Mucormycosis (black fungus) infection and misuse of corticosteroids in COVID 19 patients in Syria

Mohsen, Aya Yaser; Mohammad, Jollanar Ghanem; Al-janabi, Moatasem Hussein

doi:10.1016/j.amsu.2022.103463

Cited by 1 publication

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References 5 publications

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“…A total of 8727 cases of CAM are reported in the 88 qualified studies ( Table 1 ), the majority of them from India (n = 8388, 96.1%), 208 patients (2.4%) were from Egypt and 40 patients (0.46%) from Europe (France and Germany) ( Figure 2 ). CAM cases have also been reported in USA [ 41 ], Pakistan [ 70 ], Iran [ 84 ], Oman [ 113 ], Syria [ 115 ], Iraq [ 116 ], Latin America [ 117 ] and Turkey [ 7 ].…”

Section: Incidence Of Cammentioning

confidence: 99%

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

et al. 2022

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A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.

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