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Kamath GM, Jeganathan S, Salim S, Antony RM, Kamath AR, Hiran H. Comment on: Case series of central retinal artery occlusion in COVID-19-associated rhino-orbito-cerebral mucormycosis. Indian J Ophthalmol 2024; 72:755-756. [PMID: 38648440 DOI: 10.4103/ijo.ijo_2538_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- Gurudutt M Kamath
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sangeetha Jeganathan
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Sreelakshmi Salim
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Reeja Mariam Antony
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Ajay R Kamath
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Harshitha Hiran
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Velasco JC, Vargas LJ, García L, Torres IJ, González IC. Oral mucormycosis associated with COVID-19 and diabetes mellitus: Case report and literature review. Biomedica 2024; 44:10-15. [PMID: 38648346 DOI: 10.7705/biomedica.6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/04/2024] [Indexed: 04/25/2024]
Abstract
Mucormycosis is an invasive opportunistic fungal infection with high mortality, mainly detected in people with COVID-19, especially those with underlying diseases such as diabetes mellitus. Mucormycosis prevalence is 0.005 to 1.7 cases per million inhabitants, and it has been increasing in countries like India and Pakistan. This mycosis can affect different organs, and clinical manifestations reflect the transmission mechanism. Frequent forms are rhino-orbital-cerebral and pulmonary. This disease should be suspected in patients with necrotic injuries on mucous membranes or skin. We present a case of a patient with diabetes mellitus and diagnosed with oral mucormycosis associated with COVID-19.
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Affiliation(s)
- Julio César Velasco
- Departamento de Investigación, Hospital Regional de la Orinoquía, Yopal, Colombia
| | | | - Lorena García
- Departamento de Investigación, Hospital Regional de la Orinoquía, Yopal, Colombia
| | - Iván José Torres
- Cirugía Maxilofacial, Hospital Regional de la Orinoquía, Yopal, Colombia
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He D, Wang Z. Multiple Gastric Ulcers in An Immunosuppressed Patient with COVID-19 Infection caused by Mucormycosis. J Gastrointestin Liver Dis 2024; 33:16. [PMID: 38554417 DOI: 10.15403/jgld-5149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 04/01/2024]
Affiliation(s)
- Du He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan; 2) Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .
| | - Zhu Wang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan; 2) Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .
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Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Singh Sibia RP, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre retrospective study from India. Clin Microbiol Infect 2024; 30:368-374. [PMID: 38081413 DOI: 10.1016/j.cmi.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM. METHODS We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality. RESULTS We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival. DISCUSSION CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | - Deepak Thangaraju
- Department of Microbiology, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Atul K Patel
- Department of Infectious Diseases, Sterling Hospital, Ahmedabad, India
| | | | - Ashwini Tayade
- Department of Infectious Diseases, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Sudhir Bhandari
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Vishwanath Gella
- Department of Pulmonary Medicine, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Surabhi Madan
- Department of Infectious Diseases, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Vinaykumar Hallur
- Department of Microbiology, All India Institute of Medical Science Bhubaneswar, Odisha, India
| | | | - Arjun Srinivasan
- Department of Pulmonary Medicine, Royal Care Hospital, Coimbatore, India
| | | | | | - Sanjay Pujari
- Department of HIV Medicine and Infectious Diseases, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Tanu Singhal
- Department of Infectious Diseases, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Puneet Saxena
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College, Chandigarh, India
| | - Vasant Nagvekar
- Department of Infectious Diseases, Global Hospital, Mumbai, India
| | - Parikshit Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pratik Savaj
- Department of Infectious Diseases, Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Kamlesh Patel
- Department of Microbiology and Infection Prevention & Control, Sterling Hospital, Ahmedabad, India
| | - Anuradha Deshmukh
- Department of Microbiology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Aruna Vyas
- Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Raghava Rao Gandra
- Department of Pulmonary Medicine, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Srinivas Kishore Sistla
- Department of Otorhinolaryngology, Asian Institute of Gastroenterology, Hyderabad, Telengana, India
| | - Priyadarshini A Padaki
- Department of Microbiology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Dharshni Ramar
- Clinical Associate, Department of Research, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Bharani Rachagulla
- Department of Pulmonary Medicine, Yashoda Hospitals, Somajiguda, Hyderabad, India
| | | | | | - Sunil Pawar
- Department of Internal Medicine, Government Medical College, Patiala, Punjab, India
| | - Piyush Gugale
- Department of HIV Medicine and Infectious Diseases, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Pradeep Hosamani
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Sunil Narayan Dutt
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Satish Nair
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | | | - Sanjiv Badhwar
- Department of Otorhinolaryngology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Kiran Kumar Kompella
- Department of Internal Medicine and Infectious Diseases, Army Hospital (Research and Referral), New Delhi, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College, Chandigarh, India
| | - Milind Navlakhe
- Department of Otorhinolaryngology, Global Hospital, Mumbai, India
| | - Amrita Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Poorvesh Dhakecha
- Clinical Associate, Department of Research, Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
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Tekin R, Erdem T, Tekin RC. Rhino-orbital and pulmonary mucormycosis in a patient with acute myeloid leukaemia. Br J Hosp Med (Lond) 2024; 85:1. [PMID: 38416528 DOI: 10.12968/hmed.2023.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Recep Tekin
- Department of Infectious Diseases, University of the Dicle, Diyarbakır, Turkey
| | - Tajdin Erdem
- Department of Infectious Diseases, University of the Dicle, Diyarbakır, Turkey
| | - Rojbin C Tekin
- Department of Radiology, Dagkapi State Hospital, Diyarbakır, Turkey
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Urias-Barreras CM, Rodríguez-Archilla A, Canizalez-Roman A, Bastidas DA, León-Sicairos NM. Maxillary mucormycosis and aspergillosis in post-COVID-19 patients in Mexico: A case series. J Stomatol Oral Maxillofac Surg 2024; 125:101615. [PMID: 37648209 DOI: 10.1016/j.jormas.2023.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Fungal infections, during or as a consequence of SARS-CoV-2 infection, associated with uncontrolled diabetes mellitus and indiscriminate use of corticosteroids have been reported. In the jaw, mostly mucormycosis has been diagnosed in hospitals. METHODS A retrospective, cross-sectional, descriptive study of the clinical, imaging, and histopathologic characteristics of maxillary invasive fungal infection in post-COVID-19 patients diagnosed in a private non-hospital oral pathology service in Mexico during 2020-2022 was conducted. RESULTS We found 20 cases of maxillary invasive fungal infections in post-COVID-19 patients, 75% including a diagnosis of mucormycosis and 25% diagnosed as probable aspergillosis. The most common signs and symptoms were exposed necrotic bone followed by tooth mobility, discharge, and pain. On imaging, unilateral maxillary sinus involvement was observed in 6 cases (30%), and bilateral maxillary sinus involvement was observed in 3 cases (15%). CONCLUSIONS It is essential to consider the association of osteonecrosis of the jaw in post-COVID-19 patients, with aspergillosis, not only mucormycosis, for early diagnosis and appropriate treatment.
