanimation, Département Médical Universitaire ESPRIT, Colombes, France
| | - Marie-Elisabeth Bougnoux
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Laboratoire de Mycologie-Parasitologie, Paris, France
| | - Victor Gerber
- Hôpitaux Civils de Colmar, Service de Réanimation Médicale, Colmar, France
| | - Justin Michel
- Université Aix Marseille, AP-HM, Hôpital de La Conception, Service Oto-Rhino-Laryngologie et Chirurgie Cervico-faciale, Marseille, France
| | - Marjorie Cornu
- Université de Lille, Inserm U1285, CHU Lille, Laboratoire Parasitologie-Mycologie.,CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Stéphane Bretagne
- Institut Pasteur, CNRS, Université de Paris, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et des Antifongiques, Paris, France.,Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Laboratoire de Mycologie-Parasitologie, Paris, France
| | - Fanny Lanternier
- Institut Pasteur, CNRS, Université de Paris, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et des Antifongiques, Paris, France.,Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Paris, France
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22
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Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients. J Fungi (Basel) 2022; 8:jof8010058. [PMID: 35049999 PMCID: PMC8779574 DOI: 10.3390/jof8010058] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.
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23
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Dogra S, Arora A, Aggarwal A, Passi G, Sharma A, Singh G, Barnwal RP. Mucormycosis Amid COVID-19 Crisis: Pathogenesis, Diagnosis, and Novel Treatment Strategies to Combat the Spread. Front Microbiol 2022; 12:794176. [PMID: 35058909 PMCID: PMC8763841 DOI: 10.3389/fmicb.2021.794176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 01/01/2023] Open
Abstract
The havoc unleashed by COVID-19 pandemic has paved way for secondary ominous fungal infections like Mucormycosis. It is caused by a class of opportunistic pathogens from the order Mucorales. Fatality rates due to this contagious infection are extremely high. Numerous clinical manifestations result in damage to multiple organs subject to the patient's underlying condition. Lack of a proper detection method and reliable treatment has made the management of this infection troublesome. Several reports studying the behavior pattern of Mucorales inside the host by modulation of its defense mechanisms have helped in understanding the pathogenesis of this angio-invasive infection. Many recent advances in diagnosis and treatment of this fungal infection have not been much beneficial. Therefore, there is a need to foster more viable strategies. This article summarizes current and imminent approaches that could aid effective management of these secondary infections in these times of global pandemic. It is foreseen that the development of newer antifungal drugs, antimicrobial peptides, and nanotechnology-based approaches for drug delivery would help combat this infection and curb its spread.
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Affiliation(s)
- Shreya Dogra
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Akanksha Arora
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Aashni Aggarwal
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Gautam Passi
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Akanksha Sharma
- Department of Biophysics, Panjab University, Chandigarh, India
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Ravi P. Barnwal
- Department of Biophysics, Panjab University, Chandigarh, India
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24
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Akhtar N, Khurshid Wani A, Kant Tripathi S, Prakash A, Amin-Ul Mannan M. The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review. CURRENT RESEARCH IN BIOTECHNOLOGY 2022; 4:337-349. [PMID: 35942223 PMCID: PMC9347179 DOI: 10.1016/j.crbiot.2022.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/02/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Since December 2019 SARS-CoV-2 infections have affected millions of people worldwide. Along with the increasing number of COVID-19 patients, the number of cases of opportunistic fungal infections among the COVID-19 patients is also increasing. There have been reports of the cases of aspergillosis and candidiasis in the COVID-19 patients. The COVID-19 patients have also been affected by rare fungal infections such as histoplasmosis, pneumocystosis, mucormycosis and cryptococcosis. These fungal infections are prolonging the stay of COVID-19 patients in hospital. In this study several published case reports, case series, prospective and retrospective studies were investigated to explore and report the updated information regarding candidiasis, crytptococcosis, aspergillosis, mucormycosis, histoplasmosis, and pneumocystosis infections in COVID-19 patients. In this review, the risk factors of these co-infections in COVID-19 patients have been reported. There have been reports that the comorbidities and the treatment with corticoids, monoclonal antibodies, use of mechanical ventilation, and use of antibiotics during COVID-19 management are associated with the emergence of fungal infections in the COVID-19 patients. Hence, this review analyses the role of these therapies and comorbidities in the emergence of these fungal infections among COVID-19 patients. This review will help to comprehend if these fungal infections are the result of the co-morbidities, and treatment protocol followed to manage COVID-19 patients or directly due to the SARS-CoV-2 infection. The analysis of all these factors will help to understand their role in fungal infections among COVID-19 patients which can be valuable to the scientific community.
