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Kurien R, Varghese L, Cherian LM, Inja RR, Thampi M, Chowdhary S, Bright RR, Abraham L, Panicker R, Rajendran N, Ganesan P, Sahu S, Irodi A, Manesh A, Peter J, Michael JS, Thomas M, Karuppusami R, Varghese GM, Rupa V. A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 2024; 76:611-619. [PMID: 38440599 PMCID: PMC10909060 DOI: 10.1007/s12070-023-04226-x] [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: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.
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Affiliation(s)
- Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Ranjeetha Racheal Inja
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Manu Thampi
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Stuti Chowdhary
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Rakesh R Bright
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Abraham
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Raga Panicker
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Nithya Rajendran
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Priya Ganesan
- Department of Emergency Medicine, Christian Medical College, Vellore, 632004 India
| | - Shalini Sahu
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Aparna Irodi
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College, Vellore, 632004 India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, 632004 India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002 India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
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Mohammadi K, Mohiyuddin SMA, Prasad KC, Rajan A, Indu Varsha G, Natrajan A, Sakalecha AK, Jose DA. Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause? Indian J Otolaryngol Head Neck Surg 2024; 76:55-63. [PMID: 38440575 PMCID: PMC10908983 DOI: 10.1007/s12070-023-04077-6] [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: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 03/06/2024] Open
Abstract
The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.
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Affiliation(s)
- Kouser Mohammadi
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - K. C. Prasad
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Akshaya Rajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - Arvind Natrajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Anil k. Sakalecha
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Diana Ann Jose
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
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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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Shen M, Wang J, Lei M, Wang Z. The outcome and the risk factors of mucormycosis among patients with hematological diseases: a systematic and meta-analysis. Front Med (Lausanne) 2023; 10:1268840. [PMID: 38098845 PMCID: PMC10720036 DOI: 10.3389/fmed.2023.1268840] [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] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives Mucorale has come into a significant pathogen over recent decades. Nonetheless, mucormycosis-related mortality rates among patients with hematological disorders remain unascertained. Thus, we conducted a meta-analysis to determine mortality rates of mucormycosis in patients with hematology-related conditions. Methods We scoured PubMed, Embase, and Web of Science for original papers exploring the intersection of Mucormycosis and Hematological Diseases (from 2000 to 2022). We scrutinized the overall mortality across three distinct periods, as well as differentiating between high-income and middle-income nations. We further evaluated the pooled mortality and the risk differential (RD) across several subgroups. Results The overall mortality rate for hematology patients with mucormycosis was 61%, within a 95% confidence interval (CI) of 0.54-0.68. A significant observation was that mortality rates were somewhat lower in high-income countries compared to middle-income countries (0.60 versus 0.64, p = 0.45). Importantly, we discovered that a combination of surgical and medical treatment significantly improved survival rates compared to medical treatment alone [mortality 0.49 versus 0.67, RD -0.19 (95%CI -0.38-0.00, I2 63.7%)]. As might be expected, disseminated mucormycosis posed a significantly higher risk of death compared to isolated mucormycosis [0.60 versus 0.57, RD death 0.16 (95%CI 0.03-0.28)]. Additionally, our analysis showed no discernible differences in survival rates between genders, between patients with and without breakthrough infection, between those who received mucor-active or mucor-inactive drugs prior to mucor infection, or between those on a multi-drug regimen and those on a single drug treatment. Conclusion Despite the high mortality rates associated with mucormycosis in patients with hematological disorders, those receiving both medical and surgical interventions, as well as those with isolated infection sites, exhibited improved survival outcomes. Conversely, factors such as gender, the presence of breakthrough infection, the use of mucor-active drugs before mucor infection, and multi-drug administration did not significantly influence patient outcomes.
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Affiliation(s)
| | | | | | - Zhiming Wang
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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Rao P, Rangankar V, Rohatgi S, Dubey P, Gitay A, Singh A, Jadhav SL, Nirhale S, Naphade P. Predictors of disease severity in COVID-19 associated mucormycosis: impact of HbA1C levels, time lag to mucormycosis onset, and radiologic patterns of paranasal sinuses and spaces involvement. Infect Dis (Lond) 2023; 55:755-766. [PMID: 37480325 DOI: 10.1080/23744235.2023.2238073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Identifying early predictors of severe Covid-19 associated mucormycosis (CAM) can help improve management and treatment outcomes. OBJECTIVES Primary: To identify clinical and radiological predictors of disease severity in CAM. Secondary: To describe patterns of central nervous system (CNS) involvement in CAM. METHODS A total of 71 patients with CAM were included in the study. Based on the anatomical extent of involvement on MRI, patients were divided into three groups: Sinus (paranasal sinuses), Orbit (orbital spread), and CNS (CNS spread). Clinical parameters and radiological patterns of involvement of sinuses and extra sinus spaces were studied between the three groups. Patterns of CNS involvement were also described. RESULTS A shorter time lag between COVID-19 infection and CAM, as well as high HbA1C levels, were found to be associated with severe disease. Involvement of the sphenoid, ethmoid and frontal sinuses, T1 hyperintense signal in the sphenoid, as well as bony involvement of the sphenoid sinus, were significantly associated with severe disease. Extra-sinus spread into pre/retroantral space, pterygopalatine fossa, and masticator spaces were also significantly associated with a severe disease course. The most common pattern of CNS spread was cavernous sinus involvement, followed by pachymeningeal spread and cranial nerve involvement. CONCLUSION Early identification of the above-described predictors in patients presenting with CAM can help detect those at risk for developing severe disease. A longer duration of amphotericin, combined with a more aggressive surgical approach in selected cases, may lead to better long-term outcomes.