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Affiliation(s)
- Cynthia M Urias-Barreras
- School of Dentistry, Autonomous University of Sinaloa, Culiacan, Sinaloa 80013, Mexico; Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Alberto Rodríguez-Archilla
- Department of Stomatology, Oral Medicine Unit, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Secretariat of Health, The Women's Hospital, Culiacan, Sinaloa 80020, Mexico
| | - Daniela A Bastidas
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico
| | - Nidia M León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; Departamento de Investigación, Hospital Pediátrico de Sinaloa "Dr. Rigoberto Aguilar Pico" Servicios de Salud de Sinaloa. Blvd. Constitución S/N, Colonia Jorge Almada, C.P, Culiacan, Sinaloa 80200, Mexico.
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Raj A, Singh P, Sadhukhan K, Chandra B, Kranti B, Kumar S, Sinha U, Kokkayil P, Bhadani PP, Sinha P, Sanepalli S, Tiwari P, Nanda J. Survival benefit of exenteration in COVID-19-associated rhino-orbital mucormycosis. Indian J Ophthalmol 2024; 72:190-194. [PMID: 38099361 PMCID: PMC10941941 DOI: 10.4103/ijo.ijo_2543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.
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Affiliation(s)
- Amit Raj
- Department of Ophthalmology, AIIMS, Patna, Bihar, India
| | | | | | | | - Bhavana Kranti
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Subhash Kumar
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | | | | | - Prerna Sinha
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Sravani Sanepalli
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Pragati Tiwari
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Jayadev Nanda
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
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Hunter N, Kusnik A, Hatem L, Chodos A, Baratta A, Penmetsa P, Levin Y. Angioinvasive gastrointestinal mucormycosis with duodenal necrosis and perforation in a patient with visceral myopathy. Z Gastroenterol 2024; 62:199-203. [PMID: 37044123 DOI: 10.1055/a-2053-9149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
A 55-year-old woman with a past medical history of visceral myopathy with multiple resultant abdominal surgeries, colectomy caused by severe pseudo-obstruction, and end-stage renal disease on hemodialysis presented with complaints of nausea, abdominal distention, vomiting, and diarrhea for five days. Small-bowel obstruction was identified on CT. She subsequently developed acute gastrointestinal bleeding, anemia, and hemodynamic instability. Extensive gastric ulceration with frank hemorrhage prompted urgent subtotal gastrectomy with multiple intraoperative findings, including a necrotic distal duodenum. Surgical pathology showed invasive fungal infection of the duodenum with perforation, morphologically compatible with invasive mucormycosis. The patient was started on intravenous liposomal amphotericin B, but despite best efforts, the patient ultimately succumbed to this invasive fungal infection in addition to sepsis and multi-organ failure.
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Affiliation(s)
- Nicole Hunter
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Alexander Kusnik
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Layla Hatem
- Department of Pathology, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Ari Chodos
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Anthony Baratta
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Prasad Penmetsa
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
| | - Yana Levin
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA, Rochester Regional Health, Rochester, United States
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Watson M, Fong R, Schoemaker D, Due S. Black fungus: gastrointestinal invasive mucormycosis causing small bowel perforation, gastric and peristomal ulceration. ANZ J Surg 2024; 94:252-253. [PMID: 37803490 DOI: 10.1111/ans.18716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Matthew Watson
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rebecca Fong
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Schoemaker
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Steven Due
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
- Department of Surgery, Flinders University, Adelaide, South Australia, Australia
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de Lucena LA, de Oliveira FG, de Andrade MMP, de Paula KC, Praxedes MRG, de Oliveira RA. Mucormycosis-induced hypercalcemia: a case report. CEN Case Rep 2024; 13:66-71. [PMID: 37289341 PMCID: PMC10248959 DOI: 10.1007/s13730-023-00800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Hypercalcemia is a vital laboratory marker because it can show underlying severe diseases like cancer and infections. Of all the causes of hypercalcemia, primary hyperparathyroidism, and malignancies are the most common, but granulomatous diseases, such as certain fungal infections, can also be the cause. Here we describe the case of a 29-year-old woman, an insulin-dependent diabetic, found unconscious and tachypneic at home. In the emergency room, the medical team diagnosed diabetic ketoacidosis (DKA) and acute kidney injury (AKI). During hospitalization, despite resolving acidemia, persistent hypercalcemia attracted attention. Laboratory tests showed decreased parathyroid hormone (PTH) levels, confirming non-PTH-dependent hypercalcemia. Computed tomography (CT) of the chest and abdomen demonstrated no alterations, but an upper digestive endoscopy revealed an ulcerated and infiltrative lesion in the stomach. A biopsy showed a granulomatous infiltrate due to mucormycosis infection. The patient received liposomal amphotericin B for 30 days and isavuconazonium for two months. Serum calcium levels improved during treatment. Inquiry of the etiology of hypercalcemia should begin with the PTH assay; high levels are consistent with hyperparathyroidism; low levels, with calcium or vitamin D intoxication, malignancies, prolonged immobilization, and granulomatous diseases. In the latter cases, the overproduction of 1-alpha-hydroxylase by the granulomatous tissue increases the conversion of 25(OH)vitamin D into 1-25(OH)vitamin D, which causes the intestinal absorption of calcium. We have described the first hypercalcemia related to mucormycosis infection in a young diabetic patient, although case presentations associate other fungal infections with elevated serum calcium.
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Affiliation(s)
- Larissa Araújo de Lucena
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil
| | | | | | | | | | - Rodrigo Azevedo de Oliveira
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil.
- Casa de Saúde São Lucas, CSSL, Natal, 59020-160, Brazil.
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Gerber M, Rajput RV, Hont AB. Successful treatment of disseminated mucormycosis in a pediatric patient with Wilms tumor. Pediatr Blood Cancer 2024; 71:e30788. [PMID: 38015110 DOI: 10.1002/pbc.30788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Monica Gerber
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Roma V Rajput
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Amy B Hont
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
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Thomas PA. Comment on: Case series of central retinal artery occlusion in COVID-19-associated rhino-orbito-cerebral mucormycosis. Indian J Ophthalmol 2024; 72:299-300. [PMID: 38273694 PMCID: PMC10941946 DOI: 10.4103/ijo.ijo_2256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Philip Aloysius Thomas
- Institute of Ophthalmology, Joseph Eye Hospital, P.B. 138, Tiruchirapalli, Tamil Nadu, India
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Ji R. Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report. BMC Infect Dis 2024; 24:136. [PMID: 38287258 PMCID: PMC10823596 DOI: 10.1186/s12879-023-08220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/04/2023] [Indexed: 01/31/2024] Open
Abstract
Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
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Affiliation(s)
- Ran Ji
- Department of the Surgical Intensive Care Unit (SICU), The Second Affiliated Hospital Zhejiang, University School of Medicine, NO. 88 Jiefang Road,Shangcheng District Hangzhou, 310009, Zhejiang, China.
