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Palomba E, Colaneri M, Azzarà C, Fava M, Maccaro A, Renisi G, Viero G, Kaur H, Chakrabarti A, Gori A, Lombardi A, Bandera A. Epidemiology, Clinical Manifestations, and Outcome of Mucormycosis in Solid Organ Transplant Recipients: A Systematic Review of Reported Cases. Open Forum Infect Dis 2024; 11:ofae043. [PMID: 38887489 PMCID: PMC11181195 DOI: 10.1093/ofid/ofae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/20/2024] Open
Abstract
Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTRs). We systematically reviewed 183 cases occurring in SOTRs, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%), and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7% of cases reported within 100 days of transplantation and 20.6% occurring at least 1 year after transplant. The 90-day and 1-year mortality rates were 36.3% and 63.4%, respectively. Disseminated disease had the highest mortality at both time points (75% and 93%). Treatment with >3 immunosuppressive drugs showed a significant impact on 90-day mortality (odds ratio [OR], 2.33; 95% CI, 1.02-5.66; P = .0493), as did a disseminated disease manifestation (OR, 8.23; 95% CI, 2.20-36.71; P = .0027) and the presence of diabetes (OR, 2.35; 95% CI, 1.01-5.65; P = .0497). Notably, prophylaxis was administered to 12 cases with amphotericin B. Further investigations are needed to validate these findings and to evaluate the potential implementation of prophylactic regimens in SOTRs at high risk.
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Affiliation(s)
- Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Cecilia Azzarà
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Fava
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Renisi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Viero
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Institution and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Infectious Disease and Microbiology, Doodhadhari Burfani Hospital and Research Institute, Haridwar, India
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
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Shaikh Z, Mishra A, Chadaram S, Preetam C, Biswas R, Adhikari A, Alagappan A, Parida PK, Pradhan P, Samal DK, Mahakud S, Hallur V, Nayak A, Das KK, Chakraborty S, Sharma P, Veetil AK, Karakkandy V, Mittal Y, Chithambaram KS, Swarup A, Chenniappan S, Shah A. To evaluate the efficacy of topical anti-fungal therapy in postoperative cases of COVID Associated Mucormycosis (CAM): A single-blinded randomized control trial. Am J Otolaryngol 2023; 44:103702. [PMID: 36521349 DOI: 10.1016/j.amjoto.2022.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/30/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the efficacy of 0.1 % w/w Liposomal Amphotericin-B gel with 10 % w/w Povidone-Iodine and saline nasal douching in preventing revision surgery in patients with CAM. STUDY DESIGN Multi-arm, parallel randomized control trial. STUDY SETTING The trial was conducted in the Department of ENT, All India Institute of Medical Sciences (AIIMS) Bhubaneswar. METHODS Participants: Microbiologically and histologically proven cases of mucormycosis who underwent surgical debridement were included in the study. INTERVENTIONS Postoperatively, patients were randomized into three groups based on the type of topical intervention received, in the form of Lipid-based Amphotericin B gel, povidone‑iodine ointment or saline nasal douching. OUTCOME Requirement of revision surgery in postoperative cases of CAM. RANDOMIZATION Participants were allotted to one of the three arms by block randomization. BLINDING Single-blinded trial. RESULTS Numbers randomized: 15 participants were randomized to each group. Recruitment: Completed recruiting. Numbers analyzed: 15 participants were analyzed in each group. OUTCOMES Control arm's risk of revision surgery was 4.50 (95 % CI: 1.16-17.44) times than Lipid-based Amphotericin B gel arm and 1.50 (95 % CI: 0.71-3.16) times that of the Povidone- Iodine arm. The difference was statistically significant (p = 0.02) for Amphotericin but not for Povidone-Iodine. CONCLUSIONS Topical Amphotericin-B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery. TRIAL REGISTRATION CTRI/2021/10/037257. Clinical Trials Registry of India.
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Affiliation(s)
- Zaid Shaikh
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Abhijeet Mishra
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Srinivas Chadaram
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Chappity Preetam
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Reetika Biswas
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Alamelu Alagappan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradipta K Parida
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mahakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinay Hallur
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anindya Nayak
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Krishna Kinkar Das
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swagata Chakraborty
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Yash Mittal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Anurita Swarup
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swathi Chenniappan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anwer Shah
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
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Khafagy R, Gupta S, Campisi P, Waters V. Treatment of localized mucormycosis using nasal amphotericin B irrigation in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28175. [PMID: 31925929 DOI: 10.1002/pbc.28175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/21/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Rana Khafagy
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paolo Campisi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
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Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol 2018; 43:1454-1464. [PMID: 29947167 DOI: 10.1111/coa.13175] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 06/22/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon yet potentially lethal fungal infection. Although most cases originate from developing countries, an ageing population and increased prevalence of chronic illness may mean some clinicians practicing in developed countries will encounter ROCM cases in their careers. Yohai et al published a systematic review of 145 case reports from 1970 to 1993 assessing prognostic factors for patients presenting with ROCM. We present an updated review of the literature and assess whether survival outcomes have changed in the two decades since that seminal paper. SEARCH STRATEGY An extensive Medline literature search was performed for case reports published between 1994 and 2015. RESULTS In total, 210 published cases were identified from the literature review, of which 175 patients from 140 papers were included in this review. Fifty-five were female, with an overall mean age of 43 years. Overall survival rate was 59.5%, which was not significantly better than the previous series reported (60%) reported by Yohai et al. Survival rates in patients with chronic renal disease had improved, from 19% to 52%, and in patients with leukaemia (from 13% to 50%). Facial necrosis and hemiplegia remained poor prognostic indicators (33% and 39% survival rates, respectively). Early commencement of medical treatment related to better survival outcomes (61% if commenced within first 12 days of presentation, compared to 33% if after 13 days). Timing of surgery had less of an effect on overall survival. However, in 28 cases that did not receive any surgical treatment, survival was only 21%. CONCLUSIONS Although overall survival rates have not improved, survival in patients with renal disease were better, potentially due to the introduction of liposomal amphotericin B which is less nephrotoxic. Prompt recognition of ROCM, reversal of predisposing co-morbidities and aggressive medical treatment remain the cornerstone of managing this highly aggressive disease.