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Affiliation(s)
- Nahid Akhtar
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Atif Khurshid Wani
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Surya Kant Tripathi
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ajit Prakash
- Department of Biochemistry and Biophysics, University of North Carolina, Chapel Hill, NC 27599, United States
| | - M Amin-Ul Mannan
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
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25
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Ghosh D, Dey S, Chakraborty H, Mukherjee S, Halder A, Sarkar A, Chakraborty P, Ghosh R, Sarkar J. Mucormycosis: A new threat to Coronavirus disease 2019 with special emphasis on India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 15:101013. [PMID: 35342843 PMCID: PMC8934183 DOI: 10.1016/j.cegh.2022.101013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 01/03/2023] Open
Abstract
The main reason for the growth of mucormycosis in people with Coronavirus disease-2019 (COVID-19) is mainly produced by Rhizopus spp. The infective mechanisms and issues recognized in Rhizopus spp. are the cell wall, germination proteins, and enzymes assisted to iron sequestration, CotH protein, and positive regulation of the GRP78 cell receptor. Mucormycosis is mainly caused by the Rhizopus spp. such as R. oryzae, R. microsporus, R. arrhizus, R. homothallicus, etc. that are gifted to numerous host defense mechanisms and attribute to the endothelium via specific receptors, GRP78 simplifying their endocytosis and angio-invasion. Factors such as hyperglycemia, elevated iron concentrations, and ketoacidosis have been shown to contribute to the pathogenesis in the tentative situation. The analytical data of 'black fungus disease' or 'mucormycosis', specify India reported for about 42.3% of published cases, followed by the USA about 16.9%, Iraq, Bangladesh, Iran, Paraguay, and 1 case each from Brazil, Mexico, Italy, UK, China, France, Uruguay, Turkey, and Austria. The COVID-19 infection is maybe a predisposing factor for mucormycosis and is related to a high mortality rate. Early recognition and restriction of hyperglycemia, liposomal amphotericin B, and surgical debridement are the bases in the successful managing of mucormycosis.
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Affiliation(s)
- Deganta Ghosh
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sagardeep Dey
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Himanko Chakraborty
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sneha Mukherjee
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Ankita Halder
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Akash Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Pallab Chakraborty
- Department of Botany, Acharya Prafulla Chandra College, New Barrakpur, Kolkata, West Bengal, India, 700131
| | - Rajdeep Ghosh
- GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India, 533296
| | - Joy Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084,Corresponding author
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26
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Baddley JW, Thompson GR, Chen SCA, White PL, Johnson MD, Nguyen MH, Schwartz IS, Spec A, Ostrosky-Zeichner L, Jackson BR, Patterson TF, Pappas PG. Coronavirus Disease 2019-Associated Invasive Fungal Infection. Open Forum Infect Dis 2021; 8:ofab510. [PMID: 34877364 PMCID: PMC8643686 DOI: 10.1093/ofid/ofab510] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic IFI following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis, and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols, and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis, and management of COVID-19-associated fungal infections.
