A Comparative Analysis of Mucormycosis in Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes in the Southwest United States

Al-Obaidi, Mohanad; Youssefi, Babak; Bardwell, James; Bouzigard, Rory; Le, Christopher H.; Zangeneh, Tirdad T.

doi:10.1016/j.amjmed.2021.04.008

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…with significantly worse outcomes. 36,39,105,144,252 Patients with extrasinus extension to the orbit (33% mortality), skull base (50% mortality), cavernous sinus (HR of 2.7 at 1 month), and brain (100% mortality) appear to have worse survival, 3,5,41,49,173,211,253 yet only intracranial involvement was independently association with worse prognosis in the largest systematic review to date. 4…”

Section: Extent Of Disease Involvementmentioning

confidence: 99%

“…They demonstrated that patients with disease limited to the nasal cavity were more likely to have complete surgical resection and improved survival 6 . However, involvement of the nasal septum or bilateral disease have been associated with significantly worse outcomes 36,39,105,144,252 . Patients with extrasinus extension to the orbit (33% mortality), skull base (50% mortality), cavernous sinus (HR of 2.7 at 1 month), and brain (100% mortality) appear to have worse survival, 3,5,41,49,173,211,253 yet only intracranial involvement was independently association with worse prognosis in the largest systematic review to date 4 .…”

Section: Outcomes and Survivalmentioning

confidence: 99%

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Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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BackgroundAcute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.MethodsThe PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non‐sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.ResultsA review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.ConclusionBased on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.

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Section: Extent Of Disease Involvementmentioning

confidence: 99%

Section: Outcomes and Survivalmentioning

confidence: 99%

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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“…Before the COVID-19 era, mucormycosis is known for its poor prognosis, especially with delayed management may lead to a high mortality rate. There was no difference in the mortality between solid organ transplants and diabetes mellitus with a mortality of about 28%, (2/7 (28.57%) vs 5/18 (27.78%); p = 0.66 in patients with solid organ transplant and diabetes mellitus, respectively) [ 58 ]. However, another study showed higher mortality of 49% among diabetes mellitus patients compared to 30% among non-diabetic patients[ 58 ].…”

Section: Outcomes and Prognosismentioning

confidence: 99%

“…There was no difference in the mortality between solid organ transplants and diabetes mellitus with a mortality of about 28%, (2/7 (28.57%) vs 5/18 (27.78%); p = 0.66 in patients with solid organ transplant and diabetes mellitus, respectively) [ 58 ]. However, another study showed higher mortality of 49% among diabetes mellitus patients compared to 30% among non-diabetic patients[ 58 ]. Morbidity and mortality were linked to the invasive nature of the underlying disease[ 59 ].…”

Section: Outcomes and Prognosismentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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Background The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. Purpose In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. Results Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. Conclusion With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

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“…Increase in mucormycosis in Indian context appears to be an unholy intersection of trinity of diabetes (high prevalence genetically), rampant use of corticosteroid (increases blood glucose and opportunistic fungal infection) and COVID-19 (cytokine storm, lymphopenia, endothelial damage). [2] Any case of documented non-bacteriological sinusitis in diabetic patients, even without ketoacidosis, should prompt suspicion of a mucormycosis diagnosis. [3] Phycomycosis or zygomycosis was first described in 1885 by Paltauf and later coined as Mucormycosis in 1957 by Baker an American pathologist for an aggressive infection caused by Rhizopus.…”

Section: Introductionmentioning

confidence: 99%

Incidence and outcome of mucormycosis in diabetic patients with COVID-19

Melvindominic

Senthil

Sudhan

et al. 2022

ijhs

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Aims and objectives: Diabetes Mellitus predisposes patients to invasive fungal infections. Aim of this study is to find out the incidence and outcome of Mucormycosis in diabetic patients with COVID-19. Materials and Methodology: A Retrospective study of 150 patients with COVID-19 who were admitted in VMKVMCH COVID-19 Ward, Salem from May 2021 to July 2021 was included in the study. Results: Among 150 hospitalized patients with COVID 19 infection, 32 patients had CAM with an incidence of 3.36%. In patients with CAM, 87.5% had Diabetes Mellitus as the most common co-morbidity. The majority of the patients had poor glycemic control with a mean HbA1c of 9.06%. Out of the total study population, 93% had prior exposure to high dose corticosteroids. During the study period, 12.5% patients of CAM did not survive. Conclusion: Mucormycosis is an angioinvasive fungal infection with high mortality. The disease has surged in COVID 19 pandemic due to uncontrolled diabetes and improper corticosteroid use.

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A Comparative Analysis of Mucormycosis in Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes in the Southwest United States

Cited by 5 publications

References 30 publications

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

COVID-19 and mucormycosis superinfection: the perfect storm

Incidence and outcome of mucormycosis in diabetic patients with COVID-19

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