COVID-19-Associated Pulmonary Mucormycosis

Krishna, Vidya; Bansal, N.K.; Morjaria, Jaymin B.; Kaul, Sundeep

doi:10.3390/jof8070711

Cited by 15 publications

(5 citation statements)

References 60 publications

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“…Rhino-orbito-cerebral CAM should be described as associated with COVID-19 patients, but in this study, only pulmonary cases were detected, which represent less than 10% of CAM reported cases. Cases have been reported among immunocompromised hosts with worsening respiratory insufficiency, progressive pneumonia, persistent fever, and organ failure [50].…”

Section: Discussionmentioning

confidence: 99%

Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico

Román-Montes

Bojorges-Aguilar

Corral-Herrera

et al. 2023

JoF

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Background: Invasive Fungal Infections (IFI) are emergent complications of COVID-19. In this study, we aim to describe the prevalence, related factors, and outcomes of IFI in critical COVID-19 patients. Methods: We conducted a nested case–control study of all COVID-19 patients in the intensive care unit (ICU) who developed any IFI and matched age and sex controls for comparison (1:1) to evaluate IFI-related factors. Descriptive and comparative analyses were made, and the risk factors for IFI were compared versus controls. Results: We found an overall IFI prevalence of 9.3% in COVID-19 patients in the ICU, 5.6% in COVID-19-associated pulmonary aspergillosis (CAPA), and 2.5% in invasive candidiasis (IC). IFI patients had higher SOFA scores, increased frequency of vasopressor use, myocardial injury, and more empirical antibiotic use. CAPA was classified as possible in 68% and 32% as probable by ECMM/ISHAM consensus criteria, and 57.5% of mortality was found. Candidemia was more frequent for C. parapsilosis Fluconazole resistant outbreak early in the pandemic, with a mortality of 28%. Factors related to IFI in multivariable analysis were SOFA score > 2 (aOR 5.1, 95% CI 1.5–16.8, p = 0.007) and empiric antibiotics for COVID-19 (aOR 30, 95% CI 10.2–87.6, p = <0.01). Conclusions: We found a 9.3% prevalence of IFIs in critically ill patients with COVID-19 in a single center in Mexico; factors related to IFI were associated with higher SOFA scores and empiric antibiotic use for COVID-19. CAPA is the most frequent type of IFI. We did not find a mortality difference.

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Section: Discussionmentioning

confidence: 99%

Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico

Román-Montes

Bojorges-Aguilar

Corral-Herrera

et al. 2023

JoF

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“…Imagiologic findings are also unspecific and may include pulmonary infiltrates, parenchymal consolidation, multiple nodular lesions, pleural effusion, thick-walled cavities, mediastinal or hilar lymphadenopathy, and pneumothorax. The reverse halo sign is often associated with mucormycosis but was only described in up to 18% of cases [11,12]. Combined medical and surgical treatment is more effective than pharmacological treatment alone; however, in this case, only systemic antifungal therapy could be offered because the patient's clinical condition did…”

Section: Discussionmentioning

confidence: 85%

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

Pereira,

Neves,

Ruão

et al. 2024

Cureus

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Coronavirus disease 2019 is often linked to a broad range of opportunistic bacterial and fungal infections. The second wave of the COVID-19 pandemic has witnessed an unprecedented surge in mucormycosis cases, predominantly in India, while the disease remained relatively rare in Europe. The authors describe the case of a 62-year-old female patient admitted to the hospital for consolidation therapy with chemotherapy as a part of the treatment protocol for acute myeloid leukemia. During hospitalization, she was diagnosed with nosocomial COVID-19, which later progressed to respiratory deterioration. COVID-19 with bacterial superinfection was presumed, leading to the initiation of empirical antibiotic therapy. A bronchoscopy was performed several days later due to a lack of improvement, revealing an infection by the Rhizopus microsporus complex. Despite antifungal treatment, the patient experienced an unfavorable clinical course and ultimately died. Given the high index of suspicion required to diagnose pulmonary mucormycosis, which can lead to delays in appropriate treatment and increase the burden of disease, the authors are aiming to enhance its awareness.

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“…10 Somehow till date no reliable biomarkers and molecular test etc is available for mucormycosis. 11 Mucormycosis can easily be diagnosed clinically if the most common rhino-orbito-cerebral site is involved. The Time interval of diagnosis from Covid to mucormycosis was near 15 days; among them, only 10% were observed to have PMM.…”

Section: Discussionmentioning

confidence: 99%

“…10 It remained difficult to diagnose isolated PMM cases during active Covid pneumonia but somehow it was reported with high mortality of >80% in the absence of early clinical suspicion and treatment. 11 Most of these cases belonged to mechanical ventilator group, in association with diabetes, systemic high dose steroid, and other immunomodulator therapy like Tocilizumab, or with leucopenia and or lymphopenia. 7,9 In our case a history of covid treatment was present without the documentation of covid positivity.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Mucormycosis: A Case Report and Systematic Review of the Literature

Agrawal,

Jain,

Patel

et al. 2024

CIJMR

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The pulmonary mucormycosis (PMM) caused by Mucorales is a highly lethal invasive fungal infection in which early diagnosis and management is imperative. Otherwise, the mortality may exceed 80%. PMM does not have specific symptoms; hence, awareness of the disease and the treating physician’s suspicion can detect or diagnose it earlier. The fungal infection also needs to be differentiated from aspergillosis and other common fungal infections so an appropriate treatment is instituted.Case Report: A 62-year-old male was admitted with a six-month cough with scanty expectoration and a short history of progressive breathlessness for the last five days. He had a known case of diabetes and also an old-treated case of tuberculosis. He had a history of COVID-19 pneumonia (without a positive report). No history of fever, chest pain and hemoptysis. However, chest X-ray and HRCT thorax revealed a fibro-cavitary lesion in the right upper lobe with sputum and CBNAAT negative for AFB. The FOB examination detected complete occlusion with protruded soft yellowish and black material in the right main upper lobe bronchus, which was reported as mucormycosis. The patient was treated with amphotericin and then with oral antifungal.Discussion: An upsurge of mucormycosis was reported in our country during the COVID-19 era, leaving behind aspergillosis and another fungus. The rhino-orbit-cerebral is the most common site for this fungal infection and is essentially reported in an immune-compromised host as happened in our diabetic patient but as PMM. The Post TB sequelae with residual fibro-cavitary lesions, COPD and solid organ transplantation cases are the other risk factors and our country has enough of a vulnerable population. Our case was detected in the post-Covid period and required attention to epidemiological change or something else?Conclusion: An early rapid diagnosis and management of mucormycosis is crucial to minimizing mortality. The treatment by amphotericin is the best choice followed by Posaconazole or Isavuconazole as step-down oral medication. The increasing incidence of this infection in our country is challenging,

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COVID-19-Associated Pulmonary Mucormycosis

Cited by 15 publications

References 60 publications

Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico

Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

Pulmonary Mucormycosis: A Case Report and Systematic Review of the Literature

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