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15
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Sasani E, Pakdel F, Khodavaisy S, Salehi M, Salami A, Sohrabi M, Aminishakiba P, Amirafzali I, Salami Khaneshan A. Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review. Mycopathologia 2024; 189:10. [PMID: 38231407 DOI: 10.1007/s11046-023-00808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Mucormycosis and aspergillosis are angioinvasive infections mainly occurring in immunocompromised patients. However, mixed infection with mucormycosis and aspergillosis in post-COVID-19 patients is rare. In this report, we will report four cases and comprehensively review the published literature on COVID-19 associated mixed infection of aspergillosis and mucormycosis. METHOD Besides four of our cases, we searched for published articles using PubMed/MEDLINE, Scopus, and Web of Science databases from the beginning of 2020 until October 2023. RESULT During the COVID-19 pandemic, we analyzed 52 cases (4 from our research and 48 from other studies). The most common underlying disease (59.6%) was diabetes mellitus. However, 19.2% of COVID-19 patients had no underlying condition. Interestingly, rhino-orbital-cerebral mucormycosis featured prominently in India and Iran, while other countries primarily reported a higher prevalence of pulmonary cases. CONCLUSION In conclusion, this study highlights the presence of mixed aspergillosis and mucormycosis in COVID-19 patients who previously had common underlying diseases or even a healthy immune system. Therefore, managing COVID-19 patients should involve screening serum and respiratory samples using biomarkers to detect superinfections.
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Affiliation(s)
- Elahe Sasani
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzad Pakdel
- Department of Oculo-Facial Plastic Surgery, Farabi Eye Hospital, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Zoonoses Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Salami
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Sohrabi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouyan Aminishakiba
- Pathology Department, Cancer Institute Hospital, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Amirafzali
- Resident of Internal Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arezoo Salami Khaneshan
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Barahimi E, Hamidi M, Hassani-Azad M, Farshidi F, Ardeshiri M, Sheybani-Arani M. Bell's palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis. J Med Case Rep 2024; 18:29. [PMID: 38217020 PMCID: PMC10790248 DOI: 10.1186/s13256-023-04298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Mucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell's palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve. CASE PRESENTATION A 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient's vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell's palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa. CONCLUSION Fungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell's palsy.
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Affiliation(s)
- Elham Barahimi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Makiye Hamidi
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Hassani-Azad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzaneh Farshidi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Ardeshiri
- Department of Radiology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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17
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Bosnar D, Zagorec MK, Bušić M. Comment on "Central retinal artery occlusion in rhino-orbital-cerebral mucormycosis: An inflammatory-prothrombotic state". Asia Pac J Ophthalmol (Phila) 2024; 13:100045. [PMID: 38331219 DOI: 10.1097/apo.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Damir Bosnar
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Mira Knežić Zagorec
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Mladen Bušić
- Department of Ophthalmology, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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18
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Motevasseli S, Nazarpour A, Dalili Kajan Z, Yousefi Z, Khosravifard N, Kashi F, Roudbari N. Post-COVID mucormycosis osteomyelitis and its imaging manifestations in the North of Iran: case series. Oral Radiol 2024; 40:69-80. [PMID: 36063355 PMCID: PMC9441844 DOI: 10.1007/s11282-022-00650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022]
Abstract
Mucormycosis is an invasive fungal infection that usually affects patients with immunocompromised conditions. In the context of the COVID-19 pandemic and the following corticosteroid therapy, mucormycosis prevalence has increased. The situation may be more complicated with some underlying diseases such as diabetes mellitus. In addition, due to the vicinity of maxillary bone to the nasal cavity and paranasal sinuses, which are the main routes for the infection to spread, dentists, maxillofacial radiologists, and surgeons may be the first to encounter these patients. Post-COVID mucormycosis osteomyelitis is one of the complications of this infection Bone destruction and the erosion or breach of cortical boundaries of the maxilla and the bone structures in the vicinity of paranasal sinuses are the most critical radiographic findings of post-covid osteomyelitis. Herein, there are some cases of post-covid mucormycosis osteomyelitis involving the maxillary and other facial bones.
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Affiliation(s)
- Safa Motevasseli
- Department of Maxillofacial Surgery, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Nazarpour
- Department of Maxillofacial Surgery, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Dalili Kajan
- Department of Maxillofacial Radiology, Dental Sciences Research Center, Dental School, Guilan University of Medical Sciences, End of Professor Samii Blvd., Rasht, 41941-73774 Iran
| | - Zahra Yousefi
- Department of Dentomaxillofacial Radiology, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Negar Khosravifard
- Department of Maxillofacial Radiology, Dental Sciences Research Center, Dental School, Guilan University of Medical Sciences, End of Professor Samii Blvd., Rasht, 41941-73774 Iran
| | - Faezeh Kashi
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Niousha Roudbari
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
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19
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Hu L, Chen X. A fatal case of disseminated pulmonary and renal mucormycosis caused by Rhizopus microspores. Rev Inst Med Trop Sao Paulo 2023; 65:e54. [PMID: 37878971 PMCID: PMC10588994 DOI: 10.1590/s1678-9946202365054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/01/2023] [Indexed: 10/27/2023] Open
Abstract
Rhinocerebral and pulmonary mucormycosis are the main manifestations of mucormycosis; however, disseminated pulmonary associated with renal mucormycosis is rarely reported. In this paper, we report a rare fatal case of disseminated pulmonary and renal mucormycosis caused by Rhizopus microsporus in a 50-year-old man with poorly controlled hypertension, type 2 diabetes, and prolonged use of corticosteroids for the treatment of his reiterative gouty arthritis. In this patient, the use of corticosteroids and poorly controlled diabetes were considered underlying risk factor for his disseminated mucormycosis, along with acute renal dysfunction, suggesting the need for clinical suspicion of disseminated pulmonary and renal mucormycosis in hospitalized patients with poorly controlled diabetes and immunocompromised host.
