High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Bhatt, Kinal; Agolli, Arjola; Patel, Madhusudan; Garimella, Radhika; Devi, M. Poornima; Garcia, Efrain; Amin, Hilman Zulkifli; Domingue, C.; Castillo, Richardo; Sanchez-Gonzalez, Marcos A.

doi:10.15190/d.2021.5

Cited by 137 publications

(144 citation statements)

References 39 publications

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“…As summarized in Tables 1 and 2 , most patients had severe COVID-19 pneumonia requiring intensive care, intubation and ventilation. In addition, most patients had underlying diabetes mellitus and received steroids [ 28 , 64 , 65 ]. The presence of diabetes mellitus is a major predisposing factor for mucormycosis as described in a meta-analysis among 600 (70%) of 851 patients with rhino-orbital–cerebral mucormycosis [ 19 ].…”

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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“…Furthermore, a person taking immunosuppressants, such as corticosteroids and monoclonal antibodies, may experience severe lymphocytopenia. Because lymphocytes play an important role in the immune defense function against infection, patients with COVID-19 are highly susceptible to bacterial and fungal secondary infections causing a high mortality rate in patients with COVID-19 (Bhatt et al 2021 ). About 3.6–13% of patients with COVID-19 developed a secondary bacterial or fungal infection and the mortality rate among these patients was about 33.3–56.7% (Khurana et al 2021 ; Vijay et al 2021 ).…”

Section: Potential Therapeutic Effects Of Boswellic Acids and B Serrata Extract Against Covid-19-induced Secondary Micmentioning

confidence: 99%

Boswellic acids/Boswellia serrata extract as a potential COVID-19 therapeutic agent in the elderly

et al. 2021

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The most severe cases of COVID-19, and the highest rates of death, are among the elderly. There is an urgent need to search for an agent to treat the disease and control its progression. Boswellia serrata is traditionally used to treat chronic inflammatory diseases of the lung. This review aims to highlight currently published research that has shown evidence of potential therapeutic effects of boswellic acids (BA) and B. serrata extract against COVID-19 and associated conditions. We reviewed the published information up to March 2021. Studies were collected through a search of online electronic databases (academic libraries such as PubMed, Scopus, Web of Science, and Egyptian Knowledge Bank). Several recent studies reported that BAs and B. serrata extract are safe agents and have multiple beneficial activities in treating similar symptoms experienced by patients with COVID-19. Because of the low oral bioavailability and improvement of buccal/oral cavity hygiene, traditional use by chewing B. serrata gum may be more beneficial than oral use. It is the cheapest option for a lot of poorer people. The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity. B. serrata and BA act by multiple mechanisms. The most common mechanism may be through direct interaction with IκB kinases and inhibiting nuclear factor-κB-regulated gene expression. However, the most recent mechanism proposed that BA not only inhibited the formation of classical 5-lipoxygenase products but also produced anti-inflammatory LOX-isoform-selective modulators. In conclusion a small to moderate dose B. serrata extract may be useful in the enhancing adaptive immune response in mild to moderate symptoms of COVID-19. However, large doses of BA may be beneficial in suppressing uncontrolled activation of the innate immune response. More clinical results are required to determine with certainty whether there is sufficient evidence of the benefits against COVID-19.

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“…New coronavirus disease (COVID-19) continues to exhibit remarkable repercussions worldwide along with its atypical manifestations. Novel reports of SARS-CoV-2 infection underline the risk of opportunistic fungi infections, namely the pulmonary aspergillosis and mucormycosis, that accompany viral symptoms, leading to death by invading multi-organ systems [ 1 ]. Experience from SARS patients showed that incidence of fungal co-infection was 14.8–27%, and it was higher in severely ill SARS patients reaching up to 33% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%