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Affiliation(s)
- John W Baddley
- Department of Medicine, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California, Davis Medical Center, Sacramento, California, USA
| | - Sharon C -A Chen
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
| | - Melissa D Johnson
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | | | - Thomas F Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Peter G Pappas
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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27
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Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World. Mycopathologia 2021; 186:739-754. [PMID: 34414555 PMCID: PMC8375614 DOI: 10.1007/s11046-021-00584-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to a concerning resurgence of mucormycosis. More than 47,000 cases of mucormycosis were reported in three months from India. We update our systematic review on COVID-19-associated mucormycosis (CAM) till June 21st, 2021, comparing cases reported from India and elsewhere. We included individual patient details of 275 cases of CAM, of which 233 were reported from India and 42 from the rest of the world. Diabetes mellitus was the most common underlying risk factor for CAM in India than in other countries. The fatality rate of cases reported from India (36.5%) was less than the globally reported cases (61.9%), probably due to the predominance of rhino-orbital mucormycosis. On a multivariate analysis, we found that pulmonary or disseminated mucormycosis cases and admission to the intensive care unit were associated with increased mortality, while combination medical therapy improved survival. The paucity of pulmonary and disseminated mucormycosis cases from India suggests that these cases were either not diagnosed or reported, further supported by a trend of search data from the Google search engine. In this review, we discuss the factors explaining the substantial rise in cases of CAM. We also propose a hypothetical model describing the epidemiologic triad of CAM.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Shivaprakash M Rudramurthy
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Arunaloke Chakrabarti
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Department of Medical Microbiology, Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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28
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COVID-19-associated mixed mold infection: A case report of aspergillosis and mucormycosis and a literature review. J Mycol Med 2021; 32:101231. [PMID: 34864498 PMCID: PMC8620017 DOI: 10.1016/j.mycmed.2021.101231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022]
Abstract
COVID-19-associated mold infections have been increasingly reported, and the main entity is COVID-19-associated aspergillosis (CAPA). Similarly, COVID-19-associated mucormycosis has been reported in hematology, and its prevalence is high and has been increasing in the diabetic population in India during the third COVID-19 pandemic wave. Simultaneous infection with Mucorales and Aspergillus is rare and even rarer during COVID-19. Here, we report the case of a previously immunocompetent patient with severe SARS-CoV-2 infection complicated with probable CAPA and mucormycosis co-infection. Specific diagnostic tools for mucormycosis are lacking, and this case highlights the advantages of analyzing blood and respiratory samples using the quantitative polymerase chain reaction to detect these fungi. We further reviewed the literature on mixed Aspergillus/Mucorales invasive fungal diseases to provide an overview of patients presenting with both fungi and to identify characteristics of this rare infection.
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29
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Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:jof7110921. [PMID: 34829210 PMCID: PMC8620819 DOI: 10.3390/jof7110921] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.
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30
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Riad A, Shabaan AA, Issa J, Ibrahim S, Amer H, Mansy Y, Kassem I, Kassem AB, Howaldt HP, Klugar M, Attia S. COVID-19-Associated Mucormycosis (CAM): Case-Series and Global Analysis of Mortality Risk Factors. J Fungi (Basel) 2021; 7:837. [PMID: 34682258 PMCID: PMC8540212 DOI: 10.3390/jof7100837] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the novel coronavirus disease (COVID-19) outbreak, the cases of COVID-19 co-infections have been increasingly reported worldwide. Mucormycosis, an opportunistic fungal infection caused by members of the Mucorales order, had been frequently isolated in severely and critically ill COVID-19 patients. METHODS Initially, the anamnestic, clinical, and paraclinical features of seven COVID-19-associated mucormycosis (CAM) cases from Egypt were thoroughly reported. Subsequently, an extensive review of the literature was carried out to describe the characteristics of CAM cases globally, aiming to explore the potential risk factors of mortality in CAM patients. RESULTS Out of the seven reported patients in the case series, five (71.4%) were males, six (85.7%) had diabetes mellitus, and three (42.9%) had cardiovascular disease. All patients exhibited various forms of facial deformities under the computed tomography scanning, and two of them tested positive for Mucorales using the polymerase chain reaction (PCR) testing. Liposomal amphotericin B (LAmB) was prescribed to all cases, and none of them died until the end of the follow-up. On reviewing the literature, 191 cases were reported worldwide, of which 74.4% were males, 83.2% were from low-middle income countries, and 51.4% were aged 55 years old or below. Diabetes mellitus (79.1%), chronic hypertension (30%), and renal disease/failure (13.6%) were the most common medical comorbidities, while steroids (64.5%) were the most frequently prescribed medication for COVID-19, followed by Remdesivir (18.2%), antibiotics (12.7%), and Tocilizumab (5.5%). CONCLUSIONS As the majority of the included studies were observational studies, the obtained evidence needs to be interpreted carefully. Diabetes, steroids, and Remdesivir were not associated with increased mortality risk, thus confirming that steroids used to manage severe and critical COVID-19 patients should not be discontinued. Lung involvement, bilateral manifestation, and Rhizopus isolation were associated with increased mortality risk, thus confirming that proactive screening is imperative, especially for critically ill patients. Finally, surgical management and antimycotic medications, e.g., amphotericin B and posaconazole, were associated with decreased mortality risk, thus confirming their effectiveness.
