Clinicopathological Study of Mucormycosis in COVID-19 Patients: Experience From a Tertiary Care Center in South India

Kandasamy, Sangeetha; Muthuraju, Srinivas; Vasugi, Arumugam; Chandrasekar, Megala; Murugan, Roopmala; Inbasekaran, Poovizhi; Prabu, R

doi:10.7759/cureus.23016

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…and Candida sp.) in eight (14%) cases, which was higher than the present study (4.44%) [19] In the study of Anuja et al, KOH mount was positive for fungal elements in 62 patients and fungi isolated in 37 patients, out of total 90 patients of invasive fungal sinusitis. Aspergillus group and Mucorales contribute equally being found in 17 samples each [20], whereas Mucorales exceeded Aspergillus group in the present study.…”

Section: Bharathi Et Alcontrasting

confidence: 68%

Mucor Mycosis and Other Fungal Infections in Covid-19 Patients During Second Wave of Pandemic at a Tertiary Care Hospital

2023

Asian J Pharm Clin Res

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Objectives: In India, there has been a sudden Surge in Mucor mycosis cases during second wave of COVID-19, made the Government of India declare it as a notifiable disease. In this background, we did a study to know the fungal etiology of the suspected Mucor mycosis cases and to know the positivity rate of Mucor mycosis in COVID-19 patients during the second wave of the COVID-19 pandemic. Methods: In a retrospective study, we examined different samples from 112 Covid-19 positive, in-patients with suspected Mucor mycosis. A history of risk factors was taken. Potassium hydroxide (KOH) mount was done for all samples followed by culture on Sabouraud’s dextrose agar. Results: 81.25% of total cases were from 31 to 60 years of age group. Diabetes mellitus, steroid therapy, and Intensive care unit admissions were the risk factors observed. Fungal filaments were observed in 37 samples in KOH mount (33%) and culture was positive in 45 samples (40.17%). Mixed infection was seen in two cases (4.44%). The most common fungus isolated was Mucor in 23 samples (48.93%) followed by Aspergillus in 7 cases (14.89%; Aspergillus niger in four cases, Aspergillus fumigatus in 2 cases and Aspergillus flavus in 1 case) and Candida spp in 6 cases (12.76%). Among mixed infections, Mucor and A. niger in one case and Candida and A. niger in another case were isolated. Rhyzopus, Syncephalastrum, Penicillium, and Fusarium were the other fungi isolated. Conclusion: Mucorales were the most common species isolated (63.82%) followed by Aspergillus species. High suspicion and diagnosis of Mucor mycosis in Covid-19 patients is very important to initiate antifungal treatment, to reduce the mortality.

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Section: Bharathi Et Alcontrasting

confidence: 68%

Mucor Mycosis and Other Fungal Infections in Covid-19 Patients During Second Wave of Pandemic at a Tertiary Care Hospital

2023

Asian J Pharm Clin Res

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“…By June 7, 2021, around 28 252 cases of mucormycosis had been recorded by the Indian Health Ministry. 68 Since then, cases have been reported in South America, Mexico, the USA, the UK, Iran, and parts of Europe. 69–75 Thus, it has become a global threat.…”

Section: Discussionmentioning

confidence: 99%

“… 85 Most patients required radical debridement of the sinuses, resulting in significant facial disfigurement. 68 , 86 , 87 Mortality was high, up to 100% in non-prevalent countries, due to delays in recognition and diagnosis and the limited resources available during the COVID-19 pandemic. 88–90 Indeed, CAM has highlighted the current lack of knowledge about mucormycosis (in general).…”

Section: Discussionmentioning

confidence: 99%

Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens

Morrissey,

Kim,

Garnham

et al. 2024

Medical Mycology

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The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal priority pathogens list (FPPL). This systematic review aimed to evaluate the epidemiology and impact of invasive fungal disease due to Mucorales. PubMed and Web of Science were searched to identify studies published between January 1, 2011 and February 23, 2021. Studies reporting on mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence during the study time frames were selected. Overall, 24 studies were included. Mortality rates of up to 80% were reported. Antifungal susceptibility varied across agents and species, with the minimum inhibitory concentrations lowest for amphotericin B and posaconazole. Diabetes mellitus was a common risk factor, detected in 65%–85% of patients with mucormycosis, particularly in those with rhino-orbital disease (86.9%). Break-through infection was detected in 13.6%–100% on azole or echinocandin antifungal prophylaxis. The reported prevalence rates were variable, with some studies reporting stable rates in the USA of 0.094–0.117/10 000 discharges between 2011 and 2014, whereas others reported an increase in Iran from 16.8% to 24% between 2011 and 2015. Carefully designed global surveillance studies, linking laboratory and clinical data, are required to develop clinical breakpoints to guide antifungal therapy and determine accurate estimates of complications and sequelae, annual incidence, trends, and global distribution. These data will provide robust estimates of disease burden to refine interventions and better inform future FPPL.

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“…Mucormycosis may also be associated with nosocomial sources, especially during prolonged hospitalization [46]. Non-sterile equipment in hospitals is the main disseminator of infections among immunocompromised patients.…”

Section: Nosocomial Sourcesmentioning

confidence: 99%

Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives

Madhavan

Sai

Shanmugam

et al. 2022

JCM

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Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.

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Clinicopathological Study of Mucormycosis in COVID-19 Patients: Experience From a Tertiary Care Center in South India

Cited by 9 publications

References 28 publications

Mucor Mycosis and Other Fungal Infections in Covid-19 Patients During Second Wave of Pandemic at a Tertiary Care Hospital

Mucor Mycosis and Other Fungal Infections in Covid-19 Patients During Second Wave of Pandemic at a Tertiary Care Hospital

Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens

Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives

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