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Palou EY, Ramos MA, Cherenfant E, Duarte A, Fuentes-Barahona IC, Zambrano LI, Muñoz-Lara F, Montoya-Ramirez SA, Cardona-Ortiz AF, Valle-Reconco JA, Montenegro-Idrogo JJ, Bonilla-Aldana DK, Paniz-Mondolfi AE, Rodriguez-Morales AJ. COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis-A Case Report from Honduras. Vaccines (Basel) 2021; 9:826. [PMID: 34451951 PMCID: PMC8402527 DOI: 10.3390/vaccines9080826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. CASE A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. CONCLUSIONS Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.
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Affiliation(s)
- Elsa Yolanda Palou
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
| | | | - Emec Cherenfant
- Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Adoni Duarte
- Department of Morphological Sciences, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Itzel Carolina Fuentes-Barahona
- Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Department of Gynecology and Obstetrics, Hospital Escuela, Tegucigalpa 11101, Honduras
| | - Lysien I. Zambrano
- Unit of Scientific Research (UIC), Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
| | - Fausto Muñoz-Lara
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
- Department of Internal Medicine, Hospital Escuela, Tegucigalpa 11101, Honduras;
| | | | - Alex Francisco Cardona-Ortiz
- Post-Graduate Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Jorge Alberto Valle-Reconco
- Deanship, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Juan J. Montenegro-Idrogo
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima 15046, Peru
- Infectious and Tropical Diseases Service, Hospital Nacional Dos de Mayo, Lima 15072, Peru
| | - D. Katterine Bonilla-Aldana
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Semillero de Investigación en Zoonosis (SIZOO), Grupo de Investigación GISCA, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira 660003, Colombia
| | - Alberto E. Paniz-Mondolfi
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Laboratory of Microbiology, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Instituto de Investigaciones Biomédicas IDB/Incubadora Venezolana de la Ciencia, Barquisimeto 3001, Venezuela
| | - Alfonso J. Rodriguez-Morales
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Risaralda 660003, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15046, Peru
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Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel) 2020; 6:jof6040265. [PMID: 33147877 PMCID: PMC7711598 DOI: 10.3390/jof6040265] [Citation(s) in RCA: 279] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.
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Affiliation(s)
- Anna Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2107-462-607
| | | | - Maria Drogari-Apiranthitou
- Fourth Department of Internal Medicine, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece;
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