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Affiliation(s)
- Liuyang Hu
- The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi
Academy of Medical Sciences, Department of Laboratory Medicine, Nanning, Guangxi,
China
| | - Xingchun Chen
- The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi
Academy of Medical Sciences, Department of Laboratory Medicine, Nanning, Guangxi,
China
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20
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Malakar S, Elhence A, Prasad P, Ghoshal UC, Pandey G, Mohindra S. Primary gastric mucormycosis presenting with post-Coronavirus disease - 19 upper gastrointestinal bleed. Indian J Gastroenterol 2023; 42:736-737. [PMID: 36401772 PMCID: PMC9676801 DOI: 10.1007/s12664-022-01298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sayan Malakar
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Anshuman Elhence
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pallavi Prasad
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Gaurav Pandey
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Samir Mohindra
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
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21
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Panigrahi MK, Singh P, Mishra P, Durgeshwar G. Coronavirus disease 2019 associated pulmonary mucormycosis. Infection 2023; 51:1601-1602. [PMID: 37067756 PMCID: PMC10106873 DOI: 10.1007/s15010-023-02038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/10/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Manoj Kumar Panigrahi
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Pratima Singh
- Department of Pulmonary Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Pritinanda Mishra
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Gopal Durgeshwar
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
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22
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Manesh A, Devasagayam E, Bhanuprasad K, Varghese L, Kurien R, Cherian LM, Dayanand D, George MM, Kumar SS, Karthik R, Vanjare H, Peter J, Michael JS, Thomas M, Mathew BS, Samuel P, Peerawaranun P, Mukaka M, Rupa V, Varghese GM. Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study. Clin Microbiol Infect 2023; 29:1298-1305. [PMID: 37348653 PMCID: PMC10281032 DOI: 10.1016/j.cmi.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. METHODS This prospective, pragmatic study included adults with diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. Patients received short (7-14 days) or long (15-28 days) intravenous antifungal therapy (short intravenous antifungal treatment [SHIFT] or long intravenous antifungal treatment [LIFT], respectively) depending on the presence or absence of brain involvement. All patients received step-down posaconazole tablets, debridement, and glycemic control. The primary outcome was the treatment success at week 14, which was determined by assessing survival and the absence of disease progression through clinical evaluation and nasal endoscopy. Log-binomial regression analysis (risk ratio and 95% CI) was performed to assess factors associated with the primary outcome. RESULTS Intravenous therapy was administered to 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 (median duration, 22 days). Treatment success at 3 months was 88% (217/248; 95% CI, 83-91%): SHIFT group, 93% (189/203; 89-96%); LIFT group, 62% (28/45; 47-76%). All-cause mortality was 12% (30/251): SHIFT group, 6% (13/205); LIFT group, 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00-1.05]; p 0.027), diabetic ketoacidosis at presentation (2.32 [1.20-4.46]; p 0·012), glycated haemoglobin A1c (1.19 [1.03-1.39]; p 0.019), stroke (3.93 [1.94-7.95]; p 0·0001), and brain involvement (5.67 [3.05-10.54]; p < 0.0001) were independently associated with unsuccessful outcomes. DISCUSSION Short intravenous amphotericin B with step-down posaconazole tablets should be further studied as primary treatment option for diabetes or COVID-19-associated mucormycosis in randomized controlled trials.
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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
| | - Kundakarla Bhanuprasad
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lalee Varghese
- Department of ENT 3 & Rhinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Regi Kurien
- Department of ENT 3 & Rhinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lisa M Cherian
- Department of ENT 3 & Rhinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mithun M George
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Selwyn S Kumar
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Harshad Vanjare
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Joy S Michael
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binu S Mathew
- Department of Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna Samuel
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vedantam Rupa
- Department of ENT 3 & Rhinology, 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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23
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Hristova R, Vlahova A, Christova M, Stamatov K, Stanimirov P. Finegoldia magna and Mucorales molds co-infection in a severe case of SARS-CoV-2 disease. J Infect Dev Ctries 2023; 17:1231-1236. [PMID: 37824356 DOI: 10.3855/jidc.17647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/23/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Rhino-orbito-cerebral mucormycosis has been reported as a sequela after coronavirus disease in immunocompromised patients with poorly controlled diabetes mellitus. Most cases have been identified in India, with only 19 reported elsewhere. METHODOLOGY We herein report the results of clinical, imaging, microbiological, and histopathological studies in an immunocompetent 67-year-old male with rhino-orbital infection by Finegoldia magna and Mucorales molds following severe SARS-CoV-2 disease associated with new-onset decompensated diabetes mellitus. RESULTS Microbiological and histological studies confirmed the presence of both Mucorales molds and Finegoldia magna, which was successfully treated with antibiotics and a specific anti-fungal agent (Posaconazole). CONCLUSIONS Careful multidisciplinary follow-up of patients treated for severe SARS-CoV-2 disease is necessary for the timely diagnosis of complications such as uncontrolled diabetes mellitus and opportunistic infections.
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Affiliation(s)
- Rozaliya Hristova
- Department of Ophthalmology, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Alexandrina Vlahova
- Department of General and Clinical Pathology, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Maria Christova
- Department of Nephrology, University Hospital St. Ivan Rilski, Department of Internal Medicine, Medical University Sofia, Sofia, Bulgaria
| | - Konstantin Stamatov
- Department of Dental, Oral and Maxillofacial Surgery, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Pavel Stanimirov
- Department of Dental, Oral and Maxillofacial Surgery, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
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24
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Hanks J, Unai S, Bribriesco A, Insler S, Yu E, Banzon J, Mireles-Cabodevila E, Adi A, Elgharably H, Yun J, Krishnan S. Successful treatment of pulmonary mucormycosis ( Lichtheimia spp.) in a post-partum patient with COVID-19 ARDS requiring extra-corporeal membrane oxygenation using salvage therapy. Perfusion 2023; 38:1315-1318. [PMID: 35979585 PMCID: PMC9389274 DOI: 10.1177/02676591221111031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Case Summary: A 31-year-old female presented to a regional hospital at 27 weeks pregnant and was found to have COVID-19 ARDS. She underwent intubation and caesarian section for worsening hypoxia and non-reassuring fetal heart tones. Hypoxemia was refractory to proning requiring ECMO and transfer to a tertiary care center. Admission chest radiography showed a new right lower lobe cavitating lesion with computed tomography scan revealing a large multi-loculated cavity in the right lung and extensive bilateral ground-glass opacities. The patient was started on amphotericin and posaconazole, with final respiratory cultures growing Lichtheimia spp. Source control was discussed via possible open thoracostomy, but medical management alone was continued. Total ECMO support was 3 weeks. At the time of discharge to acute rehab, 1 month of amphotericin and posaconazole had been completed, with continuation of posaconazole. At last update, she had been discharged from rehab and was back home with her infant. Conclusion: Pulmonary mucormycosis, even in the non-ECLS population, carries a high mortality. Treatment in pulmonary disease with surgery improves mortality but is not always feasible. Salvage therapy with extended course antifungal medications may be an option for those not amendable.
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Affiliation(s)
- Justin Hanks
- Department of Internal Medicine, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - Shinya Unai
- Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - Alejandro Bribriesco
- Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - Steven Insler
- Department of Intensive Care and
Resuscitation, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - Eileen Yu
- Case Western Reserve
University, Cleveland OH, USA
| | - Jona Banzon
- Department of Infectious Disease, Cleveland Clinic
Foundation, Cleveland OH, USA
| | | | - Ahmad Adi
- Department of Intensive Care and
Resuscitation, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - Haytham Elgharably
- Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland OH, USA
| | - James Yun
- Case Western Reserve
University, Cleveland OH, USA
| | - Sudhir Krishnan
- Department of Critical Care
Medicine, Cleveland Clinic
Foundation, Cleveland OH, USA
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25
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Keyrouz E, Rizk M, Fouani MI, Mashlab H, Sadaka A. Novel Cases of Invasive Rhino-Orbital-Cerebral Mucormycosis in 2 Patients Who had Recently Recovered From Coronavirus Disease 2019. J Neuroophthalmol 2023; 43:e74-e75. [PMID: 37603434 DOI: 10.1097/wno.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elias Keyrouz
- Lebanese American University (EK), Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon; Ophthalmology Department (MR, AS), Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Ophthalmology Department (MIF), Ophthalmologist at Beirut Lasik Center, Beirut, Lebanon; and Department of Otorhinolaryngology Head and Neck Surgery (HM), Sheikh Ragheb Harb Hospital, Nabatieh, Lebanon
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26
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Lisboa ML, Grando LJ, Kretzer SL, Tomazelli KB, Bianco BC, Santos da Silva MC, Kosmann C, Meurer MI. Mucormycosis causing oral and nasal osteonecrosis in a case of acute myeloid leukemia. Spec Care Dentist 2023; 43:727-730. [PMID: 36648613 DOI: 10.1111/scd.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
AIMS Mucormycosis is a rare and aggressive fungal infection with a high mortality rate because of its rapidly progressive and destructive nature. The oral cavity is often affected under opportunistic conditions. We report a 34-year-old woman diagnosed with acute myeloid leukemia complained of slight swelling on the right side of her face with toothache and gingival swelling. An incisional biopsy was performed, and the specimen analysis revealed broad aseptate hyphae with a ribbon-like appearance, which is characteristic of opportunistic Mucorales infection. METHODS AND RESULTS The oral lesion worsened, and invasion of the fungal infection into the maxillary sinus, nasal cavity, ethmoidal air cells, and sphenoid and frontal sinuses was observed. Partial maxillectomy was performed concomitantly with the ongoing chemotherapy for leukemia. A maxillofacial prosthesis was used for functional rehabilitation. CONCLUSION Successful management requires a multimodal approach. In this case, the patient required different systemic approaches for treating leukemia and the fungal infection as well as rehabilitation with an obturator prosthesis.
