COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?

Revannavar, Shweta Mallikarjun; Supriya, P.; Samaga, Laxminarayana; Vineeth, V K

doi:10.1136/bcr-2021-241663

Cited by 189 publications

(152 citation statements)

References 11 publications

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“…A two-case report of mucormycosis was also published in April 2021, where both the patients had received corticosteroids therapy during COVID-19 [12]. Similar case reports have been published by Werthman-Ehrenreich [4], Mehta and Pandey [12], and Revannavar et al [13] on rhino-orbital mucormycosis.…”

Section: Discussionsupporting

confidence: 58%

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Singh¹,

Ganesh²,

Kumar³

et al. 2021

Cureus

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Background: Coronavirus disease (COVID-19) remains a health concern with new challenges emerging as the pandemic progresses. The recent rise of opportunistic infections especially mucormycosis in COVID-19 patients is further complicating their outcomes. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID-19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection.Methodology: Here, we present a retrospective case series of 13 patients with individual clinical characteristics along with the demography and treatment details. The data were collected retrospectively in a single center that caters to a large population of COVID-19 patients with varying severity.Results: Thirteen patients were presented with COVID-19 associated mucormycosis (CAM). The median age was higher in non-survivors (49.5 years), with a higher odds of death (23.8) in those with severe COVID, having overall mortality of 64.3%. Moreover, diabetes mellitus was present in 61.5% of patients with a mortality of 75%. About 11 (84.6%) patients had received prior steroids for COVID-19. The incidence of hyperglycemia at admission was equal among both survivors and non-survivors. Conclusion:The prevalence of mucormycosis seems to be increasing among COVID-19 patients which may be associated with increased use of steroids, the possible immunocompromised state imposed by SARS-CoV-2, or co-existing conditions such as diabetes mellitus. The mortality of CAM is remarkably high and apart from preventive practices and rational use of immunomodulators, a high index of suspicion with early diagnosis would be key to survival.

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Section: Discussionsupporting

confidence: 58%

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Singh¹,

Ganesh²,

Kumar³

et al. 2021

Cureus

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“…The reported organisms were Rhizopus spp. [ 24 , 31 , 36 , 41 – 44 , 47 , 49 , 51 , 55 ] and the others were reported as unspecified Mucorale [ 25 , 26 , 30 , 33 – 35 , 37 , 40 , 45 , 48 , 50 , 52 , 54 ]. The management of mucormycosis is usually difficult and requires urgent medical and surgical debridement while the choice of drug to treat mucormycosis is Amphotericin B [ 23 , 57 ] and Amphotericin was used in 23 of the included studies [ 24 – 26 , 30 – 37 , 40 – 44 , 46 , 47 , 49 – 54 ] and surgical debridement was reported in 20 of the included studies [ 24 – 26 , 30 , 32 – 37 , 40 , 44 – 47 , 50 – 54 ].…”

Section: Clinical Features and Managementmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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Background The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. Purpose In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. Results Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. Conclusion With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

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“…Decreased CD4+ and CD8+ T-cell population, which are mediators of protective cell mediated immunity against fungal pathogens, increase the propensity of opportunistic mycotic infections in COVID-19 affected patients. Moreover, background of poorly controlled DM, which is seen in majority of the patients presenting with post-COVID Mucorales infection further jeopardises the host response [11][12][13]. Furthermore, steroid therapy, which has evolved as an integral part of moderate to severe COVID-19 management, leads to impaired glycemic state as well as waning immune response.…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control

Mitra

Janweja

Sengupta

2021

Eur Arch Otorhinolaryngol

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Objective To document and analyse demographic data, clinical presentation, possible interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM). Method 32 patients having history of SARS-CoV-2 infection with features of ROCM were observed in terms of their history, presenting features, clinical, microbiological examination, type of surgical intervention, surgical sites of involvement which were subsequently analyzed. Results The mean (± S.D.) age of patients was 57 ± 13 years. All patients were diabetic. Mean (± S.D.) time of onset of ROCM symptoms, since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients received steroid therapy; 28.1% received high flow nasal oxygen. 87.5% patients had blurring of vision, 65.62% headache, 59.37% cheek and eyelid swelling, 50% proptosis, 46.87% ophthalmoplegia, 40.62% ptosis, 40.62% loss of sensation over cheek, 25% orbital pain. Examination of specimen with KOH mount revealed Mucor spp. in all patients. 87.5% patients underwent endoscopic sinus surgery with debridement with/without orbital clearance; 56.25% maxillectomy; 25% orbital exenteration. 87.5% patients had paranasal sinus involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had involvement of pterygopalatine fossa±infratemporal fossa. 50% patients had disease in Vidian canal and pterygoid wedge. 25% of patients had involvement of palate and 56.25% cheek and eyelid soft tissues. Conclusion A judicious COVID treatment protocol, high index of suspicion, close monitoring of high-risk patients and early institution of treatment can prevent case severity and reduce mortality.

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COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?

Cited by 189 publications

References 11 publications

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

COVID-19 and mucormycosis superinfection: the perfect storm

Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control

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