A Fatal Case of Rhizopus azygosporus Pneumonia Following COVID-19

Kanwar, Anubhav; Jordan, Alex; Olewiler, Scott; Wehberg, Kurt E.; Cortés, Michael; Jackson, Brendan R

doi:10.3390/jof7030174

Cited by 61 publications

(61 citation statements)

References 17 publications

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“…Researchers recommended severe COVID-19 should be considered as a risk factor for invasive fungal infections, particularly those who receive immunosuppressive medications like steroids and IL-6 inhibitors (tocilizumab). Because there are no non-invasive tests available for invasive fungal infections, researchers believe cases of mucormycosis cases may be higher in numbers than what is reported 49 .…”

Section: Discussionmentioning

confidence: 88%

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Bhatt

Agolli

Patel

et al. 2021

Discoveries (Craiova)

123

121

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Severe COVID-19 disease is associated with an increase in pro-inflammatory markers, such as IL-1, IL-6, and tumor necrosis alpha, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells, which increase the susceptibility to bacterial and fungal infections. One such opportunistic fungal infection is mucormycosis. Initially, it was debated whether a person taking immunosuppressants, such as corticosteroids, and monoclonal antibodies will be at higher risk for COVID-19 or whether the immunosuppresive state would cause a more severe COVID-19 disease. However, immunosuppressants are currently continued unless the patients are at greater risk of severe COVID-19 infection or are on high-dose corticosteroids therapy. As understood so far, COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. It is also noted that 85% of the COVID-19 patients’ laboratory findings showed lymphopenia. This means that patients with severe COVID-19 have markedly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells and, since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. This report is intended to raise awareness of the importance of early detection and treatment of mucormycosis and other fungal diseases, such as candidiasis, SARS-CoV-2-associated pulmonary aspergillosis, pneumocystis pneumonia and cryptococcal disease, in COVID-19 patients, to reduce the risk of mortality.

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Section: Discussionmentioning

confidence: 88%

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Bhatt

Agolli

Patel

et al. 2021

Discoveries (Craiova)

123

121

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“…Lungs observed with Rhizopus microsporus COVID-19 ARDS with acute myeloid leukemia was observed with mucormycosis in postmortem Zurl et al (2021) 66-year-old male Diabetes mellitus – KOH mount – COVID-19 with ophthalmoplegia. Rhino-orbital cellulitis with ischemia This was the first study with orbital infarction syndrome in COVID-19 patient Rao et al, 2021 56-year-old man Renal disease fatigue and shortness of breath Chest X-ray RT-PCR GMS and pleural fluid culture CT scan MALDI-TOF methylprednisolone and tocilizumab COVID-19 with mucormycosis Higher mortality rate in COVID-19 with mucormycosis Kanwar et al (2021) 31 patients Different diseases COVID-19 symptoms Pathological examination – Mucormycosis found in 1 patient Reconstruction of head and neck during COVID-19 pandemic Rashid et al, 2021 18 patients 16 patients were diabetic facial cellulitis, maxillary sinusitis, headache, necrosis of palatal bone/mucosa or acute loss of vision MRI and CT scans KOH mount voriconazole, posaconazole Maxillofacial and rhino-cerebro-orbital fungal infections Significant increase of angioinvasive maxillofacial fungal infections in diabetic patients with COVID-19 Moorthy et al (2021) 55-year-old man follicular lymphoma Inflammatory response RT-P...…”

Section: Possible Role Of Action Of Mucormycosis Among Covid-19 Patientsmentioning

confidence: 99%

“…It is extremely important for the doctors treating patients with COVID-19 to be mindful of patients with underlying illnesses and prescribed steroids or immunosuppressants ( Sarkar et al, 2021 ). Despite the tremendous burden on the healthcare system due to the overwhelming increase in cases, more vigilance is required in utilizing preventive measures for this condition ( Kanwar et al, 2021 ). Also, it is important to periodically check the air in the hospital wards and the oxygen therapy machinery for spores ( Suryanarayanan and Shaanker, 2021 ).…”

Section: Covid-19 and Mucormycosis: A Tangled Relationmentioning

confidence: 99%

Mucormycosis: An opportunistic pathogen during COVID-19

Iyer¹,

Jayaramayya

Venkatesan

et al. 2021

Environmental Research

128

122

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The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second wave of this disease has led to panic in many countries, including India and some parts of the world suffering from the third wave. As there are no proper treatment options or remedies available for this deadly infection, supportive care equipment's such as oxygen cylinders, ventilators and heavy use of steroids play a vital role in the management of COVID-19. In the midst of this pandemic, the COVID-19 patients are acquiring secondary infections such as mucormycosis also known as black fungus disease. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid high rate of mortality and morbidity rates. Mucormycosis is caused by the inhalation of its filamentous (hyphal form) fungi especially in the patients who are immunosuppressed. Recent studies have documented alarming number of COVID-19 patients with mucormycosis infection. Most of these patients had diabetes and were administered steroids for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and were consequently more prone to mucormycosis. Hence, the present review emphasizes mucormycosis and its related conditions, its mechanism in normal and COVID-19 affected individuals, influencing factors and challenges to overcome this black mold infection. Early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in COVID-19 affected patients.

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“…The increasing number of recent case series of mucormycosis complicating COVID-19 patients in the United States, 10 – 16 Austria, 17 Brazil, 18 Mexico, 19 Italy, 20 France, 21 Iran, 22 – 24 and India, 25 – 34 raises concerns regarding the misuse of immunosuppressive drugs in patients with COVID-19. Mucormycosis is a neglected mycosis that should be considered in the context of patients with COVID-19, in the same way as COVID-19 associated pulmonary aspergillosis, and it is possibly underreported.…”

mentioning

confidence: 99%

“…Classically, uncontrolled diabetes mellitus, neutropenia, and corticosteroid therapy are known risk factors for mucormycosis. 22 , 37 There is an urgent need to reconsider the careful use of these drugs in patients with severe COVID-19 due to the high prevalence of underlying comorbidities in these patients, 11 – 13 , 25 , 28 – 30 including diabetes mellitus, 13 , 16 , 19 , 26 , 28 – 30 hematological malignancies (i.e. acute myeloid leukemia), 17 end-stage kidney disease, 27 and organ transplant recipients.…”

mentioning

confidence: 99%