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Affiliation(s)
- Mariah Luz Lisboa
- Núcleo de Odontologia Hospitalar, Hospital Universitário Professor Polydoro Ernani de São Thiago, HU-UFSC/EBSERH, Florianópolis, SC, Brazil
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Liliane Janete Grando
- Departamento de Patologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Sara Letícia Kretzer
- Laboratório de Micologia, Hospital Universitário Professor Polydoro Ernani de São Thiago, HU-UFSC/EBSERH, Florianópolis, SC, Brazil
| | - Karin Berria Tomazelli
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Bianca Carla Bianco
- Programa, de Pós-Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Cleumara Kosmann
- Secretaria Estadual de Saúde de Santa Catarina, Florianópolis, SC, Brazil
| | - Maria Inês Meurer
- Departamento de Patologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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27
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Sun G, Weiss A, Zhao J, Silver M, DeMaio M, Dehbashi S. Isolated cerebral Mucormycosis and Aspergillosis coinfection in an immunocompromised adult. BMJ Case Rep 2023; 16:e255909. [PMID: 37640409 PMCID: PMC10462942 DOI: 10.1136/bcr-2023-255909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Opportunistic fungal infections are a major cause of mortality in immunosuppressed patients, with mucormycosis and aspergillosis as two of the most commonly identified fungal organisms. Coinfection with mucormycosis and aspergillosis is rare, but cases have been reported in literature, most commonly presenting as disseminated invasive fungal infection with cerebrorhino-orbital involvement in an immunocompromised patient. Infections are most commonly caused by direct implantation of spores with localised angioinvasion. Haematogenous spread is rare, with most cases secondary to haematological malignancies or intravenous drug use. Coinfection with mucormycosis and aspergillosis portends a poor prognosis, with a high mortality rate. Thus, prompt recognition and intervention are crucial to prevent poor outcomes. In this unique case report, we describe a case of isolated cerebral mucormycosis and aspergillosis coinfection, not previously reported in literature.
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Affiliation(s)
- George Sun
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Allison Weiss
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Joy Zhao
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Mitchell Silver
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Michael DeMaio
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sara Dehbashi
- Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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28
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Soleimanifar N, Assadiasl S, Rostamian A, Abdollahi A, Salehi M, Abdolmaleki M, Barzegari S, Sobati A, Sadr M, Mohebbi B, Mojtahedi H, Nicknam MH. Percentage of Th1 and Th17 cells and serum level of IL-17 and IFN-γ cytokines in COVID-19-associated mucormycosis. Med Mycol 2023; 61:myad090. [PMID: 37604786 DOI: 10.1093/mmy/myad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/08/2023] [Accepted: 08/19/2023] [Indexed: 08/23/2023] Open
Abstract
The considerable number of the 2019 coronavirus disease (COVID-19) patients who developed mucormycosis infections in West and Central Asia urged a need to investigate the underlying causes of this fatal complication. It was hypothesized that an immunocompromised state secondary to the excessive administration of anti-inflammatory drugs was responsible for the outburst of mucormycosis in COVID-19 patients. Therefore, we aimed to study the implication of two major subsets of adaptive immunity T helper (Th)-1 and Th17 cells in disease development. Thirty patients with COVID-19-associated mucormycosis, 38 with COVID-19 without any sign or symptom of mucormycosis, and 26 healthy individuals were included. The percentage of Th1 and Th17 cells in peripheral blood, as well as the serum levels of interleukin (IL)-17 and interferon-gamma (IFN-γ), were evaluated using flow cytometry and ELISA techniques, respectively. Th17 cell percentage in patients with COVID-19-associated mucormycosis was significantly lower than in COVID-19 patients (P-value: <0.001) and healthy subjects (P-value: 0.01). In addition, the serum level of IL-17 in COVID-19 patients was significantly higher than that of healthy individuals (P-value: 0.01). However, neither the frequency of Th1 cells nor the serum level of IFN-γ was different between the study groups. Given the critical role of Th17 cells in the defense against mucosal fungal infections, these findings suggest that low numbers of Th17 and insufficient levels of IL-17 might be a predisposing factor for the development of mucormycosis during or after COVID-19 infection.