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Affiliation(s)
- Prajwal Rao
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Varsha Rangankar
- Department of Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Shalesh Rohatgi
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Prashant Dubey
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Advait Gitay
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Anmol Singh
- Department of Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - S L Jadhav
- Department of Community Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Satish Nirhale
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Pravin Naphade
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, India
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Darazam IA, Babamahmoodi A, Ebrahimi MJ, Moafi M, Dilmaghani NA, Mardani M, Shokouhi S, Gharehbagh FJ, Chalmiani EM, Shabani M, Bidari F, Jamali E, Khoshsirat S, Shahriari M, Sabeti S, Rahmani Z, Mousavinejad SA, Ebrahimzadeh K, Hallajnejad M. Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021). IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2467-2473. [PMID: 38106820 PMCID: PMC10719695 DOI: 10.18502/ijph.v52i11.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 12/19/2023]
Abstract
Background Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection. Methods In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran. Results The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era. Conclusion The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased.
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Affiliation(s)
- Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Babamahmoodi
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Antimicrobial-Resistant Research Center, Mazandaran University of Medical Sciences, Ghaemshahr, Mazandaran, Iran
| | - Mohammad Javad Ebrahimi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Moafi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Mahmoudi Chalmiani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meinoosh Shabani
- Infectious Diseases and Tropical Medicine Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Jamali
- Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrokh Khoshsirat
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Ophthalmic Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Rahmani
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mousavinejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hallajnejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lusida M, Arifijanto MV, Rachman BE, Alkaff FF. Difficulty in management of acute invasive fungal rhinosinusitis in Indonesia during the COVID-19 pandemic: A case report. Respir Med Case Rep 2023; 46:101916. [PMID: 38046461 PMCID: PMC10689262 DOI: 10.1016/j.rmcr.2023.101916] [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] [Received: 04/20/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 12/05/2023] Open
Abstract
Invasive fungal rhinosinusitis is a rare disease with a high morbidity and mortality rate. Lately, COVID-19 has been associated with an increased incidence of this disease. We present the first case of COVID-19-associated acute invasive fungal rhinosinusitis found in Indonesia. The risk factors for the disease include corticosteroid use and antibiotic use. The case was complicated with left orbital cellulitis and cerebral abscess. Difficulty of management in Indonesia during the COVID-19 pandemic includes hesitancy of the patient to seek medical care and the availability of surgical team for COVID-19-positive patients. Monitoring of corticosteroid and antibiotic use must be emphasized during the pandemic. Awareness of the disease needs to be increased in Indonesia.
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Affiliation(s)
- Michael Lusida
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, 60286, Indonesia
| | - M. Vitanata Arifijanto
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, 60286, Indonesia
- Division of Tropical Medicine and Infectious Disease, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, 60286, Indonesia
| | - Brian Eka Rachman
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, 60286, Indonesia
- Division of Tropical Medicine and Infectious Disease, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, 60286, Indonesia
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, And Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, East Java 60132, Indonesia
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
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Acharya S, Behera SK, Purohit S, Sahu A, Panda BB, Behera S. COVID-19-Associated Rhino-Orbital Mucormycosis in a Tertiary Health Care Center in Odisha, India. Cureus 2023; 15:e43811. [PMID: 37731437 PMCID: PMC10508707 DOI: 10.7759/cureus.43811] [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: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Background Mucormycosis is an opportunistic infection that mainly affects immunocompromised individuals, including those with uncontrolled diabetes, malignancies, or those who have exposure to high-dose corticosteroids for a long time. Western Odisha, India, witnessed a significant rise in post-COVID-19 rhino-orbital mucormycosis (ROM), which created a need for comprehensive research on post-COVID-19 ROM. Objective This study aimed to investigate the prevalence, clinical characteristics, and outcomes of post-COVID-19 ROM in a tertiary care hospital in Western Odisha, India, with the objective of understanding ROM as a nationally notifiable disease. Subjects and methods A prospective hospital-based study was conducted. Mucormycosis cases were reported within the period, from May 17, 2021, to July 31, 2021, including all post-COVID-19 patients who exhibited clinical manifestations of mucormycosis. Patients with histopathologically negative reports of mucormycosis were excluded. Results Of the 35 included, 25 were diagnosed with ROM. The age group of 46-50 years showed a predominance (n=6), with a mean age of 50.53 years. The male-to-female ratio was 2:1. Specifically, 88% of the patients included had diabetes mellitus, 8% had chronic kidney diseases, 8% had sepsis, and 4% had hypertension. ROM was the predominant manifestation (60%, n=15), with the majority presenting with orbital cellulitis (80%), followed by unilateral orbital apex syndrome (12%), bilateral orbital apex syndrome (4%), ophthalmic vein involvement (4%), and osteomyelitis of the maxillary sinus (4%). Irrigation of the wound was performed, and all 25 ROM patients received IV liposomal amphotericin B (L-AMB). Conclusion Post-COVID-19 status with elevated blood sugar levels was a major risk factor for ROM. Early diagnosis, debridement, L-AMB, retrobulbar AMB deoxycholate, and exenteration are the possible solutions.
