Diabetes mellitus and Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): A wake-up call from Egypt

Alfishawy, Mostafa; Elbendary, Amira; Younes, Alaa; Negm, Ahmed; Hassan, Walid Shehata; Osman, Safinaz; Nassar, Mahmoud; Elanany, Mervat

doi:10.1016/j.dsx.2021.102195

Cited by 28 publications

(17 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high prevalence of DM in the country, which ranges in recent cluster analyses in different regions from 16.7% 34 to 20.9%, 35 could explain the burden of CAM. 33 Other factors noticed in our sample that can contribute to the disease load include the delay in presentation (median 20.5 days), inadvertent use of corticosteroids in mild-moderate cases (30.8% of the patients), and self-medication for the viral infection in homes instead of seeking hospital care for moderate-severe cases, especially in Upper Egypt (6.7% in metropolitan Cairo, and 45.4% in Upper Egypt).…”

Section: Discussionmentioning

confidence: 82%

“…El-Kholy et al 32 conducted a prospective longitudinal study on invasive fungal sinusitis that spanned the duration of the second Egyptian pandemic wave at a university hospital in another governorate, Mansoura, and detected 28 cases with CAM. Alfishawy et al 33 reported on 21 patients with CAM from 11 different hospitals in metropolitan Cairo during the third pandemic wave, of which 19 (90.5%) had DM and all had received corticosteroid treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Fouad¹,

Bakre²,

Nassar³

et al. 2021

OPTH

View full text Add to dashboard Cite

Purpose: To report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021). Methods: A multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included. Results: Of the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died. Conclusion: CAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Fouad¹,

Bakre²,

Nassar³

et al. 2021

OPTH

View full text Add to dashboard Cite

show abstract

“…Across borders, patients with COVID-19 experience notorious fungal coinfections during or after weeks or months of recovery. COVID-19–associated mucormycosis (CAM) has been reported in many countries like Austria, Brazil, Egypt, France, India, Iran, Italy, and the US [ 11 , 12 ]. A recent systematic review observed that CAM constitutes 0.3% of COVID-19 coinfections [ 13 ].…”

Section: The Surge In Covid-19–associated Mucormycosismentioning

confidence: 99%

COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

et al. 2021

View full text Add to dashboard Cite

Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19–induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19–associated mucormycosis in India.

show abstract

“…Specifically, diabetes was the most common underlying risk factor for CAM in India than in other countries. A small study from Egypt in 21 patients with CAM also found a high prevalence of diabetes (90%) [ 13 ]. Not only is diabetes prevalent in patients with CAM, glycemia is uncontrolled in most patients.…”

Section: Discussionmentioning

confidence: 99%

“… Author Site N Mortality Alfishawy et al. [ 13 ] Cairo, Egypt 21 33.3% (7/21) Mishra et al. [ 10 ] Pune, Maharashtra 32 12.5% (4/32) Sen et al.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 associated mucormycosis: A Descriptive Multisite Study from India

Gupta

Kesavadev

Krishnan

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

View full text Add to dashboard Cite

Background and aims Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. Methods Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. Results There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. Conclusion Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.

show abstract

Diabetes mellitus and Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): A wake-up call from Egypt

Cited by 28 publications

References 1 publication

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

COVID-19 associated mucormycosis: A Descriptive Multisite Study from India

Contact Info

Product

Resources

About