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Affiliation(s)
- Narjes Soleimanifar
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Assadiasl
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolrahman Rostamian
- Rheumatology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of pathology, school of medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Research center for antibiotic stewardship and antimicrobial resistance, Infectious diseases department, Tehran University of medical sciences, Tehran, Iran
| | - Mohsen Abdolmaleki
- Department of medical sciences, Aligudarz branch, Islamic Azad University, Aligudarz, Iran
| | - Saeed Barzegari
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Amol, Iran
| | - Abolfazl Sobati
- Department of nursing and midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sadr
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Mohebbi
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh Mojtahedi
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nicknam
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, Medicine School, Tehran University of Medical Sciences, Tehran, Iran
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29
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Torroella Vallejo A, Turrado-Rodríguez V, Morales Sevillano X. Mesenteric ischemia in gastrointestinal mucormycosis. Cir Esp 2023; 101:570. [PMID: 35675894 PMCID: PMC9212934 DOI: 10.1016/j.cireng.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Alba Torroella Vallejo
- Servicio de Cirugía General y Digestiva, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
| | - Víctor Turrado-Rodríguez
- Servicio de Cirugía Gastrointestinal, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Xavier Morales Sevillano
- Servicio de Cirugía Gastrointestinal, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
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30
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Yanagawa Y, Muramatsu KI, Abe M, Miyazaki Y. A Fatal Rhizopus Species Infection after Facial Injury in a Patient with Myelodysplastic Syndrome and Diabetes Mellitus. Intern Med 2023; 62:2279-2283. [PMID: 37532516 PMCID: PMC10465287 DOI: 10.2169/internalmedicine.0741-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 08/04/2023] Open
Abstract
A 73-year-old woman with myelodysplastic syndrome and diabetes mellitus, chronic renal failure and paroxysmal atrial fibrillation, received a diagnosis of facial cellulitis and was treated by antibiotics. However, her symptoms deteriorated. Facial magnetic resonance imaging (MRI) showed orbital cellulitis. She had weakness of visual acuity requiring changing the antibiotics. She also underwent steroid pulse treatment. Her symptoms temporarily improved, but she became comatose and died. Results of a molecular analysis of the residual cerebrospinal fluid indicated Rhizopus species infection. For immunocompromised hosts with refractory orbital cellulitis, mucormycosis should be considered as a differential diagnosis, and appropriate treatment should be promptly performed.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Masahiro Abe
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
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31
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Zhang L, Zhong DX, Yue M, Xuan LT, Zhang ZX, Li JJ, Li JH, Zou JZ, Yan YC, Liu R. [Clinical analysis of six cases of mucormycosis in children with acute leukemia]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:594-597. [PMID: 37749043 PMCID: PMC10509617 DOI: 10.3760/cma.j.issn.0253-2727.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 09/27/2023]
Affiliation(s)
- L Zhang
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - D X Zhong
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - M Yue
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - L T Xuan
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Z X Zhang
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J J Li
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J H Li
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J Z Zou
- Department of Pathology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y C Yan
- Department of Imaging, Capital Institute of Pediatrics, Beijing 100020, China
| | - R Liu
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
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32
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Kulkarni P, Beeraka D, Tanwar M, Kim U, Ganesan RM, Saini P. Frontal osteomyelitis post-COVID-19 associated mucormycosis. Indian J Ophthalmol 2023; 71:2906-2910. [PMID: 37417145 PMCID: PMC10491079 DOI: 10.4103/ijo.ijo_3117_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Rhino-orbito-cerebral mucormycosis (ROCM) is the most commonly noted form of mucormycosis, which is the most common secondary fungal infection following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Osteomyelitis is one of the rare sequelae of ROCM, frontal osteomyelitis being the rarest. We present four patients of coronavirus disease 2019 (COVID-19)-associated mucormycosis, who presented with frontal bone osteomyelitis after being treated for ROCM surgically and medically. This is the first case series highlighting this complication in post-COVID-19 mucormycosis patients and needs utmost attention as it can be life-threatening and can cause extreme facial disfiguration. All four patients are alive with salvage of the affected globe and vision being preserved in one patient. If identified early, disfiguration of face and intracranial extension can be avoided.
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Affiliation(s)
- Pooja Kulkarni
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Deepika Beeraka
- Ophthalmology Resident, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Meghana Tanwar
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Usha Kim
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Pragya Saini
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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33
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Kamath GM, Jeganathan S, Salim S, Antony RM, Kamath AR, Hiran H. Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol 2023; 71:2904-2906. [PMID: 37417144 PMCID: PMC10491029 DOI: 10.4103/ijo.ijo_3123_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/18/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.
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Affiliation(s)
- Gurudutt M Kamath
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sangeetha Jeganathan
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sreelakshmi Salim
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Reeja Mariam Antony
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay R Kamath
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Harshitha Hiran
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Arora P, Bais S, Singha SK. Right lower lobectomy in a post-renal transplant patient with covid associated mucormycosis and a mycotic aneurysm in the pulmonary circulation. Ann Card Anaesth 2023; 26:353-355. [PMID: 37470541 PMCID: PMC10451122 DOI: 10.4103/aca.aca_118_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
- Prateek Arora
- Department of Anesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Shruti Bais
- Department of Anesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subrata Kumar Singha
- Department of Anesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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35
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Marco DN, González-Muñoz B, Doti PI. Gastric mucormycosis presenting as fever of unknown origin in an immunocompetent host after heatstroke. Pol Arch Intern Med 2023; 133:16513. [PMID: 37351591 DOI: 10.20452/pamw.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Daniel N Marco
- Intensive Care Unit, Department of Internal Medicine, ICMID, Hospital Clínic Barcelona, Barcelona, Spain.
| | | | - Pamela-Inés Doti
- Intensive Care Unit, Department of Internal Medicine, ICMID, Hospital Clínic Barcelona, Barcelona, Spain
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36
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Liu Y, Xu J, Wang C, Lu B, Liang C, Hou G, Cui X, Cao B. Pulmonary Mucormycosis with Rib Involvement in an Immunocompromised Patient. Am J Respir Crit Care Med 2023; 207:1393-1394. [PMID: 36625734 PMCID: PMC10595448 DOI: 10.1164/rccm.202207-1290im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Yan Liu
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
- Department of Infectious Diseases, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jiuyang Xu
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
| | - Chunlei Wang
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
| | - Binghuai Lu
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
| | - Chaoyang Liang
- Department of Thoracic Surgery, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
| | - Xiaojing Cui
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine and
- National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China; and
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Narayanaswamy S, Goradia R, Bellurkar A, Patwardhan S. Isolated renal mucormycosis masquerading as emphysematous pyelonephritis. BMJ Case Rep 2023; 16:16/3/e254501. [PMID: 36931688 PMCID: PMC10030557 DOI: 10.1136/bcr-2022-254501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Mucormycosis is an acute, life-threatening infection and isolated renal involvement is rare. Due to the angioinvasive nature of the disease, it is rapidly progressive and can be lethal if not managed expeditiously. In patients with underlying conditions of immunosuppression, diabetes mellitus, transplantation, COVID-19, intravenous drug and substance use and pyelonephritis, which is unable to be controlled via regular antibiotics, mucormycosis must be considered on the differential and antifungals must be empirically started. Most cases are often diagnosed on histopathology, which causes delayed treatment and resolution. We present a case of emphysematous pyelonephritis diagnosed on imaging and was later found to have mucormycosis on histopathological examination.
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Affiliation(s)
| | - Rajvi Goradia
- Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amit Bellurkar
- Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sujata Patwardhan
- Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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38
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Loubet D, Sarton B, Lelièvre L, Grouteau G, Iriart X, Chauvin P, Fillaux J, Valentin A, Berry A, Silva S, Bonneville F, Cassaing S, Guemas E. Fatal mucormycosis and aspergillosis coinfection associated with haemophagocytic lymphohistiocytosis: A case report and literature review. J Mycol Med 2023; 33:101325. [PMID: 36270214 DOI: 10.1016/j.mycmed.2022.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
Invasive mould infections are life-threatening and mainly occur in immunocompromised patients. Whereas aspergillosis is described during haemophagocytic lymphohistiocytosis (HLH), only a few cases of concomitant mucormycosis with HLH have been reported. Here, we present an uncommon coinfection of mucormycosis and aspergillosis associated with HLH probably due to a varicella zoster virus (VZV) viraemia which was unresponsive to triple antifungal therapy (liposomal amphotericin B combined with isavuconazole and caspofungin). A review of the cases of mucormycosis with HLH showed that this uncommon association was always lethal and underscored the relevance of screening for mould infections in patients with HLH.