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Affiliation(s)
- Souvagini Acharya
- Department of Otolaryngology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Sulin K Behera
- Department of Microbiology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Somy Purohit
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Alaka Sahu
- Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Braja B Panda
- Department of Radiodiagnositic, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Sharmistha Behera
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
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9
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Manesh A, Devasagayam E, Sahu S, Bhanuprasad K, Mannam P, Karthik R, Varghese GM. Primary odontogenic onset invasive mucormycosis-an under recognized clinical entity. Clin Microbiol Infect 2023; 29:1086.e1-1086.e5. [PMID: 37179009 DOI: 10.1016/j.cmi.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES The primary source of facial mucormycosis is through inhalation of fungal sporangiospores, resulting in invasive disease in paranasal sinuses. However, dental onset mucormycosis has not been well documented in literature. The aim of this study was to describe the clinical characteristics and outcomes of patients with odontogenic onset mucormycosis. METHODS From a large cohort of mucormycosis involving the face between July 2020 and October 2021, we selected patients who had dental symptoms at onset and predominant alveolar involvement with little to no paranasal sinus disease as shown by baseline imaging. All patients had a confirmed diagnosis of mucormycosis through histopathology, with or without the growth of Mucorales in fungal culture. RESULTS Out of 256 patients with invasive mucormycosis of the face, 8.2% (21 patients) had odontogenic onset. Uncontrolled diabetes was a common risk factor, affecting 71.4% (15/21) of the patients, while recent COVID-19 illness was noted in 80.9% (17/21) of patients. The median duration of symptoms at presentation was 37 days (IQR, 14-80 days). The most common symptoms were dental pain with loose teeth (100%), facial swelling (66.7% [14/21]), pus discharge (28.6% [6/21]), and gingival and palatal abscess (28.6% [6/21]). Extensive osteomyelitis was found in 61.9% (13/21) of the patients, and 28.6% (6/21) had oroantral fistulas. The mortality rate was low, at 9.5% (2/21), with only 9.5% (2/21) of the patients having brain extension and 14.2% (3/21) in the orbit. CONCLUSION This study suggests that odontogenic onset invasive mucormycosis may be a separate clinical entity with its own distinct clinical features and prognosis.
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Affiliation(s)
- Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
| | - Emily Devasagayam
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Sahu
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kundakarla Bhanuprasad
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pavithra Mannam
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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10
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Cánovas-Márquez JT, Lax C, Tahiri G, Navarro E, Nicolás FE, Garre V. Advances in understanding infections caused by the basal fungus Mucor. PLoS Pathog 2023; 19:e1011394. [PMID: 37262085 DOI: 10.1371/journal.ppat.1011394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- José T Cánovas-Márquez
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Carlos Lax
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Ghizlane Tahiri
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Eusebio Navarro
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Francisco E Nicolás
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Victoriano Garre
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
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11
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Garag SS, Pai S, Shanbag RD, Arunkumar JS, Kavitha Y. Comparative Study of Clinical Severity and Biochemical Markers in Pre COVID-19 and COVID-19 Rhino-Orbito Cerebral Mucormycosis. Indian J Otolaryngol Head Neck Surg 2023. [PMCID: PMC10022559 DOI: 10.1007/s12070-023-03645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
In view of high surge of sinonasal mucormycosis cases after the second wave of covid 19, present study was planned to know and compare the clinical severity of the disease and also to better understand the difference in the biochemical markers during precovid and post covid period. This retrospective observational study included all cases of sinonasal mucormycosis which were treated in our institute from August 2012 to August 2021. Details of these cases were collected from hospital database system. Biochemical parameters included FBS, HbA1C, urine ketone bodies, blood pH and creatinine. Clinical severity score was measured using self-structured severity scoring system. We found that out of 74 cases treated in our hospital 28 cases were in pre covid period while 46 cases belonged to covid 19 period. Higher male predominance was seen during post covid period (76% vs. 60%). Urine ketone bodies were positive in 7% patients in precovid period compared to 26% in post-covid period. FBS and HbA1C were high approximately 80 and 90% patients respectively in both groups. Clinical severity was significantly high in post covid patients. The present study showed that in spite of similar biochemical profile. The severity of mucormycosis was high in covid positive patients. This study shows that Covid-19 is an independent high risk factor in mucormycosis patients.
