Does COVID 19 generate a milieu for propagation of mucormycosis?

Pandiar, Deepak; Kumar, Naveen; Anand, Rahul; Kamboj, Mala; Narwal, Anjali; Shameena, PM

doi:10.1016/j.mehy.2021.110613

Cited by 26 publications

(38 citation statements)

References 30 publications

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“…Thus, COVID-19–induced immunosuppression increases the risk of opportunistic infection, damages the endothelium and alveoles, easing the port of fungal invasion, and increases the glucose level due to the acute diabetes-like state caused by pancreatic damage; increased ferritin level supports fungal growth, and increased body temperature is optimal for thermotolerant fungi. Another exciting hypothesis revolves around the dysregulation of angiotensin-converting enzyme 2 expression in various bodily organs, immunosuppression, and the creation of a microenvironment system that increases the risk of coinfection in COVID-19 [ 49 ]. Up-regulation of 78-kDa glucose-regulated protein (GRP78), a heat shock protein, in patients with COVID-19 (5 times more than controls) due to increased glucose and iron content caused by diabetic ketoacidosis (DKA) or induced by dexamethasone use also facilitates fungal entry.…”

Section: How Does Mucormycosis Affect Patients With Covid-19?mentioning

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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Section: How Does Mucormycosis Affect Patients With Covid-19?mentioning

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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“…13 Another possible hypothesis is that the combination of biochemical alterations caused by the viral infection, including raised ferritin levels, acidosis, and acute cortisol stress response with elevated serum glucose levels, create the perfect environment for the growth and propagation of the fungal species. 14,15 Although most of CAM cases have been reported from India, 16,17 other countries have reported spikes in the fungal infection rates during the viral pandemic, including Egypt, 18 Chile, 19 and Iran. 20 In this report, we describe a series of CAM cases presenting to different settings within different geographical locations across Egypt during the third wave of the viral pandemic.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Fouad¹,

Bakre²,

Nassar³

et al. 2021

OPTH

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Purpose: To report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021). Methods: A multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included. Results: Of the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died. Conclusion: CAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

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“…It is suggested that venous thromboembolism (VTE) caused by COVID‐19 infection leads to mechanical ventilation, central venous catheterization, and surgery, all of which could cause damage to the elastic lamina of the blood vessels and eventually trigger the propagation of mucorales. 3 Furthermore, comorbidities such as diabetes mellitus and diabetic nephropathy are risk factors for both COVID‐19 and mucormycosis. 8…”

Section: Discussionmentioning

confidence: 99%

“…It was suggested that SARS‐CoV‐2 might increase the susceptibility to pulmonary fungal co‐infections. 3 …”

Section: Introductionmentioning

confidence: 99%

Mucormycosis infection in severe COVID‐19 patient with multiple underlying health conditions

Heydarifard

Safaei

Zadheidar

et al. 2021

Clinical Case Reports

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Does COVID 19 generate a milieu for propagation of mucormycosis?

Cited by 26 publications

References 30 publications

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

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

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Mucormycosis infection in severe COVID‐19 patient with multiple underlying health conditions

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