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Affiliation(s)
- Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Alshaimaa Ahmed Shabaan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Fayoum University, Fayoum 635 14, Egypt;
| | - Julien Issa
- Department of Biomaterials and Experimental Dentistry, Poznań University of Medical Sciences, 60-781 Poznan, Poland;
| | - Sally Ibrahim
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Fayoum University, Fayoum 635 14, Egypt;
| | - Hatem Amer
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Cairo University, Cairo 115 62, Egypt;
| | - Yossef Mansy
- Department of Oral and Maxillofacial Surgery, Maadi Military Hospital, Cairo 117 11, Egypt;
| | - Islam Kassem
- Private Oral and Maxillofacial Surgery Practice, Alexandria 215 54, Egypt;
| | - Amira Bisher Kassem
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhur University, Damanhur 225 11, Egypt;
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
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Mahalaxmi I, Jayaramayya K, Venkatesan D, Subramaniam MD, Renu K, Vijayakumar P, Narayanasamy A, Gopalakrishnan AV, Kumar NS, Sivaprakash P, Sambasiva Rao KRS, Vellingiri B. Mucormycosis: An opportunistic pathogen during COVID-19. ENVIRONMENTAL RESEARCH 2021; 201:111643. [PMID: 34237335 PMCID: PMC8258024 DOI: 10.1016/j.envres.2021.111643] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 05/06/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second wave of this disease has led to panic in many countries, including India and some parts of the world suffering from the third wave. As there are no proper treatment options or remedies available for this deadly infection, supportive care equipment's such as oxygen cylinders, ventilators and heavy use of steroids play a vital role in the management of COVID-19. In the midst of this pandemic, the COVID-19 patients are acquiring secondary infections such as mucormycosis also known as black fungus disease. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid high rate of mortality and morbidity rates. Mucormycosis is caused by the inhalation of its filamentous (hyphal form) fungi especially in the patients who are immunosuppressed. Recent studies have documented alarming number of COVID-19 patients with mucormycosis infection. Most of these patients had diabetes and were administered steroids for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and were consequently more prone to mucormycosis. Hence, the present review emphasizes mucormycosis and its related conditions, its mechanism in normal and COVID-19 affected individuals, influencing factors and challenges to overcome this black mold infection. Early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in COVID-19 affected patients.
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Affiliation(s)
- Iyer Mahalaxmi
- Livestock Farming and Bioresource Technology, Tamil Nadu, India
| | - Kaavya Jayaramayya
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Dhivya Venkatesan
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Mohana Devi Subramaniam
- SN ONGC, Department of Genetics and Molecular Biology, Vision Research Foundation, Chennai, 600 006, Tamil Nadu, India
| | - Kaviyarasi Renu
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Padmavathi Vijayakumar
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India
| | - Arul Narayanasamy
- Disease Proteomics Laboratory, Department of Zoology, Bharathiar University, Coimbatore, 641046, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Nachimuthu Senthil Kumar
- Department of Biotechnology, Mizoram University (A Central University), Aizawl, 796 004, Mizoram, India
| | - Palanisamy Sivaprakash
- Centre for Environmental Awareness, Dr. N.G.P. Institute of Technology, Coimbatore, 641048, Tamil Nadu, India
| | | | - Balachandar Vellingiri
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, 641-046, India.
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Hussain S, Baxi H, Riad A, Klugarová J, Pokorná A, Slezáková S, Líčeník R, Najmi AK, Klugar M. COVID-19-Associated Mucormycosis (CAM): An Updated Evidence Mapping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10340. [PMID: 34639637 PMCID: PMC8508302 DOI: 10.3390/ijerph181910340] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 12/17/2022]
Abstract
Mucormycosis, a serious and rare fungal infection, has recently been reported in COVID-19 patients worldwide. This study aims to map all the emerging evidence on the COVID-19-associated mucormycosis (CAM) with a special focus on clinical presentation, treatment modalities, and patient outcomes. An extensive literature search was performed in MEDLINE (Ovid), Embase (Ovid), Cochrane COVID-19 Study Register, and WHO COVID-19 database till 9 June 2021. The primary outcome was to summarize the clinical presentation, treatment modalities, and patient outcomes of CAM. Data were summarized using descriptive statistics and presented in tabular form. This evidence mapping was based on a total of 167 CAM patients with a mean age of 51 ± 14.62 years, and 56.28% of them were male. Diabetes mellitus (73.65% (n = 123)), hypertension (22.75% (n = 38)), and renal failure (10.77% (n = 18)) were the most common co-morbidities among CAM patients. The most common symptoms observed in CAM patients were facial pain, ptosis, proptosis, visual acuity, and vision loss. Survival was higher in patients who underwent both medical and surgical management (64.96%). Overall mortality among CAM patients was found to be 38.32%. In conclusion, this study found a high incidence of CAM with a high mortality rate. Optimal glycemic control and early identification of mucormycosis should be the priority to reduce the morbidity and mortality related to CAM.
