COVID-19 associated mucormycosis is not a direct consequence of SARS-CoV 2 induced immune dysfunction

Fonte, Luis; Andreu, Carlos Manuel Fernández; Ginori, María; Armas, Yaxsier de

doi:10.15761/crt.1000357

Cited by 3 publications

(5 citation statements)

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“…This immune dysregulation may lead to opportunistic fungal infections. 22 , 23 However, incidence of candida and aspergillosis is far more common than mucormycosis in ICU setting. 24 Lymphopenia as such does not increase susceptibility to mucorale as seen in an autopsy study of mucormycosis in HIV patients.…”

Section: Discussionmentioning

confidence: 99%

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T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

Dandu

Kumar

Malhotra

et al. 2022

Mycoses

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Background The second wave of COVID‐19 in India was followed by large number of mucormycosis cases. Indiscriminate use of immunosuppressive drugs, underlying diseases such as diabetes, cancers, or autoimmune diseases was thought to be the cause. However, the mortality was not as high as that seen in non‐COVID mucormycosis. Objective To study the detailed characteristics of T‐cells for evaluating the underlying differences in the T‐cell immune dysfunction in post‐COVID and non‐COVID mucor patients. Material and method The study included histopathologically confirmed cases of mucor (13 post‐COVID, 13 non‐COVID) and 15 healthy individuals (HI). Expression of T‐cell activation (CD44, HLADR, CD69, CD38) and exhaustion (CTLA, PD‐1, LAG‐3 and TIM‐3) markers was evaluated by flow cytometry. Results All cases showed significant depletion of T‐cells compared to HI. Both post‐COVID and non‐COVID groups showed increased activation and exhaustion as compared to HI. Non‐COVID mucor group showed significant activation of CD4+ T cells for HLADR and CD38 ( p = .025, p = .054) and marked T‐cell exhaustion in form of expression of LAG‐3 on both CD4+ T and CD8+ T cells in comparison with post‐COVID patients ( p = .011, p = .036). Additionally, co‐expression of PD‐1 & LAG‐3 and LAG‐3 & TIM‐3 on CD8+ T cells was statistically significant in non‐COVID mucor patients ( p = .016, p = .027). Conclusion Immunosuppression in non‐COVID mucor showed pronounced exhaustion of T‐cells in comparison to post‐COVID mucor cases implicating T‐cell immune dysfunction is much more severe in non‐COVID mucor which are in a state of continuous activation followed by extreme exhaustion leading to poorer outcome.

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Section: Discussionmentioning

confidence: 99%

“…Persistent viral stimulation of T cells leads to activation followed by exhaustion of T cells. This immune dysregulation may lead to opportunistic fungal infections 22,23 . However, incidence of candida and aspergillosis is far more common than mucormycosis in ICU setting 24 .…”

Section: Discussionmentioning

confidence: 99%

T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

Dandu

Kumar

Malhotra

et al. 2022

Mycoses

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“…Mucor is otherwise a saprophytic fungus with its spores omnipresent in the environment including nasal mucosa. These germinate inside the human body in the immunosuppressed and may spread to adnexa from the nose [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…The chances of developing secondary fungal infections are increased in post-COVID-19 patients due to various reasons that cause an immunosuppressed state in the body [4]. This situation worsens in patients with comorbidities, especially diabetics due to metabolic events that occur in the body [5]. Diabetes mellitus is the most common predisposing factor for Zygomycete infection [4,6,7].…”

Section: Discussionmentioning

confidence: 99%

case series of Covid-19-associated fungal infections: The gruesome twosome

Jangla¹,

Cherian²

2022

Indian J Case Reports

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Severe Acute Respiratory Syndrome Coronavirus-2(SARS-CoV-2) is the novel coronavirus responsible for causing Coronavirus disease (COVID-19). The pandemic has seen many ebbs and flows since its detection, particularly regarding various manifestations coupled with it. Secondary fungal infections, especially COVID-19-associated mucormycosis, have seen a summit, especially during the second wave of the pandemic. However, we reported a series of three cases of mucormycosis in association with another fungal mould from the sample received from patients infected with this virus that presented to our hospital during this pandemic. Our report is about the novelty of dual fungal infection caused by a Zygomycete group along with Aspergillus isolated from pulmonary as well as extra-pulmonary sites, all of which were confirmed on culture. Timely and multidisciplinary management of these patients helped patient survival.

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“…The surge in the number of CAM cases after second wave can be attributed to a combination of factors like environmental conditions, causative agents, host factors, and others contributed by health system. [ 1 8 12 ] Immune dysregulation that occurs in the setting of severe acute respiratory syndrome–related coronavirus 2 (SARS-CoV- 2) infections has been postulated to increase the risk of invasive mycosis during the second wave of COVID-19. [ 5 10 ] Environmental factors need to be researched in detail.…”

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confidence: 99%