COVID-19 and mucormycosis superinfection: Exploring the missing pathophysiological links

Almas, Talal; Nazar, Waqas; Khedro, Tarek; Kanawati, M. Ali; Adnan, Alishba; Almuhaileej, Mohammad; Alshamlan, Abdulaziz; Abdulhadi, Abdulaziz; Manamperi, Kuvira T.; Sarfraz, Saba

doi:10.1016/j.amsu.2021.102655

Cited by 6 publications

(8 citation statements)

References 17 publications

(17 reference statements)

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“…Also, there is evidence of immune impairment due to COVID-19 infection preventing the polymorphonuclear phagocytes from attacking the fungal spores upon entry. 8 Mucormycosis is caused by a group of moulds belonging to the Mucoromycotina subphylum and order Mucorales. 9 These organisms are present in various parts of the environment but mainly found in soil, decayed food products, and plants.…”

Section: Discussionmentioning

confidence: 99%

Unravelling features in post COVID mucormycosis: case series with review of literature

Amaran

Puranik

et al. 2022

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">In the midst of the severe acute respiratory syndrome coronavirus 2 (SARS COV-2) pandemic, the victims are acquiring secondary infections like mucormycosis. Rhinocerebral mucormycosis (ROCM), is the most prevalent form and is an invasive, opportunistic fungal infection that typically affects immunocompromised patients. It exhibits a pronounced propensity to invade blood arteries, resulting in tissue thrombosis, necrosis, and infarction. Early conventional and advanced medical imaging like computed tomography (CT) and magnetic resonance imaging (MRI) is helpful in assessing the extent of involvement of this lethal disease which requires prompt and aggressive treatment. Despite of aggressive therapy, which includes disfiguring surgical debridement and frequently adjunctive toxic antifungal therapy, the overall mortality rate is high. The prime objective of present study focuses upon, unravelling the aberrant imaging presentations along with the detailed discussion about existing common features. The current study presents, a case series of 15 patients of rhino-orbital-cerebral mucormycosis (ROCM) including clinical data; common radiographic features like sinusitis, bony erosions, and soft tissue involvement also there were few uncommon features illustrated while evaluating the radiographic imaging. All patients underwent chair side and histopathological investigations. Appropriate treatment modalities were enrolled followed by rehabilitation of the defects after a thorough follow-up over an interval of 6 months. A thorough examination of the imaging findings is necessary since the aggressive nature of the infection can involve any parts of head and neck region illustrating few rare presentations involving uncommon sites. Radiologists must be aware of these unravelling radiographic features to know the precise extension of the infection.</p><p> </p>

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Section: Discussionmentioning

confidence: 99%

Unravelling features in post COVID mucormycosis: case series with review of literature

Amaran

Puranik

et al. 2022

Int J Otorhinolaryngol Head Neck Surg

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“…TMPRSS-2 along with ACE2 receptors has a tendency to attack lymphocytes, thus reducing CD4 + and CD8 + T-cell counts, resulting in a weaker immunity, also inducing lymphopenia. The reduction in the T-cell number consequently increases interleukin levels and effectively achieves the state of the cytokine storm (48). The cytokine storm weakens the defence system reserve pool, causes the atrophy of lymphoid tissue, and prevents the further production, differentiation and proliferation of protective lymphocytes.…”

Section: Aetiology and Pathophysiology Of The Fungusmentioning

confidence: 99%

An emergence of mucormycosis during the COVID‑19 pandemic (Review)

Gayathri,

Soundarya

2024

World Acad Sci J

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Mucormycosis was highly prevalent during the coronavirus disease 2019 pandemic, particularly during the second wave, causing increased health risks to immunosuppressed or compromised individuals. This infection is long-standing, lasting for years, specifically in immunocompromised individuals. There are no apparent risk factors and the fungus affects skin/subcutaneous tissues, resulting in the loss of facial aesthetics. In addition, individuals with a hyperglycaemic condition or diabetes mellitus, the fungus can lead to more severe complications, which are often fatal. While in patients with diabetic ketoacidosis, a high risk of infection with Rhizopus oryzae is observed, with the production of ketoreductase; this enzyme in turn hydrolyses host ketone bodies. Relatively effective medications are becoming available; however, the prognosis of patients affected by this fungus may improve with an increase in awareness and early diagnosis with the intervention of expert surgeons, radiologists and microbiologists to effectively combat the condition. The present review discusses the types, symptoms and available treatment strategies for mucormycosis.

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“…Overall, these results show significant associations of higher serum PCT concentrations with both MV and in-hospital fatality. COVID-19 patients with weakened immunity are also particularly vulnerable to bacterial and fungal superinfections [64][65][66][67][68][69][70]. Also, bacterial infections can result from the use of mechanical ventilators, which are commonly used to treat severe respiratory failure in patients with COVID- 19 [65, 71, 72].…”

Section: Plos Onementioning

confidence: 99%

Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity

et al. 2023

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The Coronavirus-19 disease (COVID-19) has claimed over 6.8 million lives since first being reported in late 2019. The virus that causes COVID-19 disease is highly contagious and spreads rapidly. To date, there are no approved prognostic tools that could predict why some patients develop severe or fatal disease outcomes. Early COVID-19 studies found an association between procalcitonin (PCT) and hospitalization or duration of mechanical ventilation and death but were limited by the cohort sizes. Therefore, this study was designed to confirm the associations of PCT with COVID-19 disease severity outcomes in a large cohort. For this retrospective data analysis study, 27,154 COVID-19-positive US veterans with post-infection PCT laboratory test data and their disease severity outcomes were accessed using the VA electronic healthcare data. Cox regression models were used to test the association between serum PCT levels and disease outcomes while controlling for demographics and relevant confounding variables. The models demonstrated increasing disease severity (ventilation and death) with increasing PCT levels. For PCT serum levels above 0.20 ng/ml, the unadjusted risk increased nearly 2.3-fold for mechanical ventilation (hazard ratio, HR, 2.26, 95%CI: 2.11–2.42) and in-hospital death (HR, 2.28, 95%CI: 2.16–2.41). Even when adjusted for demographics, diabetes, pneumonia, antibiotic use, white blood cell count, and serum C-reactive protein levels, the risks remained relatively high for mechanical ventilation (HR, 1.80, 95%CI: 1.67–1.94) and death (HR, 1.76, 95%CI: 1.66–1.87). These data suggest that higher PCT levels have independent associations with ventilation and in-hospital death in veterans with COVID-19 disease, validating previous findings. The data suggested that serum PCT level may be a promising prognostic tool for COVID-19 severity assessment and should be further evaluated in a prospective clinical trial.

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COVID-19 and mucormycosis superinfection: Exploring the missing pathophysiological links

Cited by 6 publications

References 17 publications

Unravelling features in post COVID mucormycosis: case series with review of literature

Unravelling features in post COVID mucormycosis: case series with review of literature

An emergence of mucormycosis during the COVID‑19 pandemic (Review)

Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity

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