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Affiliation(s)
- Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
| | - Harveen Baxi
- Independent Researcher, New Delhi 110062, India;
| | - Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
| | - Andrea Pokorná
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Simona Slezáková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
| | - Radim Líčeník
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
| | - Abul Kalam Najmi
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (J.K.); (A.P.); (S.S.); (R.L.)
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Yasmin F, Najeeb H, Naeem A, Dapke K, Phadke R, Asghar MS, Shah SMI, De Berardis D, Ullah I. COVID-19 Associated Mucormycosis: A Systematic Review from Diagnostic Challenges to Management. Diseases 2021; 9:65. [PMID: 34698143 PMCID: PMC8544552 DOI: 10.3390/diseases9040065] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has caused significant destruction, claiming over three million lives worldwide. Post SARS-COV-2 invasion, immunosuppression with hyperglycemia and elevated ferritin levels along with steroidal treatment creates a perfect storm for opportunistic infections. There is increasing evidence of mucormycosis co-infection in COVID-19 patients, during or post-treatment. A worse prognosis, a late diagnosis, and limited guidelines of screening and management of COVID-19 associated mucormycosis have made healthcare professionals fear an epidemic alongside a pandemic. This review geographically reports cases of COVID-19 associated mucormycosis (CAM), evaluates characteristics, clinical manifestations, and outcomes of mucormycosis in COVID-19 active or recovered patients. It further describes preventive strategies and recommendations for optimal management therapy that can be adopted worldwide to curtail an impending threat to the healthcare system.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan; (F.Y.); (A.N.)
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan; (F.Y.); (A.N.)
| | - Aisha Naeem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan; (F.Y.); (A.N.)
| | - Kartik Dapke
- Indira Gandhi Government Medical College, Nagpur 440018, India; (K.D.); (R.P.)
| | - Rachana Phadke
- Indira Gandhi Government Medical College, Nagpur 440018, India; (K.D.); (R.P.)
| | | | | | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4, 64100 Teramo, Italy;
| | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar 25000, Pakistan;
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Mohammadi F, Badri M, Safari S, Hemmat N. A case report of rhino-facial mucormycosis in a non-diabetic patient with COVID-19: a systematic review of literature and current update. BMC Infect Dis 2021; 21:906. [PMID: 34479495 PMCID: PMC8415695 DOI: 10.1186/s12879-021-06625-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND COVID-19 disease may be associated with a wide range of bacterial and fungal infections. We report a patient with COVID-19 infection who developed rhino-facial mucormycosis during treatment with corticosteroids. CASE PRESENTATION A 59-year-old non-diabetic male patient was admitted with a diagnosis of COVID-19 based on positive RT-PCR and CT of the lungs. Due to sever lung involvement, he was treated with methylprednisolone. The patient was re-admitted to hospital, due to nasal obstruction and left side facial and orbital swelling, several days after discharge. In sinus endoscopic surgery, debridement was performed and the specimens were sent to pathology and mycology laboratories. A nasal biopsy showed wide hyphae without septa. The sequenced PCR product revealed Rhizopus oryzae. Despite all medical and surgical treatment, the patient died. In addition, the characteristics of patients with COVID-19-associated mucormycosis were reviewed in 44 available literatures. In most studies, diabetes mellitus was the most common predisposing factor for mucormycosis. CONCLUSION Our report highlights the need for assessing the presence of mucormycosis in patients with COVID-19 and also it shows that physicians should consider the potential for secondary invasive fungal infections in COVID-19 cases.
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Affiliation(s)
- Faezeh Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, PO Box: 34199-15315, Qazvin, Iran.
| | - Milad Badri
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shapoor Safari
- Department of Otolaryngologist, Fellowship of Rhinology, Razi Hospital, Qazvin, Iran
| | - Nima Hemmat
- Department of Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Ramphul K, Verma R, Kumar N, Ramphul Y, Mejias S, Lohana P. Rising concerns of Mucormycosis (Zygomycosis) among COVID-19 patients; an analysis and review based on case reports in literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021271. [PMID: 34487063 PMCID: PMC8477096 DOI: 10.23750/abm.v92i4.11787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023]
Abstract
As the world continues to struggle with the pandemic of COVID-19 (coronavirus disease 2019), several cases of mucormycosis have been reported in these patients with a high mortality rate. We conducted a review of literature and found 19 articles with 20 patients who developed mucormycosis during their COVID-19 infection.14 (70%) were males, and 6(30%) were females. While their mean age was 52.2 ± 17.3 years, affected men were older than females. Ten (50%) patients also had diabetes. Common clinical findings included ophthalmologic complaints, fever, shortness of breath, and facial pain. Amphotericin B was the most common antifungal used and around 40% of cases needed surgical management of the infection. Steroid use was reported in around 12 cases (60%). Unfortunately, the mortality rate was 65% in this group of patients. Several changes in care should be brought for a consistent prevention, early diagnosis, and strong management of mucormycosis in COVID-19 patients.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine.