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Affiliation(s)
- Dorian Loubet
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France
| | - Benjamine Sarton
- Critical Care Unit, University Hospital of Purpan, Toulouse, France; Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
| | - Lucie Lelièvre
- Department of Infectious and Tropical Diseases, CHU Toulouse, Toulouse, France
| | - Gaspard Grouteau
- Department of Infectious and Tropical Diseases, CHU Toulouse, Toulouse, France
| | - Xavier Iriart
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse, CNRS UMR5051, INSERM UMR1291, UPS, Toulouse, France
| | - Pamela Chauvin
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France
| | - Judith Fillaux
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France
| | - Alexis Valentin
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France; PHARMA-Dev, UMR 152 IRD-UPS, Université Toulouse, France
| | - Antoine Berry
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse, CNRS UMR5051, INSERM UMR1291, UPS, Toulouse, France
| | - Stein Silva
- Critical Care Unit, University Hospital of Purpan, Toulouse, France; Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
| | - Fabrice Bonneville
- Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France
| | - Sophie Cassaing
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France; RESTORE Institute, UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Emilie Guemas
- Department of Parasitology and Mycology, CHU Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse, CNRS UMR5051, INSERM UMR1291, UPS, Toulouse, France.
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Ren J, Yang F, Su Y, Wang H, Luo S. Skin mucormycosis secondary to herpes zoster in a patient with diabetic ketoacidosis. Eur J Dermatol 2023; 33:49-51. [PMID: 37178036 DOI: 10.1684/ejd.2023.4415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Camhi D, López MI, Wiener A, Heinriksen K, Pérez I, Verdugo F, Rosas R, Farías P. [Invasive mucormycosis during COVID-19 infection. Report of two cases]. Rev Med Chil 2023; 151:125-128. [PMID: 37906754 DOI: 10.4067/s0034-98872023000100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/30/2023] [Indexed: 11/02/2023]
Abstract
COVID-19 disease is associated with a significant number of opportunistic infections, including invasive fungal infections such as mucormycosis. The prevalence of the latter is rare, estimated to be between 0.005 and 1.7 per million inhabitants. Risk factors include hematological diseases, Diabetes Mellitus with poor metabolic control, solid organ transplantation, neutropenia, and prolonged administration of systemic corticosteroids. We report two males aged 60 and 75 years with pulmonary and tracheobronchial invasive mucormycosis, respectively. Both patients had a deficient metabolic control of their diabetes as a predisposing risk factor added to severe COVID-19 infection. High suspicion and early diagnosis are essential for prompt treatment, especially considering the associated high morbidity and mortality of this fungal infection.
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Affiliation(s)
- Dana Camhi
- Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | | | - Alan Wiener
- Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | | | - Ignacio Pérez
- Facultad de Medicina, Universidad de los Andes, Santiago, Chile
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Gálvez-Romero JL, Perea-Peña A, Huerta-Jurado P, Parra-Salazar MA, Tepalcingo-Aguilar LM, Ramírez-Sandoval MP, Gijón-Mitre R, Navarro-Alvarado R, Hernández-Moreno LL, Barradas-Arroyo D, Coronado-Cervántes B, Rodríguez-Serrano JA, Baños-Lara MDR. Rhino-orbital mucormycosis in a Mexican patient with COVID-19: Case report. Rev Alerg Mex 2023; 69:93-97. [PMID: 36928250 DOI: 10.29262/ram.v69i2.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. CASE REPORT We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien ́s progression was satisfactory. CONCLUSIONS pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.
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Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila) 2023; 12:16-20. [PMID: 36706330 DOI: 10.1097/apo.0000000000000593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The aim was to evaluate patient profiles of rhino-orbital-cerebral mucormycosis (ROCM) cases with central retinal artery occlusion (CRAO) postcoronavirus disease 2019. DESIGN A nonrandomized retrospective case-control study. METHODS The ROCM cases presenting with CRAO were compared with a control ROCM group without CRAO at a tertiary care center. Demography, systemic status, clinical features, histopathology, imaging, and blood profile were assessed for any specific risk factors. RESULTS A total of 12 patients were seen in the CRAO group and 16 in the non-CRAO group. The male-to-female ratio was 3:1 with a mean age of 49.5 years. In the CRAO group, 75% had diabetes mellitus with mean hemoglobin A1c of 9.03%, and 66.7% had received steroid treatment. All cases were histopathologically confirmed positive for mucor. There was a significant difference in mean D-dimer and serum ferritin between the 2 groups, with higher level in the CRAO group. All patients with CRAO had light perception-negative vision, with total ophthalmoplegia and proptosis seen in 66.7% of cases. Four patients had orbital apex involvement, 5 had cavernous sinus involvement, and 8 had intracranial involvement in the CRAO group. CONCLUSIONS Inflammatory markers D-dimer and serum ferritin were significantly associated with CRAO, suggestive of hyperinflammatory and hypercoagulable state. A high index of suspicion should be maintained in cases with elevated markers and prophylactic anticoagulants can be started to prevent CRAO in a subset of patients.
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Affiliation(s)
- Manjari Tandon
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Moorthy A, Nayak T, Bachalli PS, Tripathi KK, Dutt SN, Kale P, Bhat P, Suresh PK, Gaikwad R, Raju A, Krishna S, Conjeevaram A, Mehta S, Anil-Kumar A, Haldipur D. COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes. Eur Arch Otorhinolaryngol 2023; 280:713-721. [PMID: 35849188 PMCID: PMC9289352 DOI: 10.1007/s00405-022-07544-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/05/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aditya Moorthy
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
- Apollo Hospitals, Bengaluru, Karnataka, India
| | - Tulasi Nayak
- Trustwell Hospitals, Bengaluru, Karnataka, India.
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India.
| | - Prithvi S Bachalli
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
- Apollo Hospitals, Bengaluru, Karnataka, India
| | | | | | - Preeti Kale
- Trustwell Hospitals, Bengaluru, Karnataka, India
| | - Prashanth Bhat
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Praveen K Suresh
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Rohith Gaikwad
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Arjun Raju
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Medall Diagnostics, Bengaluru, India
| | - Shreya Krishna
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | | | - Sushma Mehta
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Abhinav Anil-Kumar
- Trustwell Hospitals, Bengaluru, Karnataka, India
- Rangadore Memorial Hospital, Bengaluru, Karnataka, India
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Rashid M, Rajan AK, Thunga G, Shanbhag V, Nair S. Impact of Diabetes in COVID-19 Associated Mucormycosis and its Management: A Non-Systematic Literature Review. Curr Diabetes Rev 2023; 19:1-10. [PMID: 35209828 DOI: 10.2174/1573399818666220224123525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND COVID-19 has become extremely dangerous manifesting itself in a variety of forms ranging from a simple flu-like illness to death. COVID-19 associated mucormycosis (CAM) is a global threat with diabetes being a major contributor. OBJECTIVE This review aims to give a clear picture of the impact of hyperglycemia in CAM along with its management. METHODS Google and Google Scholar were searched and studies that addressed the impact of diabetes in CAM were considered for this review. We also performed a bibliographic search of the specific article to find additional studies. RESULTS A series of events such as unregulated activation of innate immune system modification, pro-inflammatory M1 macrophages activation, and the depletion of natural killer cell activity is very common in patients with COVID-19. In addition, the exacerbated cytokine syndrome and hyperinflammatory response may elevate the severity of this condition, which further leads to higher mortality. The impaired immune phase which follows provide the niche for increased infection among diabetic patients making them more prone towards developing mucormycosis and associated infections. Early detection, surgical debridement, and appropriate medical treatment with antifungals and hypoglycaemic agents may help control the infection and associated morbidity and mortality. COVID-19 drugs, hypoglycaemic agents, antifungals, and comorbidities have all been associated with adverse side effects and drug interactions. CONCLUSION Clinicians should be well aware of this deadly disease and manage COVID-19, diabetes, and mucormycosis through individualized treatment regimens to improve patient outcomes.