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Affiliation(s)
- Santosh S. Garag
- grid.415414.10000 0004 1765 8845Department of ENT, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - Shraddha Pai
- grid.415414.10000 0004 1765 8845Department of ENT, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - Raghunath D. Shanbag
- grid.415414.10000 0004 1765 8845Department of ENT, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - J. S. Arunkumar
- grid.415414.10000 0004 1765 8845Department of ENT, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - Y. Kavitha
- grid.415414.10000 0004 1765 8845Department of ENT, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
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12
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COVID-19-associated mucormycosis: A systematic review and meta-analysis of 958 cases. Clin Microbiol Infect 2023:S1198-743X(23)00122-2. [PMID: 36921716 PMCID: PMC10008766 DOI: 10.1016/j.cmi.2023.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases during the COVID-19 pandemic. OBJECTIVES To provide a comprehensive insight into the characteristics of COVID-19-associated mucormycosis (CAM), through a systematic review and meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science, Cochrane, CINAHL, Ovid MEDLINE, and FungiSCOPE. STUDY ELIGIBILITY CRITERIA Studies reporting individual-level information in adult CAM patients between January 1, 2020 and December 28, 2022. PARTICIPANTS Adults who developed mucormycosis during or after COVID-19. ASSESSMENT OF RISK OF BIAS Quality assessment was performed based on the National Institutes of Health Quality Assessment Tool for Case Series Studies. METHODS OF DATA SYNTHESIS Demographic information and clinical features were documented for each patient. Logistic regression analysis was used to predict the risk of mortality. RESULTS 958 individual cases reported from forty-five countries were eligible. 88.1% (844/958) were reported from low- or middle-income countries (LMIC). Corticosteroid use for COVID-19 (78.5%, 619/789) and diabetes (77.9%, 738/948) were common. Diabetic ketoacidosis (p<0.001), history of malignancy (p<0.001), underlying pulmonary (p=0.017) or renal disease (p<0.001), obesity (p<0.001), hypertension (p=0.040), age (>65 years) (p=0.001), Aspergillus co-infection (p=0.037), and tocilizumab use during COVID-19 (p=0.018) increased the mortality. CAM occurred on average 22 days after COVID-19 and 8 days after hospitalization. Diagnosis of mucormycosis in patients with Aspergillus co-infection and pulmonary mucormycosis was made on average 15.4 days (range 0-35) and 14.0 days (range 0-53) after hospitalization, respectively. Cutaneous mucormycosis accounted for <1% of cases. The overall mortality rate was 38.9% (303/780). CONCLUSION Mortality of CAM was high, and most reports were from LMIC countries. We detected novel risk factors for CAM such as older age, specific comorbidities, Aspergillus co-infection and tocilizumab use, in addition to previously identified factors.
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13
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Gupta A, Kayarat B, Gupta N. COVID-19 associated Mucormycosis (CAM): Implications for perioperative physicians - A narrative review. Saudi J Anaesth 2023; 17:58-64. [PMID: 37032681 PMCID: PMC10077799 DOI: 10.4103/sja.sja_640_22] [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: 09/08/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 12/24/2022] Open
Abstract
Mucormycosis once considered a rare disease with an incidence of 0.005 to 1.7 per million, has become one of the greatest menaces during the coronavirus disease (COVID-19) pandemic. India alone has contributed to nearly 70% of the global caseload of COVID-associated mucormycosis (CAM) and it had even been declared as a notifiable disease. Second wave of COVID-19 pandemic saw a steep rise in the incidence of mucormycosis and these patients have been presenting to anesthesiologists for various surgical procedures due to its primary or secondary sequelae. Rhino-orbito-cerebral mucormycosis (ROCM) is the commonest manifestation and is caused by Rhizopus arrhizus. Injudicious use of corticosteroids in vulnerable patients could have been a major contributing factor to the sudden rise in ROCM during the pandemic. Concerns related to anesthetic management include COVID-19 infection and post COVID sequalae, common presence of uncontrolled diabetes mellitus, possibility of difficult mask-ventilation and/or intubation, various drug therapy-associated adverse effects, and interaction of these drugs with anesthetic agents. Thorough preoperative optimization, multidisciplinary involvement, perioperative care, and vigilance go a long way in improving overall outcomes in these patients.
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Affiliation(s)
- Anju Gupta
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Kayarat
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Onco-Anaesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, India
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14
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Arbune M, Arbune AA, Nechifor A, Chiscop I, Sapira V. Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature. Antibiotics (Basel) 2022; 12:antibiotics12010031. [PMID: 36671232 PMCID: PMC9854657 DOI: 10.3390/antibiotics12010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration.
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Affiliation(s)
- Manuela Arbune
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Anca-Adriana Arbune
- Neurology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Alexandru Nechifor
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Iulia Chiscop
- Clinical Surgical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
| | - Violeta Sapira
- Clinical Medical Department, “Dunarea de Jos” University from Galati, 800008 Galati, Romania
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15
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Guo L, Zhang J, Lei J, Wang G. Hemorrhagic Fever with Renal Syndrome Complicated with Rhino Mucormycosis: A Case Report. Infect Drug Resist 2022; 15:7139-7145. [PMID: 36510587 PMCID: PMC9738960 DOI: 10.2147/idr.s391035] [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: 10/01/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Mucormycosis (MCR) is a rare but aggressive fungal disease. Rhino-orbito-cerebral mucormycosis is the most common clinical form of MCR infection, and sinonasal inoculation is the primary site of infection. The morbidity and mortality rates associated with MCR remain high. In this case report, we describe the successful use of amphotericin B in a 40-year-old male with hemorrhagic fever with renal syndrome (HFRS) complicated by rhinomucormycosis. This case report provides evidence for the successful treatment of HFRS.
