Recent Advances in the Pathogenesis of Mucormycoses

Petrikkos, George; Tsioutis, Constantinos

doi:10.1016/j.clinthera.2018.03.009

Cited by 64 publications

(81 citation statements)

References 67 publications

(127 reference statements)

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“…The species of the Mucorales order attaches to the endothelium by specific receptors, followed by endocytosis and angioinvasion. 6 The basal ganglia are involved in 72.3% of isolated cerebral mucormycosis as the fungus spreads by hematogenous seeding through the middle cerebral artery perforating branches, 7 as observed in the present case.…”

Section: Discussionsupporting

confidence: 52%

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

et al. 2020

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Mucormycosis is an opportunistic fungal disease that commonly presents as cutaneous or rhinocerebral infections associated with immunocompromised states. It may exceptionally present as isolated involvement of the brain with a varied clinical presentation, which may be difficult to diagnose early, leading to increased mortality. Herein, we report the case of a 42-yearold immunocompetent female with left-sided limb weakness and a history of recurrent vomiting and headache for the last two years. Clinically, glioma was suspected, but histopathological examination revealed a few broad aseptate fungal hyphae. As no other organ was involved, the diagnosis of isolated cerebral mucormycosis was rendered. Reporting this case, we show an unusual presentation of a central nervous system mucormycosis masquerading a tumor in an immunocompetent patient. The case also highlights the importance of a careful histopathological examination to avoid missing the presence of occasional fungal hyphae. Ideally, recognition of fungal hyphae in the brain, during intraoperative consultation, can prompt brain tissue culture for definitive diagnosis and early empirical antifungal therapy, which may prove life-saving.

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Section: Discussionsupporting

confidence: 52%

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

et al. 2020

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“…34 Iron metabolism plays a central role in the pathogenesis of mucormycosis. 7,[35][36][37] Patients with iron overload states (including those receiving deferoxamine chelation therapy) are predisposed to mucormycosis. 7 Deferoxamine increases in vitro fungal growth by acting as a siderophore for Mucorales.…”

Section: Pathogenesismentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

149

108

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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“…14 The establishment of mucormycosis requires spores inhalation and/or seeding onto the airways or any vulnerable epithelium; germinating into angioinvasive hyphae-utilising host conditions such as hyperglycaemia, ketoacidosis, iron overload and neutropeniacausing endothelial damage, leading to local haemorrhage, thrombosis and necrosis; and eventual dissemination to involve multiple organs. 14,15 In this study, we present a case of sinonasal mucormycosis in an uncontrolled diabetic patient following dexamethasone therapy on a background influenza pneumonia and provide a review of current literature on influenza and COVID-19 associated mucormycosis (CAM) cases.…”

Section: Introductionmentioning

confidence: 99%

The double‐edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza‐associated mucormycosis versus COVID‐19 associated mucormycosis

Ahmadikia

Hashemi

Khodavaisy

et al. 2021

Mycoses

175

201

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Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID‐19, that requires critical care including ventilatory support, use of corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double‐edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44‐year‐old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID‐19 associated mucormycosis.

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Recent Advances in the Pathogenesis of Mucormycoses

Cited by 64 publications

References 67 publications

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Mucormycosis

The double‐edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza‐associated mucormycosis versus COVID‐19 associated mucormycosis

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