Clinical and microbiological features and outcomes of mucormycosis in critically ill patients

Rothe, Kathrin; Braitsch, Krischan; Okrojek, Rainer; Heim, Markus; Rasch, Sebastian; Verbeek, Mareike; Schmid, Roland M.; Busch, Dirk H.; Lahmer, Tobias

doi:10.1016/j.ijid.2021.06.066

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…A retrospective case series published prior to COVID-19 pandemic reported a mortality rate of 100% in eight critically ill patients with pulmonary mucormycosis. 14 A recent systemic review found pooled mortality of pulmonary mucormycosis of 57%, similar to our study where mortality rate was 54.7%. 15 …”

Section: Discussionsupporting

confidence: 91%

Clinical characteristics, outcome, and factors associated with mortality of pulmonary mucormycosis: a retrospective single-center study from Pakistan

Khalid,

Khanum,

Habib

et al. 2024

Therapeutic Advances in Infection

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Introduction and objective: Pulmonary mucormycosis is a rare but rapidly progressive fatal disease. Limited data exist on the outcomes and factors associated with poor prognosis of pulmonary mucormycosis. The objective of this study was to evaluate clinical characteristics, factors associated with mortality, and outcomes of pulmonary mucormycosis at a tertiary care hospital in Pakistan. Methods: This was a retrospective observational study conducted at a tertiary care hospital in Karachi, Pakistan. Medical records of hospitalized patients diagnosed with proven or probable pulmonary mucormycosis between January 2018 and December 2022 were reviewed. Univariate and regression analyses were performed to identify factors associated with mortality. Results: Fifty-three pulmonary mucormycosis patients (69.8% male) were included, with mean age of 51.19 ± 21.65 years. Diabetes mellitus was the most common comorbidity [ n = 26 (49.1%)]. Chronic lung diseases were present in [ n = 5 (9.4%)], and [ n = 16 (30.2%)] had concurrent coronavirus disease 2019 (COVID-19) pneumonia. The predominant isolated Mucorales were Rhizopus [ n = 32 (60.3%)] and Mucor species [ n = 9 (17%)]. Main radiological findings included consolidation [ n = 39 (73.6%)] and nodules [ n = 14 (26.4%)]. Amphotericin B deoxycholate was prescribed in [ n = 38 (71.7%)], and [ n = 14 (26.4%)] of patients received combined medical and surgical treatment. The median [interquartile range (IQR)] hospital stay was 15.0 (10.0–21.5) days. Intensive care unit (ICU) care was required in [ n = 30 (56.6%)] patients, with 26 (49.1%) needing mechanical ventilation. Overall mortality was seen in 29 (54.7%) patients. Significantly higher mortality was found among patients requiring mechanical ventilation 20/29 (69%, p = 0.002). Immunosuppression ( p = 0.042), thrombocytopenia ( p = 0.004), and mechanical ventilation ( p = 0.018) were identified as risk factors for mortality on multivariable analysis. Conclusion: This study provides essential insights into the clinical characteristics, outcomes, and mortality factors associated with pulmonary mucormycosis. The mortality rate was high (54.7%), particularly in patients with immunosuppression, thrombocytopenia, and those who required mechanical ventilation.

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Section: Discussionsupporting

confidence: 91%

Clinical characteristics, outcome, and factors associated with mortality of pulmonary mucormycosis: a retrospective single-center study from Pakistan

Khalid,

Khanum,

Habib

et al. 2024

Therapeutic Advances in Infection

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“…The diagnosis relies upon microscopic observation of characteristic broad ribbon like hyphae with right angle branching or microbiology culture or molecular techniques. When pulmonary-CAM is suspected, lung biopsy can be done but is invasive and often deferred in high-risk ICU patients on mechanical ventilation in whom BAL is a good option [ 75 ]. Routine tests like vision, pupil, ocular motility, and sinus tenderness can be helpful in picking up ROCM early [ 52 ].…”