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Affiliation(s)
- Litao Guo
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jingjing Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jin’e Lei
- Department of Clinical Laboratory, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China,Correspondence: Jin’e Lei, Department of Clinical Laboratory, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China, Email
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China,Gang Wang, Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China, Email
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16
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Rastkar M, SeyedAlinaghi S, Asanjarani B, Siri G, Abdollahi H, Ghadami L, Hasibi M, Khodashahi R, Bagheri A, Asadollahi‐Amin A. The relationship between cumulative dose of immunosuppressive agents and COVID‐19‐associated mucormycosis: A multicenter cross‐sectional study. Health Sci Rep 2022; 5:e950. [PMID: 36439042 PMCID: PMC9682188 DOI: 10.1002/hsr2.950] [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: 08/01/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Aims Immunosuppressive therapy has a key role in developing coronavirus disease‐2019 (COVID‐19)‐associated mucormycosis. In this study, we investigated the effect of the type and cumulative dose of immunosuppressive agents on COVID‐19‐associated mucormycosis. Methods We designed a descriptive cross‐sectional study involving three COVID‐19 hospitals in Iran. Clinical and demographic data were gathered from the medical records and checked by two independent researchers to minimize errors in data collection. Results Seventy‐three patients were included in the study. The mean age of cases was 57.41 (SD = 12.64) and 43.8% were female. Among patients, 20.5% were admitted to the intensive care unit (ICU) during COVID‐19. Furthermore, 17 patients (23.29%) had a history of diabetes mellitus. Sixty‐nine patients (94.52%) had a history of receiving corticosteroids (dexamethasone) during treatment of COVID‐19, and of those, five patients (6.85%) received Tocilizumab beside. The mean cumulative dose of corticosteroids prescribed was 185.22 mg (SD = 114.738). The average cumulative dosage of tocilizumab was 720 mg (SD = 178.89). All of the included patients received amphotericin B for mucormycosis treatment, and 42 survived (57.53%). Also, there was a significant relationship between hospitalization in ICU for COVID‐19 and the mucormycosis outcome (p = 0.007). However, there weren't any significant associations between cumulative doses of immunosuppressive drugs and mucormycosis outcome (p = 0.52). Conclusion The prevalence of COVID‐19‐associated mucormycosis is increasing and should be considered in the treatment protocols of COVID‐19. Controlling risk factors such as diabetes, malignancy and the administration of immunosuppressive agents based on recommended dosage in validated guidelines are ways to prevent mucormycosis.
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Affiliation(s)
- Mohsen Rastkar
- Students’ Scientific Research Center, Tehran University of Medical Sciences Tehran Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Behzad Asanjarani
- Department of Internal Medicine, Amir Alam Hospital Tehran University of Medical Sciences Tehran Iran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam Hospital Tehran University of Medical Sciences Tehran Iran
| | - Hamed Abdollahi
- Department of Anesthesia and Critical Care, Amir Alam Hospital Complexes Tehran University of Medical Sciences Tehran Iran
| | - Ladan Ghadami
- Department of Health Care Management, Amir Alam Hospital Complexes Tehran University of Medical Sciences Tehran Iran
| | - Mehrdad Hasibi
- Department of Internal Medicine, Amir Alam Hospital Tehran University of Medical Sciences Tehran Iran
| | - Rozita Khodashahi
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - AmirBehzad Bagheri
- Student Research Committee, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery Interdisciplinary Consortium on Advanced Motion Performance, Baylor College of Medicine Houston Texas USA
| | - Ali Asadollahi‐Amin
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
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17
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Arjmand P, Bahrami M, Mohammadie ZE, Taherynejad M, Khorasani NY, Mehrad‐Majd H, Roshanzamir I, Bakhshaee M. Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features. Laryngoscope Investig Otolaryngol 2022; 7:LIO2899. [PMID: 36249085 PMCID: PMC9539365 DOI: 10.1002/lio2.899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Mucormycosis is a rare yet devastating fungal disease with a frequently fatal outcome. The purpose of this study was to compare the prevalence of mucormycosis, evaluate its risk factors, and assess the patients' outcomes in pre-COVID-19 and COVID-19 era. Methods In this retrospective observational study, clinical data of 158 patients with confirmed histopathological diagnosis of mucormycosis were collected from the medical records departments of Imam Reza and Ghaem hospitals, Mashhad, Iran during 2018-2021. The collected data were risk factors associated with mucormycosis including age, gender, underlying diseases, details of corticosteroid administration, and complications such as blindness and mortality. Results Of 158 studied patients, 48 patients were diagnosed in the pre-pandemic period whereas 110 cases were admitted during the pandemic era. COVID-19 associated mucormycosis (CAM) was observed in 58.1% of the pandemic cases. In the pre-pandemic period, cancer (89.5% vs. 39%, p < .001) was significantly more prevalent while during the pandemic era, the prevalence of diabetes mellitus (16.7% vs. 51%, p < .001) was remarkably higher. Moreover, the mortality rate of mucormycosis was considerably reduced after the pandemic (64.6%-45.4%), especially in CAM patients (35.9%). Conclusion The COVID-19 pandemic has led to an increased prevalence of mucormycosis, due to the convergence of interlinked risk factors such as diabetes mellitus, corticosteroid therapy, and COVID-19. Therefore, clinicians must be aware of the probable occurrence of mucormycosis in the first or second week of COVID-19 infection in vulnerable patients and use the steroids cautiously. Level of evidence 4 Laryngoscope Investigative Otolaryngology, 2022.
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Affiliation(s)
- Parisa Arjmand
- Department of Otorhinolaryngology, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Milad Bahrami
- Department of Laboratory Sciences, Faculty of Paramedical SciencesMashhad University of Medical SciencesMashhadIran
| | | | | | | | - Hassan Mehrad‐Majd
- Cancer Molecular Pathology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Imaneh Roshanzamir
- Sinus and Surgical Endoscopic Research Center, Department of OtorhinolaryngologyMashhad University of Medical SciencesMashhadIran
| | - Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Department of OtorhinolaryngologyMashhad University of Medical SciencesMashhadIran
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18
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Pourazizi M, Eshraghi B, Azad R, Afshar K, Mohammadbeigy I. Father–Son
COVID
‐19‐associated mucormycosis: Important role of genetic susceptibility in combination with environmental factors. Clin Case Rep 2022; 10:e6312. [PMID: 36101784 PMCID: PMC9459102 DOI: 10.1002/ccr3.6312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
In this report, a father with a history of diabetes mellitus and his son without a remarkable past medical history, both got COVID‐19‐ associated mucormycosis (CAM) as evidenced by their clinical and radiological findings. This suggests the possible role of genetics in combination with the environment in susceptibility to CAM. The simultaneous infection of a diabetic father and his son who did not have any known risk factors for COVID‐19‐associated mucormycosis (CAM) may indicate the possible role of genetics and the environment in CAM infection.