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Affiliation(s)
- Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, India
| | - Asha K Rajan
- Department of Pharmacy Practice, Jaya College of Pharmacy, Thiruninravur, Chennai, Tamil Nadu-602024, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal-576104, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, India
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Nishino M, Mizuno H, Yamada K, Kamiyamamoto S, Saito K. [Small intestinal mucormycosis associated with acute myeloid leukemia: a case report]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:920-926. [PMID: 37952967 DOI: 10.11405/nisshoshi.120.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The patient was a man in his 70s. During the treatment for acute myeloid leukemia, abdominal pain and bloody stools appeared. A diagnosis of small intestinal ileus was made by computed tomography scan. Treatment with an ileus tube did not improve his condition, and enteroscopy revealed the presence of ileal ulcers. Based on histological examination, small intestinal mucormycosis was suspected, and thus, antifungal drugs were administered. However, the patient developed perforated peritonitis and underwent small intestine resection. He was finally diagnosed with small intestinal mucormycosis with the help of the resected specimen. The gastrointestinal form of mucormycosis rarely occurs, and small intestinal lesions are very rare. Enteroscopy was helpful in its diagnosis and treatment.
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Affiliation(s)
| | - Hideki Mizuno
- Department of Gastroenterology, Toyama City Hospital
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Dogra P, Singla N, Kaushik R, Singh S, Gupta V. Primary Cutaneous Mucormycosis: A Necrotising Soft Tissue Infection with Poor Prognosis. Infect Disord Drug Targets 2023; 23:e040523216523. [PMID: 37150984 DOI: 10.2174/1871526523666230504114801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cutaneous mucormycosis is an unusual fungal infection that continues to occur. It needs aggressive surgical debridement and timely administration of antifungals due to its high fatality rate. High clinical suspicion on the part of a surgeon is required to prevent the same. CASE PRESENTATION We present two cases of cutaneous mucormycosis in which the patients succumbed to death, highlighting the seriousness of the condition. One patient had a lower leg ulcer and was diabetic, and the other patient had a gluteal abscess following an intramuscular injection. Tissue samples grew Rhizopus arrhizus and Apophysomyces sp., respectively. Both patients were treated with amphotericin B, and extensive debridement was performed. DISCUSSION Cutaneous mucormycosis can be reported in immunocompetent people, and there is a need for early recognition of the entity as a differential diagnosis of any nonhealing necrotic ulcer. CONCLUSION Proper training and education of technical and clinical staff should be done at peripheral primary and secondary care centres so as not to miss out on cases of mucormycosis and for better prognosis in a cutaneous variety of mucormycosis in surgical patients.
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Affiliation(s)
- Poornima Dogra
- Department of General Surgery, Government Medical College and Hospital, Sector 32 Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College and Hospital, Sector 32 Chandigarh, India
| | - Robin Kaushik
- Department of General Surgery, Government Medical College and Hospital, Sector 32 Chandigarh, India
| | - Simrandeep Singh
- Department of General Surgery, Government Medical College and Hospital, Sector 32 Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector 32 Chandigarh, India
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Ghonge NP, Nagpal K, Malla S. 'Black turbinates' in COVID-associated sino-nasal mucormycosis. QJM 2022; 115:851-852. [PMID: 35959989 DOI: 10.1093/qjmed/hcac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- N P Ghonge
- Radiology, Indraprastha Apollo Hospital, New Delhi 75911, India
| | - K Nagpal
- ENT, Indraprastha Apollo Hospital, New Delhi 75911, India
| | - S Malla
- Radiology, Indraprastha Apollo Hospital, New Delhi 75911, India
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Sedaghatalab M, Nouripour-Sisakht S, Cheraghzadeh SR, Sabz G, Gharaghani M. Rhizopus microsporus as Causative Agent of Mucormycosis in COVID-19 Patient. Clin Lab 2022; 68. [PMID: 36546751 DOI: 10.7754/clin.lab.2022.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The pandemic of coronavirus disease (COVID-19) emerged as a fatal infection, especially in immunocompromised patients. Currently, this infection is managed with systemic corticosteroids. Co-infection of CO-VID-19 with opportunistic fungi is increasingly recognized. METHODS We describe a case of rhino-cerebral mucormycosis 12 days following severe COVID-19 in a diabetic patient. RESULTS He received 50 mg amphotericin B and surgical debridement. The patient's symptoms improved following medical and surgical intervention. CONCLUSIONS Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis.
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Erami M, Mirhendi H, Momen-Heravi M, Hezaveh SJH, Ahsaniarani AH, Sabet SS, Aboutalebian S. A case of COVID-19-associated rhino-orbito-cerebral mucormycosis caused by Apophysomyces variabilis with a review of the literature. Front Cell Infect Microbiol 2022; 12:898477. [PMID: 36310874 PMCID: PMC9615570 DOI: 10.3389/fcimb.2022.898477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
A fatal case of COVID-19-associated mucormycosis (CAM) affected a 40-year-old woman who was initially admitted to our hospital due to a SARS-CoV-2 infection. Her clinical condition worsened, and she finally died because of respiratory failure, hemodynamic instability, and mucormycosis with invasion into the orbit and probably the brain. According to DNA sequence analysis of the fungus isolated from the patient, Apophysomyces variabilis was involved. This is the first published case of CAM and the third case of mucormycosis due to this mold.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Infectious Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Ahsaniarani
- Department Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Seddighe Sadat Sabet
- Department of Pharmaceutical, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Shima Aboutalebian,
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Mahmood F, Mahmood MU, Riaz A. Another Addition To The Covid-19 Associated Complications-Mucormycosis. J Ayub Med Coll Abbottabad 2022; 34:872-873. [PMID: 36566417 DOI: 10.55519/jamc-04-9871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
New manifestations of coronavirus disease are appearing over time. The association between coronavirus and mucormycosis must be given serious consideration. Without early diagnosis and treatment, there may be rapid progression of the disease, with high mortality from complications. We present a case of a 40-year-old male who presented with rhino-orbital-cerebral mucormycosis and COVID-19 infection. With this case, we highlight the importance of considering mycotic coinfection in COVID-19 patients with diabetes and the significance of its early diagnosis and treatment.
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Affiliation(s)
- Fizza Mahmood
- Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | | | - Aniqa Riaz
- Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan
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