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Affiliation(s)
- Casey Vaughan
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Amanda Bartolo
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Nimisha Vallabh
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Rhino-Orbita-Maxillary Mucormycosis After Liver Transplantation: A Case Report. Transplant Proc 2017; 48:3210-3213. [PMID: 27932183 DOI: 10.1016/j.transproceed.2016.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/03/2016] [Indexed: 12/14/2022]
Abstract
Mucormycosis is a rare lethal complication of organ transplantation that progresses rapidly, and the prognosis is dismal if diagnosed late. We present a surviving liver transplant recipient in whom severe rhino-orbita-maxillary mucormycosis developed 1 month after liver transplantation. Prompt diagnosis with tissue biopsy, local control of the underlying condition with aggressive surgical debridement, and appropriate administration of systemic antifungal therapies are essential to improve prognosis and survival.
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Topical amphotericin B in combination with standard therapy for severe necrotizing skin and soft-tissue mucormycosis in an infant with bilineal leukemia: case report and review. J Pediatr Hematol Oncol 2014; 36:e468-70. [PMID: 24732057 DOI: 10.1097/mph.0000000000000166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
During chemotherapy for bilineal leukemia, a 6-month-old infant presented with a necrotizing skin and soft-tissue infection of the chest wall due to Rhizopus sp. Successful outcome was achieved by systemically administered liposomal amphotericin B and local wound control with the novel administration of topical deoxycholate amphotericin B and surgical resection.
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Callejas CA, Douglas RG. Fungal rhinosinusitis: what every allergist should know. Clin Exp Allergy 2014; 43:835-49. [PMID: 23889239 DOI: 10.1111/cea.12118] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/06/2013] [Accepted: 02/22/2013] [Indexed: 01/02/2023]
Abstract
The interaction between fungi and the sinonasal tract results in a diverse range of diseases with an equally broad spectrum of clinical severity. The classification of these interactions has become complex, and this review seeks to rationalize and simplify the approach to fungal diseases of the nose and paranasal sinuses. These conditions may be discussed under two major headings: non-invasive disease (localized fungal colonization, fungal ball and allergic fungal rhinosinusitis) and invasive disease (acute invasive rhinosinusitis, chronic invasive rhinosinusitis and granulomatous invasive rhinosinusitis). A diagnosis of fungal rhinosinusitis is established by combining findings on history, clinical examination, laboratory testing, imaging and histopathology. The immunocompetence of the patient is of great importance, as invasive fungal rhinosinusitis is uncommon in immunocompetent patients. With the exception of localized fungal colonization, treatment of all forms of fungal rhinosinusitis relies heavily on surgery. Systemic antifungal agents are a fundamental component in the treatment of invasive forms, but are not indicated for the treatment of the non-invasive forms. Antifungal drugs may have a role as adjuvant therapy in allergic fungal rhinosinusitis, but evidence is poor to support recommendations. Randomized controlled trials need to be performed to confirm the benefit of immunotherapy in the treatment of allergic fungal rhinosinusitis. In this article, we will summarize the current literature, addressing the controversies regarding the diagnosis and management of fungal rhinosinusitis, and focussing on those aspects which are important for clinical immunologists and allergists.
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Affiliation(s)
- C A Callejas
- Otorhinolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bibashi E, de Hoog GS, Pavlidis TE, Symeonidis N, Sakantamis A, Walther G. Wound infection caused by Lichtheimia ramosa due to a car accident. Med Mycol Case Rep 2012; 2:7-10. [PMID: 24432204 PMCID: PMC3885937 DOI: 10.1016/j.mmcr.2012.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/04/2012] [Indexed: 02/05/2023] Open
Abstract
A 32-year-old immunocompetent man sustained severe traumas contaminated with organic material due to a car accident. An infection caused by Lichtheimia ramosa at the site of contamination was early diagnosed and cured by multiple surgical debridement and daily cleansing with antiseptic solution only.
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Affiliation(s)
- Evangelia Bibashi
- Department of Microbiology, Hippokration General Hospital, 49, Konstantinoupoleos Str., GR-546 42 Thessaloniki, Greece
| | - G. Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Theodoros E. Pavlidis
- 2 Propedeutical Surgical Department, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, 49, Konstantinoupoleos Str., GR-546 42 Thessaloniki, Greece
| | - Nikolaos Symeonidis
- 2 Propedeutical Surgical Department, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, 49, Konstantinoupoleos Str., GR-546 42 Thessaloniki, Greece
| | - Athanasios Sakantamis
- 2 Propedeutical Surgical Department, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, 49, Konstantinoupoleos Str., GR-546 42 Thessaloniki, Greece
| | - Grit Walther
- CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
- Corresponding author. Tel.: +49 3641 5321038; fax: +49 3641 5320803.
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