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Affiliation(s)
- Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Bahram Eshraghi
- Department of Ophthalmology, Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Roya Azad
- Department of Radiology, Faculty of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Kimia Afshar
- Student Research Committee Isfahan University of Medical Sciences Isfahan Iran
| | - Iman Mohammadbeigy
- Isfahan Eye Research Center Isfahan University of Medical Sciences Isfahan Iran
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19
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Diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis: a systematic review and meta-analysis. J Laryngol Otol 2022; 136:788-798. [PMID: 35514092 PMCID: PMC9203420 DOI: 10.1017/s0022215122001074] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to compute the pooled prevalence of diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. METHOD A systematic literature review was performed in PubMed, Scopus, Web of Science, Embase and Google Scholar. The cross-sectional studies that reported the frequency of diabetes mellitus in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis were included. RESULTS Eighteen eligible studies with a total number of 3718 patients were included in the current study. The pooled prevalence of diabetes in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis was 89 per cent and with new-onset diabetes was 32 per cent. The pooled prevalence of steroid use was high (79 per cent) too. The all-cause mortality rate was 24 per cent. CONCLUSION Diabetes mellitus was the most frequent underlying condition in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. The second most frequent underlying condition was steroid use during coronavirus disease 2019 infection. The appropriate control of hyperglycaemia and rational prescription of steroids during the treatment of coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis is recommended.
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20
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Sharifi A, Akbari Z, Shafie’ei M, Nasiri N, Sharifi M, Shafiei M, Zand A. Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:425-432. [PMID: 35943425 PMCID: PMC9451608 DOI: 10.1097/iop.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). METHODS The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. RESULTS A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. CONCLUSIONS Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.
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Affiliation(s)
- Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Akbari
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shafie’ei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Meraj Sharifi
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohadeseh Shafiei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Zand
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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21
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COVID-19-Associated Mucormycosis: A Matter of Concern Amid the SARS-CoV-2 Pandemic. Vaccines (Basel) 2022; 10:vaccines10081266. [PMID: 36016154 PMCID: PMC9415927 DOI: 10.3390/vaccines10081266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/16/2022] Open
Abstract
Mucormycosis is an invasive fungal infection caused by fungi belonging to order Mucorales. Recently, with the increase in COVID-19 infections, mucormycosis infections have become a matter of concern globally, because of the high morbidity and mortality rates associated with them. Due to the association of mucormycosis with COVID-19 disease, it has been termed COVID-19-associated mucormycosis (CAM). In the present review, we focus on mucormycosis incidence, pathophysiology, risk factors, immune dysfunction, interactions of Mucorales with endothelial cells, and the possible role of iron in Mucorales growth. We review the limitations associated with current diagnostic procedures and the requirement for more specific, cost-effective, convenient, and sensitive assays, such as PCR-based assays and monoclonal antibody-based assays for the effective diagnosis of mucormycosis. We discuss the current treatment options involving antifungal drug therapies, adjunctive therapy, surgical treatment, and their limitations. We also review the importance of nutraceuticals-based therapy for the prevention as well as treatment of mucormycosis. Our review also highlights the need to explore the potential of novel immunotherapeutics, which include antibody-based therapy, cytokine-based therapy, and combination/synergistic antifungal therapy, as treatment options for mucormycosis. In summary, this review provides a complete overview of COVID-19-associated mucormycosis, addressing the current research gaps and future developments required in the field.
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22
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Chen Z, Luo J, Li S, Xu P, Zeng L, Yu Q, Zhang L. Characteristics of Living Systematic Review for COVID-19. Clin Epidemiol 2022; 14:925-935. [PMID: 35958161 PMCID: PMC9359410 DOI: 10.2147/clep.s367339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The systematic review aims to analyze and summarize the characteristics of living systematic review (LSR) for coronavirus disease 2019 (COVID-19). Methods Six databases including Medline, Excerpta Medica (Embase), Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science, and Technology Journal Database (VIP), were searched as the source of basic information and methodology of LSR. Descriptive analytical methods were used to analyze the included COVID-19 LSRs, and the study characteristics of COVID-19 LSRs were further assessed. Results Sixty-four COVID-19 LSRs were included. Eighty-nine point one percent of LSRs were published on Science Citation Index (SCI) journals, and 64.1% publication with an impact factor (IF) >5 and 17.2% with an IF >15 among SCI journals. The first unit of the published LSRs for COVID-19 came from 19 countries, with the largest contribution from the UK (17.2%, 11/64). Forty point six percent of LSRs for COVID-19 were related to therapeutics topic which was considered the most concerned perspective for LSRs for COVID-19. Seventy-six point six percent of LSRs focused on the general population, with less attention to children, pregnant women and the elderly. However, the LSR for COVID-19 was reported incomplete on “living” process, including 40.6% of studies without search frequency, 79.7% of studies without screening frequency, 20.3% of studies without update frequency, and 65.6% of studies without the timing or criteria of transitioning LSR out of living mode. Conclusion Although researchers in many countries have applied LSRs to COVID-19, most of the LSRs for COVID-19 were incomplete in reporting on the “living” process and less focused on special populations. This could reduce the confidence of health-care providers and policy makers in the results of COVID-19 LSR, thereby hindering the translation of evidence on COVID-19 LSR into clinical practice. It was necessary to explicitly enact preferred reporting items for systematic reviews and meta-analyses (PRISMA) to improve the reporting quality of LSR and support ongoing efforts of therapeutics research for special patients with COVID-19.
