COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs

Rodríguez-Morales, Alfonso J.; Sah, Ranjit; Millán-Oñate, José; González, Ángel; Montenegro-Idrogo, Juan José; Scherger, Sias; Franco‐Paredes, Carlos; Henao‐Martínez, Andrés F.

doi:10.1177/20499361211027065

Cited by 41 publications

(37 citation statements)

References 72 publications

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“…Systemic steroids could further exaggerate the underlying glycemic control as well as impede the body’s immune system. The use of high dose corticosteroid had been used in patients with COVID-19 disease [ 74 ]and the use of such medications required assessment [ 75 ]. One study showed that adherence to the use of low dose corticosteroid and good glycemic control were important in having no mucormycosis among 1027 ICU patients despite the use of corticosteroids in 89% and that 40% had diabetes mellitus [ 76 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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Background The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. Purpose In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. Results Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. Conclusion With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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“…Researchers warn that the impact of COVID-19 has been greatly neglected as patients continue to develop multisystemic manifestations for more than 7 months [ 10 ]. COVID-19 deteriorates immune status of patients, paves the way for opportunistic and secondary infections, and worsens preexisting clinical conditions [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

et al. 2021

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Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19–induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19–associated mucormycosis in India.

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“…For these reasons, when suspecting mucormycosis, it is important to assess by appropriate CNS imaging ( Figure 2 and Figure 3 ). Nowadays, in context of the COVID-19 pandemic, prevalent risk factors, such as diabetes, especially decompensated [ 4 , 5 , 6 , 8 , 17 , 20 ], and most importantly the inappropriate use of steroids, has led to an increase of cases similar to the one presented herein [ 15 ]. For those patients with known risk factors such as diabetes, malignancies (particularly haematological), steroid use, neutropenia, HIV/AIDS, and immunosuppression in general, mucormycosis should always be considered in the differential diagnosis, in order to deliver prompt treatment [ 1 , 15 ].…”

Section: Discussionmentioning

confidence: 89%

“…Surgical debridement, antifungal treatment and, if possible, adequate control of underlying risk factors are critical for managing these patients [ 15 , 39 ]. The main antifungal drugs used for treatment of mucormycosis include amphotericin B, isavuconazole, and posaconazole.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, as with other drugs, such as chloroquine, there has been an inappropriate use of these drugs in clinical scenarios where only marginal or no benefits have been achieved [ 11 , 12 , 13 , 14 ]. Likely associated to an inappropriate use of steroids, a growing number of mucormycosis among patients with COVID-19, now catalogued as COVID-19 associated mucormycosis (CAM), have been reported in multiple countries across the globe [ 15 ], including also some Latin American countries such as Brazil and Mexico [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

et al. 2021

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Background: Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. Case: A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. Conclusions: Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.

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COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs

Cited by 41 publications

References 72 publications

COVID-19 and mucormycosis superinfection: the perfect storm

COVID-19 and mucormycosis superinfection: the perfect storm

COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

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