COVID‐19‐associated mucormycosis: An updated systematic review of literature

Pal, Rimesh; Singh, Birgurman; Bhadada, Sanjay Kumar; Banerjee, Mainak; Bhogal, Ranjitpal Singh; Hage, Neemu; Kumar, Ashok

doi:10.1111/myc.13338

Cited by 236 publications

(279 citation statements)

References 73 publications

(180 reference statements)

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“…The most common form of Mucormycosis reported in 42% of the patients was that of the rhino-orbital type. Corticosteroid therapy (85%) was mainly used for treatment [ 17 ]. In a retrospective multicenter study conducted in India between September and December 2020, it was discovered that 187 (65.2%) of 287 patients with mucormycosis had CAM, with a prevalence of 0.27 percent among hospitalized COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Mucormycosis and COVID-19 an epidemic in a pandemic?

Banerjee¹,

Robinson²,

Asim

et al. 2021

Nepal J Epidemiology

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Mucormycosis and aspergillosis are rare, invasive and life-threatening infections. The causative agents being namely: Aspergillus fumigatus and Rhizopus arrhizus. The case fatality rates being over 50% respectively. Invasive Aspergillosis and Mucormycosis have been established and recognized as a complication of the SARS-CoV-2 infection. These cases have been intimately linked and related to prior corticosteroid therapy. With the new B.1.617.2 and B.1.617.2.1 or AY.1 strain of the coronavirus running rampant throughout India causing unprecedented death tolls, a new crisis is evolving. Invasive “black fungus” (Mucormycosis) is creating an epidemic within a global pandemic. The unique socio-economic, genetic and health status of India’s population culminates into a melting pot which sustains the viable triad for the “black fungus” infection to gain a stronghold. Diabetes mellitus, immunosuppression and the current COVID-19 global pandemic with its massive surges in the country have produced the “perfect storm.” Eye surgeons from around India are registering a surge in invasive Mucormycosis cases with a rise in orbital compartment syndrome often calling for radical procedures such as enucleation surgeries. The “black fungus” pandemic and invasive Mucormycosis occurring in COVID-19 patients in India is a depiction of the sinister secondary infections and complications intimately linked with the virus. It is therefore of the upmost importance that countries surrounding India in particular Nepal and other Asiatic nations take great cognizance of this indolent “black fungus killer” and ensure new screening and testing protocols are put into place.

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Section: Introductionmentioning

confidence: 99%

Mucormycosis and COVID-19 an epidemic in a pandemic?

Banerjee¹,

Robinson²,

Asim

et al. 2021

Nepal J Epidemiology

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“…Out of these, 25 developed mucormycosis following recovery from COVID-19 and all except 1 received systemic steroids for management of COVID-1 while 3 received tocilizumab. Pal et al [11], in their systemic review, reported overall prevalence of diabetes to be 85% (Diabetes mellitus, type-2 in 79% including newonset in 16%, Diabetes mellitus type-1 in 6% cases). Nearly 29% in their study had presence of ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

“…This shows how the patients can be affected post-COVID. Pal et al [11] reported 39% of cases with concurrent CAM while the remaining 61% had a mean interval of 22 days between the two illnesses.…”

Section: Discussionmentioning

confidence: 99%

Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic

Budhiraja

Aggarwal

Mahajan

et al. 2021

Preprint

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Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1st March and 15th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as possible mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P < 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.

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“…An abrupt increase in the number of opportunistic fungal infections and outbreaks has been observed; in particular, several cases of COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM) have been described. Multiple factors are associated with or lead to the development of those entities, including glucocorticoids and uncontrolled glucose, viral-induced lymphopenia, and direct damage to the airway epithelium, enabling Aspergillus , as well as Mucorales , to invade tissue and promote pulmonary aspergillosis or pulmonary mucormycosis (PM) [ 27 , 28 ].…”

Section: Populations At Risk and Clinical Manifestations Of Pulmonary Aspergillosis And Pulmonary Mucormycosismentioning

confidence: 99%

Diagnosis of Pneumonia Due to Invasive Molds

Palacios

Moffarah

2021

Diagnostics

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Pneumonia is the most common presentation of invasive mold infections (IMIs), and is pathogenetically characterized as angioinvasion by hyphae, resulting in tissue infarction and necrosis. Aspergillus species are the typical etiologic cause of mold pneumonia, with A. fumigatus in most cases, followed by the Mucorales species. Typical populations at risk include hematologic cancer patients on chemotherapy, bone marrow and solid organ transplant patients, and patients on immunosuppressive medications. Invasive lung disease due to molds is challenging to definitively diagnose based on clinical features and imaging findings alone, as these methods are nonspecific. Etiologic laboratory testing is limited to insensitive culture techniques, non-specific and not readily available PCR, and tissue biopsies, which are often difficult to obtain and impact on the clinical fragility of patients. Microbiologic/mycologic analysis has limited sensitivity and may not be sufficiently timely to be actionable. Due to the inadequacy of current diagnostics, clinicians should consider a combination of diagnostic modalities to prevent morbidity in patients with mold pneumonia. Diagnosis of IMIs requires improvement, and the availability of noninvasive methods such as fungal biomarkers, microbial cell-free DNA sequencing, and metabolomics-breath testing could represent a new era of timely diagnosis and early treatment of mold pneumonia.

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COVID‐19‐associated mucormycosis: An updated systematic review of literature

Cited by 236 publications

References 73 publications

Mucormycosis and COVID-19 an epidemic in a pandemic?

Mucormycosis and COVID-19 an epidemic in a pandemic?

Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic

Diagnosis of Pneumonia Due to Invasive Molds

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