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Affiliation(s)
- Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China
| | - Jiefeng Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China
| | - Siyu Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Peipei Xu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
| | - Qin Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- National Drug Clinical Trial Institute, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Qin Yu, Email
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
- Correspondence: Lingli Zhang, Email
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23
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Elbaz M, Korem M, Ayalon O, Wiener-Well Y, Shachor-Meyouhas Y, Cohen R, Bishara J, Atamna A, Brosh-Nissimov T, Maaravi N, Nesher L, Chazan B, Reisfeld S, Zimhony O, Chowers M, Maor Y, Katchman E, Ben-Ami R. Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study. J Fungi (Basel) 2022; 8:jof8070721. [PMID: 35887476 PMCID: PMC9317957 DOI: 10.3390/jof8070721] [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: 06/10/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Highly variable estimates of COVID-19-associated fungal diseases (IFDs) have been reported. We aimed to determine the incidence of clinically important fungal diseases in hospitalized COVID-19 patients during the first year of the pandemic. We performed a multicenter survey of IFDs among patients hospitalized with COVID-19 in 13 hospitals in Israel between February 2020 and May 2021. COVID-19-associated pulmonary mold disease (PMD) and invasive candidiasis (IC) were defined using ECMM/ISHAM and EORTC/MSG criteria, respectively. Overall rates of IC and PMD among patients with critical COVID-19 were 10.86 and 10.20 per 1000 admissions, respectively, with significant variability among medical centers. PMD rates were significantly lower in centers where galactomannan was a send-out test versus centers with on-site testing (p = 0.035). The 30-day mortality rate was 67.5% for IC and 57.5% for PMD. Treatment with an echinocandin for IC or an extended-spectrum azole for PMD was associated with significantly lower mortality rates (adjusted hazard ratio [95% confidence interval], 0.26 [0.07–0.91] and 0.23 [0.093–0.57], respectively). In this multicenter national survey, variable rates of PMD were associated with on-site galactomannan testing, suggesting under-detection in sites lacking this capacity. COVID-19-related IFDs were associated with high mortality rates, which were reduced with appropriate antifungal therapy.
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Affiliation(s)
- Meital Elbaz
- Tel Aviv Sourasky Medical Center, Tel Aviv 6997801, Israel; (M.E.); (E.K.)
| | - Maya Korem
- Hadassah Medical Center, Jerusalem 9101002, Israel; (M.K.); (O.A.)
- Faculty of Medicine, Hebrew University, Jerusalem 9101002, Israel; (Y.W.-W.); (O.Z.)
| | - Oshrat Ayalon
- Hadassah Medical Center, Jerusalem 9101002, Israel; (M.K.); (O.A.)
- Faculty of Medicine, Hebrew University, Jerusalem 9101002, Israel; (Y.W.-W.); (O.Z.)
| | - Yonit Wiener-Well
- Faculty of Medicine, Hebrew University, Jerusalem 9101002, Israel; (Y.W.-W.); (O.Z.)
- Shaare Zedek Medical Center, Jerusalem 9101002, Israel
| | - Yael Shachor-Meyouhas
- Rambam Medical Center, Haifa 3109601, Israel;
- Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel; (R.C.); (B.C.); (S.R.)
| | - Regev Cohen
- Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel; (R.C.); (B.C.); (S.R.)
- Laniado Medical Center, Netanya 4290200, Israel
| | - Jihad Bishara
- Rabin Medical Medical Center, Petah-Tiqva 4910002, Israel; (J.B.); (A.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.C.); (Y.M.)
| | - Alaa Atamna
- Rabin Medical Medical Center, Petah-Tiqva 4910002, Israel; (J.B.); (A.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.C.); (Y.M.)
| | - Tal Brosh-Nissimov
- Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel; (T.B.-N.); (N.M.)
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba 8443944, Israel;
| | - Nir Maaravi
- Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel; (T.B.-N.); (N.M.)
| | - Lior Nesher
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba 8443944, Israel;
- Soroka Medical Center, Beer Sheba 8443944, Israel
| | - Bibiana Chazan
- Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel; (R.C.); (B.C.); (S.R.)
- Ha’Emek Medical Center, Afula 1834111, Israel
| | - Sharon Reisfeld
- Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel; (R.C.); (B.C.); (S.R.)
- Hillel Yaffe Medical Center, Hadera 3810101, Israel
| | - Oren Zimhony
- Faculty of Medicine, Hebrew University, Jerusalem 9101002, Israel; (Y.W.-W.); (O.Z.)
- Kaplan Medical Center, Rehovot 7610001, Israel
| | - Michal Chowers
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.C.); (Y.M.)
- Meir Medical Center, Kfar Saba 4428164, Israel
| | - Yasmin Maor
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.C.); (Y.M.)