| | - Renuka Verma
- Guru Gobind Singh Medical College, Punjab, India.
| | - Nomesh Kumar
- Liaquat University of Medicine and Health Sciences, Jamshroo, Pakistan.
| | | | | | - Petras Lohana
- Liaquat University of Medicine and Health Sciences, Jamshroo, Pakistan.
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Garg M, Prabhakar N, Muthu V, Farookh S, Kaur H, Suri V, Agarwal R. CT Findings of COVID-19-associated Pulmonary Mucormycosis: A Case Series and Literature Review. Radiology 2021; 302:214-217. [PMID: 34463553 PMCID: PMC8717687 DOI: 10.1148/radiol.2021211583] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Nasir N, Farooqi J, Mahmood SF, Jabeen K. COVID-19 associated mucormycosis: a life-threatening complication in patients admitted with severe to critical COVID-19 from Pakistan. Clin Microbiol Infect 2021; 27:1704-1707. [PMID: 34371205 PMCID: PMC8349438 DOI: 10.1016/j.cmi.2021.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nosheen Nasir
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
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Almas T, Nazar W, Khedro T, Kanawati MA, Adnan A, Almuhaileej M, Alshamlan A, Abdulhadi A, Manamperi KT, Sarfraz S. COVID-19 and mucormycosis superinfection: Exploring the missing pathophysiological links. Ann Med Surg (Lond) 2021; 68:102655. [PMID: 34377450 PMCID: PMC8342861 DOI: 10.1016/j.amsu.2021.102655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 continues to unearth new facets that portend grave clinical implications. In recent times, there has been mounting fervor regarding coronavirus disease 2019 and mucormycosis superinfection. While the correlation between the two is conspicuous, the underlying pathophysiological mechanisms that render a patient with coronavirus disease 2019 susceptible to mucormycosis, or vice versa, are still elusive.
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Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Waqas Nazar
- Cavan General Hospital, County Cavan, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - M Ali Kanawati
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alishba Adnan
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | | | | | | | - Saba Sarfraz
- Islamabad Medical and Dental College, Islamabad, Pakistan
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Abstract
BACKGROUND The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. PURPOSE In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. RESULTS Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. CONCLUSION With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.
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Rodriguez-Morales AJ, Sah R, Millan-Oñate J, Gonzalez A, Montenegro-Idrogo JJ, Scherger S, Franco-Paredes C, Henao-Martínez AF. COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs. Ther Adv Infect Dis 2021; 8:20499361211027065. [PMID: 34211710 PMCID: PMC8216396 DOI: 10.1177/20499361211027065] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Belmonte, Pereira, Risaralda 660003, Colombia. Associate Editor, Therapeutic Advances in Infectious Disease
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Jose Millan-Oñate
- Adult Infectious Diseases, Clínica Imbanaco QuirónSalud, Cali, Valle del Cauca, Colombia
| | - Angel Gonzalez
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellin, Colombia
| | | | - Sias Scherger
- Division of Infectious Diseases, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Arana C, Cuevas Ramírez RE, Xipell M, Casals J, Moreno A, Herrera S, Bodro M, Cofan F, Diekmann F, Esforzado N. Mucormycosis associated with COVID-19 in two kidney transplant patients. Transpl Infect Dis 2021; 23:e13652. [PMID: 34038014 PMCID: PMC8209809 DOI: 10.1111/tid.13652] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) predisposes patients to bacterial and fungal superinfections due to the impairment of the immunological system. Among the associated opportunistic fungal infections, mucormycosis is one of the least frequent but with the highest mortality. We describe two cases of mucormycosis in two kidney transplant recipients, while they were hospitalized for SARS‐CoV‐2 pneumonia, with rhinosinusal and musculoskeletal involvement, respectively.
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Affiliation(s)
- Carolt Arana
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
| | - Rafael E Cuevas Ramírez
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marc Xipell
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joaquim Casals
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Núria Esforzado
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
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