Rhino-oculo Cerebral Mucormycosis Resistant to Amphotericin B in a Young Patient with Diabetic Ketoacidosis

Asghar, Sarrah Ali; Majid, Zainab; Tahir, Faryal; Mir, Saifullah

doi:10.7759/cureus.4295

Cited by 9 publications

(10 citation statements)

References 7 publications

(9 reference statements)

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“…One of the limitations of using AMB is renal toxicity. However, only four patients suffered side effects of use of the AMB 6,25‐27 . Also, four patients treated with LAMB showed side effects: hypokalaemia with mild renal failure, minor nephrotoxicity, derangement of renal function and liver function test, and acute renal failure requiring haemodialysis after using LAMB.…”

Section: Resultsmentioning

confidence: 96%

“…Antifungal susceptibility showed that in addition to the high‐level resistance to AMB, the pathogen was resistant to other antifungal drugs such as voriconazole, ketoconazole and fluconazole 24 . Other studies on diabetic patients have also shown that the patients partially develop resistance to AMB following the extended duration of the treatment to nearly eight months 6 . Therefore, antibiotic resistance to CM is very important because it causes therapeutic failures and determining microbial susceptibility can help use the right medication.…”

Section: Discussionmentioning

confidence: 99%

“…Humans become infected mainly by the inhaling sporangiospores, ingestion of contaminated food and traumatic inoculation 3,4 . Some risk factors increase the chance of infection such as neutropaenia, use of steroids, organ or stem cell transplantation, intravenous drug abuse, renal insufficiency, broad‐spectrum antibiotics, prophylactic voriconazole for aspergillosis, malnutrition, iron overload and diabetes (especially ketoacidosis) 5,6 . Diabetic patients are among the most susceptible ones to mucormycosis, and diabetes has been reported to be the most important risk factor in infection in Asian countries 7 .…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Chegini

Didehdar

Khoshbayan

et al. 2020

Mycoses

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Summary Background Patients with diabetes are known as an important high‐risk group for cerebral mucormycosis (CM). Method We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. Results Forty‐five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid‐based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low‐income and health‐challenged countries. Conclusion Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low‐income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Chegini

Didehdar

Khoshbayan

et al. 2020

Mycoses

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“…It is believed that as the pH becomes acidic, the iron-protein complexes dissociate, which allows for the fungal cells to use the increased free iron [4]. In patients with diabetes mellitus, rhinocerebral mucormycosis is noted to be the most common type [5].…”

Section: Discussionmentioning

confidence: 99%

Rhinocerebral Mucormycosis and COVID-19 Pneumonia

Alekseyev¹,

Didenko²,

2021

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As the coronavirus disease 2019 (COVID-19) pandemic is evolving, more complications associated with COVID-19 are emerging. In this case report, we present a case of rhinocerebral mucormycosis concurrent with COVID-19 pneumonia in a 41-year-old man with a history of type 1 diabetes mellitus (T1DM). COVID-19 pneumonia was diagnosed with reverse transcription-polymerase chain reaction (RT-PCR). He was promptly treated with steroids and hydroxychloroquine, as this was the recommended regional COVID-19 practice patterns at the time. He was treated with intravenous (IV) fluids and an insulin drip for his diabetic ketoacidosis (DKA), cefepime and IV abelcet, along with three surgical debridements for the rhinocerebral mucormycosis. The pneumonia resolved during the course of his stay in the hospital. With prompt diagnosis and treatment of rhinocerebral mucormycosis, the patient was cleared for discharge and was instructed to complete his course of treatment with coumadin and IV abelcet at home. Saprophytic fungi cause rhinocerebral mucormycosis, a rare opportunistic infection of the sinuses, nasal passages, oral cavity and brain. It usually occurs in patients with poorly controlled diabetes mellitus or those who are immunocompromised, which is again demonstrated in this case report. In the setting of COVID-19 pneumonia and an underlying condition, healthcare professionals should act promptly. In cases where mucormycosis infection is suspected, a prompt diagnosis and treatment should be started because of the angioinvasive character and rapid disease progression that contribute to the severity of the mucormycosis infection.

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“…Among the predominant genera that cause mucormycosis, Rhizopus is the most common followed by Mucor and Lichtheimia. Mucorales are generally found in soil, decaying food, manure and dust ( Asghar et al, 2019 ; Chakrabarti et al, 2006 , 2009bib_Chakrabarti_et_al_2009 bib_Chakrabarti_et_al_2006 ; Chow et al, 2015 ; Reid et al, 2020 ). Mucormycosis was initially described in 1855, as this was the first authentic human case of this condition ( Küchenmeister, 1855 ).…”

Section: Origin Of Mucormycosismentioning

confidence: 99%

Mucormycosis: An opportunistic pathogen during COVID-19

Iyer¹,

Jayaramayya

Venkatesan

et al. 2021

Environmental Research

128

122

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The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second wave of this disease has led to panic in many countries, including India and some parts of the world suffering from the third wave. As there are no proper treatment options or remedies available for this deadly infection, supportive care equipment's such as oxygen cylinders, ventilators and heavy use of steroids play a vital role in the management of COVID-19. In the midst of this pandemic, the COVID-19 patients are acquiring secondary infections such as mucormycosis also known as black fungus disease. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid high rate of mortality and morbidity rates. Mucormycosis is caused by the inhalation of its filamentous (hyphal form) fungi especially in the patients who are immunosuppressed. Recent studies have documented alarming number of COVID-19 patients with mucormycosis infection. Most of these patients had diabetes and were administered steroids for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and were consequently more prone to mucormycosis. Hence, the present review emphasizes mucormycosis and its related conditions, its mechanism in normal and COVID-19 affected individuals, influencing factors and challenges to overcome this black mold infection. Early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in COVID-19 affected patients.

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Rhino-oculo Cerebral Mucormycosis Resistant to Amphotericin B in a Young Patient with Diabetic Ketoacidosis

Cited by 9 publications

References 7 publications

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Rhinocerebral Mucormycosis and COVID-19 Pneumonia

Mucormycosis: An opportunistic pathogen during COVID-19

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