- Wolfson Medical Center, Holon 5822012, Israel
| | - Eugene Katchman
- Tel Aviv Sourasky Medical Center, Tel Aviv 6997801, Israel; (M.E.); (E.K.)
| | - Ronen Ben-Ami
- Tel Aviv Sourasky Medical Center, Tel Aviv 6997801, Israel; (M.E.); (E.K.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.C.); (Y.M.)
- Correspondence: ; Tel.: +972-3-6974347
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Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India. THE LANCET INFECTIOUS DISEASES 2022; 22:e240-e253. [PMID: 35390293 PMCID: PMC8979562 DOI: 10.1016/s1473-3099(22)00124-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
COVID-19-associated pulmonary mucormycosis (CAPM) remains an underdiagnosed entity. Using a modified Delphi method, we have formulated a consensus statement for the diagnosis and management of CAPM. We selected 26 experts from various disciplines who are involved in managing CAPM. Three rounds of the Delphi process were held to reach consensus (≥70% agreement or disagreement) or dissensus. A consensus was achieved for 84 of the 89 statements. Pulmonary mucormycosis occurring within 3 months of COVID-19 diagnosis was labelled CAPM and classified further as proven, probable, and possible. We recommend flexible bronchoscopy to enable early diagnosis. The experts proposed definitions to categorise dual infections with aspergillosis and mucormycosis in patients with COVID-19. We recommend liposomal amphotericin B (5 mg/kg per day) and early surgery as central to the management of mucormycosis in patients with COVID-19. We recommend response assessment at 4–6 weeks using clinical and imaging parameters. Posaconazole or isavuconazole was recommended as maintenance therapy following initial response, but no consensus was reached for the duration of treatment. In patients with stable or progressive disease, the experts recommended salvage therapy with posaconazole or isavuconazole. CAPM is a rare but under-reported complication of COVID-19. Although we have proposed recommendations for defining, diagnosing, and managing CAPM, more extensive research is required.
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25
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Scharmann U, Herbstreit F, Steckel NK, Dedy J, Buer J, Rath PM, Verhasselt HL. Prevalence of COVID-19 Associated Mucormycosis in a German Tertiary Care Hospital. J Fungi (Basel) 2022; 8:jof8030307. [PMID: 35330309 PMCID: PMC8953274 DOI: 10.3390/jof8030307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/07/2023] Open
Abstract
Due to Coronavirus disease (COVID-19) a new group of patients at risk emerged with COVID-19-associated mucormycosis (CAM). Systematic studies, evaluating the prevalence of CAM are missing. To assess CAM prevalence in a tertiary care hospital in Germany, we applied direct microscopy, fungal culture and quantitative realtime in-house PCR targeting Mucorales-specific fragments of 18S and 28S rRNA on respiratory specimens of 100 critically ill COVID-19 patients. Overall, one Mucorales-PCR positive bronchoalevolar lavage was found whereas direct microscopy and fungal culture were negative in all cases. We conclude that a routine screening for CAM in Germany is not indicated.
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Affiliation(s)
- Ulrike Scharmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (U.S.); (J.B.); (P.-M.R.)
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, 45122 Essen, Germany;
| | - Nina Kristin Steckel
- West German Cancer Center, Department of Bone Marrow Transplantation, University Hospital Essen, 45122 Essen, Germany;
| | - Jutta Dedy
- Pharmacy, University Hospital Essen, 45122 Essen, Germany;
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (U.S.); (J.B.); (P.-M.R.)
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (U.S.); (J.B.); (P.-M.R.)
| | - Hedda Luise Verhasselt
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (U.S.); (J.B.); (P.-M.R.)
- Correspondence:
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26
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Tang HJ, Lai CC, Chao CM. Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11030315. [PMID: 35326778 PMCID: PMC8944752 DOI: 10.3390/antibiotics11030315] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The outbreak of COVID-19 has significantly changed the epidemiology of respiratory tract infection in several ways. The implementation of non-pharmaceutical interventions (NPIs) including universal masking, hand hygiene, and social distancing not only resulted in a decline in reported SARS-CoV-2 cases but also contributed to the decline in the non-COVID-19 respiratory tract infection-related hospital utilization. Moreover, it also led to the decreased incidence of previous commonly encountered respiratory pathogens, such as influenza and Streptococcus pneumoniae. Although antimicrobial agents are essential for treating patients with COVID-19 co-infection, the prescribing of antibiotics was significantly higher than the estimated prevalence of bacterial co-infection, which indicated the overuse of antibiotics or unnecessary antibiotic use during the COVID-19 pandemic. Furthermore, inappropriate antimicrobial exposure may drive the selection of drug-resistant microorganisms, and the disruption of infection control in COVID-19 setting measures may result in the spread of multidrug-resistant organisms (MDROs). In conclusion, NPIs could be effective in preventing respiratory tract infection and changing the microbiologic distribution of respiratory pathogens; however, we should continue with epidemiological surveillance to establish updated information, antimicrobial stewardship programs for appropriate use of antibiotic, and infection control prevention interventions to prevent the spread of MDROs during the COVID-19 pandemic.
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Affiliation(s)
- Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 710, Taiwan;
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan
- Correspondence:
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27
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Azhar A, Khan WH, Khan PA, Al-hosaini K, Owais M, Ahmad A. Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach. J Infect Public Health 2022; 15:466-479. [PMID: 35216920 PMCID: PMC8855610 DOI: 10.1016/j.jiph.2022.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
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