COVID-19 and mucormycosis superinfection: the perfect storm

Al‐Tawfiq, Jaffar A.; Alhumaid, Saad; Alshukairi, Abeer N.; Temsah, Mohamad-Hani; Barry, Mazin; Mutair, Abbas Al; Rabaan, Ali A.; Al-Omari, Awadh; Tirupathi, Raghavendra; AlQahtani, Manaf; AlBahrani, Salma; Dhama, Kuldeep

doi:10.1007/s15010-021-01670-1

Cited by 131 publications

(134 citation statements)

References 88 publications

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“…In the largest study of COVID-19-associated mucormycosis, a disease stage of <3b (orbital involvement without vision loss) was associated with a better outcome and, regardless of stage, surgery (paranasal sinus debridement and/or orbital exenteration) was associated with stable residual or regressive disease [177]. Together with infection control, the key elements of successful mucormycosis management suggested in the clinical guidelines are an early diagnosis, species identification, a combination of anti-fungal therapy and aggressive surgical resection/debridement, the optimisation of blood glucose levels, and the correct use of glucocorticoids for COVID-19 treatment (administration to hypoxic patients, and not exceeding the dose and treatment duration established by the guidelines) [213][214][215][216].…”

Section: Discussionmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

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Section: Discussionmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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“…The current rise of coronavirus disease (COVID-19) is associated with reports of fungal infections such as aspergillosis and mucormycosis, particularly among seriously ill patients treated with steroids. Recent cases of COVID-19 in India during the second wave of the pandemic are associated with increased reports of invasive mucormycosis after COVID-19 (21).…”

Section: Fungal Pandemicmentioning

confidence: 99%

“…With an increasing number of critically ill patients infected with the ongoing COVID-19 pandemic and SARS-CoV-2, mucormycosis, prevalence Risk for patients at risk of mucormycosis based on the epidemiological burden of diabetes is essential to develop a base approach. Intrinsic, severity of COVID-19 disease, and use of immunomodulators, including the combination of corticosteroids and immunosuppressants in cancer and transplant patients (21).…”

Section: Fungal Pandemicmentioning

confidence: 99%

New Unknown Sars-Cov-2 Virus Variants and Hidden Pandemics Within Them in Developing Countries

Ghasemi

Dashti

2021

Preprint

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It is not known whether one or a combination of different mutations will alter the viral clinical and epidemiological manifestations, transmissibility, virulence, or efficacy of the vaccine. Transmission of the new variant by asymptomatic carriers is also unknown. Vaccines or antiviral agents have not yet induced the pressure of the mutation; however, other mutations are anticipated after global vaccination and after the introduction of proven therapies. Thus, a willingness to rapidly emerge new options is prudent. Less virulent but highly heritable variants can also be expected, which may contribute to herd immunity. There is a need to develop clinical and rapid laboratory tests to monitor vaccinated individuals for secondary infection potentially caused by the new variant. Importantly, restrictive countermeasures, spatial distancing, personal hygiene, travel bans, and facial disguises remain relevant in the fight against the virus.

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“…As in the case of mucormycotic infections and their relationship with the immunosuppressive nature of corticosteroid therapy used in the treatment of COVID-19; a rise in cases of avascular necrosis of the femoral head is being reported and is being attributed to the sustained and aggressive corticosteroid therapy being implemented [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

Banerjee¹,

Robinson²,

Sathian

2021

Nepal J Epidemiology

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The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis. It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.

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COVID-19 and mucormycosis superinfection: the perfect storm

Cited by 131 publications

References 88 publications

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

New Unknown Sars-Cov-2 Virus Variants and Hidden Pandemics Within Them in Developing Countries

Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

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