Section: Covid-19-associated Mucormycosis (Cam)mentioning

confidence: 99%

COVID-19 and Plethora of Fungal Infections

Kundu

Singla

2022

Curr Fungal Infect Rep

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Purpose of Review Severe-acute respiratory coronavirus 2 (SARS-CoV-2) causing corona virus disease 2019 (COVID-19) has been the single most important pathogen driving health care delivery system for the last one and half years. Now, as the time is passing, many issues related to co-infections/secondary infections/superinfections in COVID-19 patients are emerging. The literature is getting enriched everyday by addition of reports from all over the world for the same. The purpose of this review is to decipher the plethora of fungal infections in COVID-19. Recent Findings COVID-19 infection along with it brought many risk factors namely lung injury, immunosuppression, need for oxygen therapy, monoclonal antibodies, steroid therapy, etc. which are known predisposing factors for fungal infections. Rather the extent and severity of fungal pathogens has been so much that it has led to new terminologies like CAC (COVID-19-associated Candida ), CAPA (COVID-19-associated pulmonary aspergillosis) and CAM (COVID-19-associated mucormycosis). There is increase in invasiveness of Candida , prevalence of aspergillosis in COVID-19 damaged lung and outbreak of mucormycosis in COVID-19 patients resulting in “double trouble,” keeping laboratory personnel, clinicians, and intensivists on their toes in managing these patients. Summary Awareness and understanding regarding these possible complications is necessary to decrease the morbidity and mortality among patients. The COVID-19 and fungal coinfections may bring more insight into ways of pathogenesis of fungal infections, need for better antifungal agents, quick diagnostic modalities, and better management policies in the near future.

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“…According to a study conducted by Sharma S, et al the prognosis remains poor even with aggressive surgery and intravenous anti-fungal therapy [ 14 ] but surprisingly our study findings suggest that patient had a positive post-operative clinical recovery scores. The present study is compared to a study done by Kathrin Rothe, et al who found the poor physiological status of these patients [ 15 ]. Al-Tawfiq JA, et al demonstrated that the outcome was favourable for patients who had surgical debridement.…”

Section: Discussionmentioning

confidence: 79%

Postoperative clinical nursing care pathway for patients with mucormycosis: An experience from a tertiary care hospital in Rajasthan, India

Kalal

Sharma

Soni

2021

Nepal J Epidemiology

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Background: The COVID-19 pandemic is a serious global health threat and it has numerous impacts on human life. India faced the problem of the second wave of COVID-19 and an unexpected new predicament in the form of mucormycosis has been added. The use of steroids drugs for long duration and comorbidity with COVID-19 infections are the risk factors of mucormycosis. It is important to understand the postoperative clinical pathway to assess and determine the policy and protocol, which help patients fasten their recovery, prevent further complications and readmission. Methods: A cross‑sectional descriptive design was used to conduct the study. We adopted the validated Immediate Post-Operative Recovery Assessment (IPR-PA) Scale to assess the postoperative clinical nursing care pathway for patients with mucormycosis. Results: The current study shows that patients had highest score in the physiology clinical recovery domain (75.25%) and the lowest post-operative clinical recovery score in psycho-social domain (20.83%). There was a significant positive correlation was found between all the domains. The medication status domains found significantly associated with participants’ age (P=.021) and physiological domains has shown significant association with received oxygen therapy during hospitalization (P=.046). Conclusion: Postoperative clinical nursing care pathway was effective to determine the progress of a patient. It helps us to know the parameter of different domains namely being physiological, physical, psycho-social and medication status. Patients required psycho-social support due to the epidemic and fear from disease.

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Clinical and microbiological features and outcomes of mucormycosis in critically ill patients

Cited by 9 publications

References 28 publications

Clinical characteristics, outcome, and factors associated with mortality of pulmonary mucormycosis: a retrospective single-center study from Pakistan

Clinical characteristics, outcome, and factors associated with mortality of pulmonary mucormycosis: a retrospective single-center study from Pakistan

COVID-19 and Plethora of Fungal Infections

Postoperative clinical nursing care pathway for patients with mucormycosis: An experience from a tertiary care hospital in Rajasthan, India

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