As the virus sowed, the fungus reaped! A comparative analysis of the clinico‐epidemiological characteristics of rhino‐orbital mucormycosis before and during COVID‐19 pandemic

Muraleedharan, Manjul; Panda, Naresh K.; Angrish, Prerna; Arora, Kanika; Patro, Sourabha Kumar; Bansal, Sandeep; Chakrabarti, Arunaloke; Rudramurthy, Shivaprakash M.; Bakshi, Jaimanti; Mohindra, Satyawati; Gupta, Richa; Virk, Ramandeep Singh; Verma, Roshan; Ramavat, Anurag Snehi; Nayak, Gyanaranjan

doi:10.1111/myc.13437

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…Even with these contusive environment prognoses in post‐COVID mucor was good with amphotericin B and itraconazole in majority of patients. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

“…The potent contributing factors for mucor in severe COVID were thought to be underlying diseases, non‐judicial steroid intake, mechanical ventilation system, hyperferritinemia, longer duration of hospital stays, improper air filtration and contaminated IV cannulas which are common for any opportunistic mucormycosis infection. Even with these contusive environment prognoses in post‐COVID mucor was good with amphotericin B and itraconazole in majority of patients 19,20 …”

Section: Discussionmentioning

confidence: 99%

“…Even with these contusive environment prognoses in post-COVID mucor was good with amphotericin B and itraconazole in majority of patients. 19,20 Severe COVID-19 is charactered by peripheral neutrophilia. 21 Neutrophils are potent in providing immunity against the mucorales by generation of oxidative metabolite which could be a reason for better prognosis in post-COVID mucor.…”

Section: Discussionmentioning

confidence: 99%

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T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

Dandu

Kumar

Malhotra

et al. 2022

Mycoses

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Background The second wave of COVID‐19 in India was followed by large number of mucormycosis cases. Indiscriminate use of immunosuppressive drugs, underlying diseases such as diabetes, cancers, or autoimmune diseases was thought to be the cause. However, the mortality was not as high as that seen in non‐COVID mucormycosis. Objective To study the detailed characteristics of T‐cells for evaluating the underlying differences in the T‐cell immune dysfunction in post‐COVID and non‐COVID mucor patients. Material and method The study included histopathologically confirmed cases of mucor (13 post‐COVID, 13 non‐COVID) and 15 healthy individuals (HI). Expression of T‐cell activation (CD44, HLADR, CD69, CD38) and exhaustion (CTLA, PD‐1, LAG‐3 and TIM‐3) markers was evaluated by flow cytometry. Results All cases showed significant depletion of T‐cells compared to HI. Both post‐COVID and non‐COVID groups showed increased activation and exhaustion as compared to HI. Non‐COVID mucor group showed significant activation of CD4+ T cells for HLADR and CD38 ( p = .025, p = .054) and marked T‐cell exhaustion in form of expression of LAG‐3 on both CD4+ T and CD8+ T cells in comparison with post‐COVID patients ( p = .011, p = .036). Additionally, co‐expression of PD‐1 & LAG‐3 and LAG‐3 & TIM‐3 on CD8+ T cells was statistically significant in non‐COVID mucor patients ( p = .016, p = .027). Conclusion Immunosuppression in non‐COVID mucor showed pronounced exhaustion of T‐cells in comparison to post‐COVID mucor cases implicating T‐cell immune dysfunction is much more severe in non‐COVID mucor which are in a state of continuous activation followed by extreme exhaustion leading to poorer outcome.

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“…Even with these contusive environment prognoses in post‐COVID mucor was good with amphotericin B and itraconazole in majority of patients. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

Dandu

Kumar

Malhotra

et al. 2022

Mycoses

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“…Although there were some reports of mucormycosis in the first wave, it reached an unprecedented extent in the second wave of COVID where almost 50,000 cases were recorded all over the country by November 2021. 5,6,11 The tropical climate and favourable temperature of the country contribute to the prevalence of fungi in the environment. 12 Diabetes is common in the Indian subcontinent.…”

Section: Link To Covid Infectionmentioning

confidence: 99%

“…Many hundreds of patients were treated in the Indian subcontinent with surgery and antifungal medication with significant morbidity and mortality in a resource-constrained environment. 5,6 Although the exact reason for the sudden surge of mucormycosis during the pandemic is still not established, the cause of COVID-associated mucormycosis (CAM) is thought to be multifactorial. 7 Coexisting diabetes and the use of steroids in treating COVID-19 pneumonia, and inadvertent and irrational use of zinc in COVID treatment protocols are implicated in the aetiology.…”

Section: Introductionmentioning

confidence: 99%

Mortality, morbidity and sequelae of COVID-associated mucormycosis; 18 months follow up study

Venkataramani¹,

Sachidananda²,

Muralidhar³

et al. 2023

Int J Otorhinolaryngol Head Neck Surg

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Background: The second wave of the COVID-19 pandemic in India was associated with an increased incidence of rhino-orbital-cerebral mucormycosis. The objective of this paper was to prospectively explore the epidemiology, management, and results of 18 months follow-up of patients presenting with COVID associated mucormycosis at a tertiary referral centre in India. Methods: Patients presenting with symptoms suggestive of COVID-associated mucormycosis over two months were included in the study. Patients were staged based on the extent of the disease. Surgery was the primary modality of treatment except in those with intracranial spread, altered sensorium, and poor prognosis. A combination of liposomal amphotericin B and posaconazole was used as adjunct medical treatment. Patients were followed up and outcomes at one year of treatment were recorded. Results: Out of a total of 26 patients who were diagnosed with COVID associated mucormycosis, 21 patients underwent bimodality treatment (medical and surgical). The extent of surgery was based on the stage of the disease. Six eyes received retrobulbar injections of Amphotericin B to salvage vision. The overall mortality was 38.46% and 23.8% in those where the intent of treatment was curative. At the end of one year, 16 of 21 operated patients survived with mild to severe sequelae. Conclusions: Mucormycosis is a deadly fungal infection with high mortality. Early diagnosis and prompt, aggressive treatment is paramount in preventing mortality. A multidisciplinary approach is useful for effective management. Continuous follow up is paramount to identifying and treating complications.

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Drug Repurposing for, ENT and Head and Neck, Infectious and Oncologic Diseases: Current Practices and Future Possibilities

Patro

Panda

Sharma

2023

Drug Repurposing for Emerging Infectious Diseases and Cancer

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As the virus sowed, the fungus reaped! A comparative analysis of the clinico‐epidemiological characteristics of rhino‐orbital mucormycosis before and during COVID‐19 pandemic

Cited by 11 publications

References 11 publications

T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

T‐cell dysfunction as a potential contributing factor in post‐COVID‐19 mucormycosis

Mortality, morbidity and sequelae of COVID-associated mucormycosis; 18 months follow up study

Drug Repurposing for, ENT and Head and Neck, Infectious and Oncologic Diseases: Current Practices and Future Possibilities

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