Mucormycosis, one month after recovery from COVID-19: A case report

Introduction

and importance: There are increasing case reports of mucormycosis in patient with coronavirus disease 2019 (Covid-19). Herein, we describe the case of mucormycosis after recovery from Covid-19.

Case presentation

The patient was a 73 years old woman with a history of chronic kidney disease, diabetes mellitus, hypertension, and dyslipidemia that referred to the emergency department with clinical presentation of Covid-19. On the third day of admission, the Covid-19 PCR test was negative, but the patient presented headache and pain in her upper jaw. Physical examination showed fever, erythema, and tenderness in the right cheek. Emergency biopsy and culture from sinus by subsection to mucormycosis conducted. and the diagnosis of mucormycosis was confirmed by the positive result of biopsy and culture. Despite anti-fungal treatment with Amphotericin B, patient developed severe diarrhea and became hemodynamically unstable. In the stool analysis, Strongyloides stercoralis was reported. Unfortunately, patient was expired on day thirty-two of this admission.

Clinical discussion

Mucormycosis is a dangerous infection, and its rapid diagnosis is so important. On the other hand, Covid-19 may associated with many nonspecific sign and symptoms. These finding may overlap with other infections.

In patients with prolonged mucormycosis infection, the development of strongyloidiasis should not be neglected. A single dose of ivermectin as strongyloidiasis prophylaxis should be given if the duration of the illness is prolonged.

Conclusion

Clinicians should consider mucormycosis and its complications after Covid-19 treatment in diabetic and immunocompromised patients.

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COVID-19 may be associated with bacterial or fungal co-infections.

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Nonspecific sign and symptoms of COVID-19, may overlap with other infections.

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Mucormycosis may occur following COVID-19, especially in patients with risk factors.

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We report a case of mucormycosis, one month after recovery from COVID-19 in a patient with poor diabetic control.

Lack of association between vitamin D insufficiency and clinical outcomes of patients with COVID-19 infection

Background

A protective effect of vitamin D against COVID-19 infection is under investigation. We aimed to analyze the effect of vitamin D sufficiency on the clinical outcomes of patients infected with COVID-19.

Methods

In this cross-sectional study we analyzed the vitamin D levels of COVID-19 patients who were admitted to Razi Hospital (an infectious disease referral center in Mazandaran province in northern Iran) from February to March 2020. Overall, a cutoff point of 30 ng/mL was used for the definition of vitamin D sufficiency.

Results

One hundred fifty-three patients were analyzed in this study who had laboratory documentation of a 25(OH) D level at the time of hospitalization. The vitamin D levels of the patients were 27.19 ± 20.17 ng/mL. In total, 62.7% (n = 96) of the patients had a 25(OH) D level of less than 30 ng/mL and 37.25% (n = 57) had a 25(OH) D level of more than 30 ng/mL. In total, 49% (n = 75) of the patients suffered from at least one underlying disease. The univariate and multivariable regression showed that vitamin D sufficiency was not associated with a statistically significant lower risk of adverse clinical outcomes of COVID-19 such as duration of hospitalization and severity of infection (P > 0.05).

Conclusions

Sufficient vitamin D levels were not found to be protective against adverse clinical outcomes in patients infected with COVID-19. Chronic disorders in COVID-19 patients were found to have greater relevance than vitamin D levels in determining the adverse outcomes of the infection. Further studies are needed to determine the role of vitamin D level in predicting the outcomes of COVID-19 infection.

The prevalence rate of hepatitis B and hepatitis C co-infection in HIV positive patients in Mazandaran province, Iran

AIM

To investigate the prevalence rate of hepatitis B (HVB) and hepatitis C (HCV) co-infection in HIV positives in Mazandaran province.

METHODS

This descriptive cross-sectional study lasted from 2008 to 2010. The population of this study included 188 HIV positive persons confirmed to be infected by tests of ELISA I, II and western blood (WB) in the hospitals of Mazandaran University of Medical Sciences and Health Services. After getting permission, 5 cc venous blood samples were taken and drawn into a lab tube without citrate.

RESULTS

Among the total of 188 HIV positive patients in Mazandaran province, only 80 patients were available, 62 had moved to other provinces, and 46 had died. Of the samples, 66 (82.5%) were males and 14 (17.5%) were females with the mean age of 37. Among the patients, nine (11.3%) were co-infected with HIV/ HBV, 27(33.8%) with HIV/HCV, while 20 (25%) were co-infected with HIV/HBV/ HCV. Only one patient had travelled abroad and eight of them stated that they had used shared syringes.

CONCLUSION

The differences in the rate of HBV and HCV co-infection can be due to the epidemiologic conditions of viruses with different factors including different risk factors causing infection with these factors such as the rate of virus penetrating the body, the manner of penetration, patients' health condition, patients' culture, and their socio-economic condition, etc.

Report of two rare complications of pandemic influenza A (H1N1)

Novel influenza A (H1N1) has created a major worldwide health problem within a short time after its emergence. This infection is often self-limited, but sometimes can cause severe and fatal complications. In this study, we present two rare complications of pandemic influenza A, who were referred to Razi University Affiliated Hospital in northern Iran. The first case was a 30-year-old man with severe headache and high fever accompanied with chills, generalized myalgia, and arthralgia. Cerebrospinal fluid analysis was consistent with aseptic meningitis. The second case, a 25-year-old pregnant woman with high fever, chills and severe fatigue and malaise, developed tachypnea, tachycardia, respiratory distress, cyanosis and loss of consciousness a few hours after admission. Echocardiography reported myopericarditis. The patient was transferred to the intensive care unit and mechanical ventilation was begun. The next day, the patient started vaginal bleeding which progressed to spontaneous abortion three days later. Diagnosis of novel influenza A (H1N1) was confirmed using real-time reverse-transcriptase PCR of a pharyngeal swab.