Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021

Didehdar, Mojtaba; Chegini, Zahra; Moradabadi, Alireza; Anoushirvani, Ali Arash; Tabaeian, Seidamir Pasha; Yousefimashouf, Milad; Shariati, Aref

doi:10.1016/j.micpath.2022.105388

Cited by 11 publications

(21 citation statements)

References 90 publications

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“…According to the findings of the present study, an uncommon etiology of intestinal necrosis could be angioinvasive mucormycosis. Gastrointestinal necrosis due to mucormycosis has been mentioned as a rare sequela of COVID-19 ( 19 – 21 ). Gastrointestinal involvement is among the rare presentations of mucormycosis, with the stomach and intestine as the most commonly involved organs, respectively ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal necrosis due to mucormycosis has been mentioned as a rare sequela of COVID-19 ( 19 – 21 ). Gastrointestinal involvement is among the rare presentations of mucormycosis, with the stomach and intestine as the most commonly involved organs, respectively ( 19 ). Two significant risk factors are diabetes and corticosteroid therapy ( 19 ), both present in one of our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal involvement is among the rare presentations of mucormycosis, with the stomach and intestine as the most commonly involved organs, respectively ( 19 ). Two significant risk factors are diabetes and corticosteroid therapy ( 19 ), both present in one of our patients. Another extremely rare etiology of intestinal ischemia observed in the present study was leukocytoclastic vasculitis (LCV), a small vessel vasculitis with microvascular immune complex deposition mainly resulting in skin lesions.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Intestinal Ischemia: A Multicenter Case Series

et al. 2022

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IntroductionGastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation.MethodsThe present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival.ResultsTwenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay.ConclusionIntestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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COVID-19 and Intestinal Ischemia: A Multicenter Case Series

et al. 2022

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“…Our analysis showed a 44% mortality rate in patients with RM (PubMed reported cases 2010-2022). Our recent investigations also showed 46.3 and 44% mortality rates in patients with ROCM and GI mucormycosis (2,15). As with GI mucormycosis and ROCM, India had the highest incidence of RM.…”

Section: Discussionmentioning

confidence: 60%

“…Mucormycosis, previously called Zygomycosis, comprises a wide range of invasive infections caused by different Mucorales species such as Rhizopus, Apophysomyces, Lichtheimia Mucor, Rhizomucor, Cunninghamella , and Saksenaea ( 1 , 2 ). Mucormycosis has been considered as a rare fungal infection but has a high mortality rate ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

et al. 2022

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BackgroundRenal mucormycosis (RM) is a rare presentation of invasive mucormycosis with a high mortality rate. There is no single systematic review of the literature that indicates the different clinical aspects of RM.MethodsA systematic search of PubMed/Medline was performed to collect individual case reports of RM in patients of all ages published between 2010 and April 2022.ResultsSeventy-one individual cases were detected through PubMed bibliographic database searches, with a final assessment performed on 60 patients with RM. India and Asia had the largest number of reported cases, with 30 (50%) and 42 (70%) reports, respectively. Also, 74 and 26% of the patients with a mean age of 33 years were male and female, respectively. RM showed 44% mortality rate in the analyzed cases. Immunosuppressive agent therapy followed by tissue transplantation (kidney and liver) and diabetes were the most remarkable risk factors in patients. Nevertheless, 22% of the patients were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in eight adult patients with an 87% mortality rate. The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases. In 55% of the patients, histopathologic examination alone was sufficient to diagnose RM, whereas molecular methods and culture were used in only 18 and 35% of patients, respectively. Surgery alone, surgery plus anti-infection therapy, and anti-infection therapy alone were used in 12, 60, and 13% of patients, respectively. Furthermore, 15% of the patients died before any treatment.ConclusionThe early diagnosis of RM is necessary. In this regard, the use of molecular-based diagnostic assays can help identify the fungus at the genus and species levels and use an appropriate treatment in the shortest possible amount of time. Because of the increase in antibiotic resistance in recent years, determining microbial susceptibility tests can lead to the better infection management. Additionally, withdrawal of immunosuppressant, appropriate surgical intervention, and antifungal therapy are the main factors associated with a successful outcome in RM.

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Disseminated Invasive Mucormycosis Infection Following Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma

2023

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Invasive fungal infections (IFI) are challenging to predict, diagnose and treat, and are associated with a particularly high mortality among patients with hematological malignancies. They are relatively uncommon in patients with lymphoma, compared with those with acute leukemia or undergoing allogeneic transplantation. We present a patient, autografted for recurrent lymphoma, with fever and refractory diarrhea persisting post engraftment, eventually attributable to disseminated mucor infection. This case illustrates the challenge of timely diagnosis and initiation of treatment for IFI in lymphoma patients, who do not routinely receive antifungal prophylaxis, and the importance of aggressive investigation and symptom-directed tissue sampling for evidence of IFI in febrile immunocompromised hosts not responding to broad-spectrum antibiotics.

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Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021

Cited by 11 publications

References 90 publications

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

Disseminated Invasive Mucormycosis Infection Following Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma

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