Fatal disseminated mucormycosis associated with <scp>COVID</scp>‐19

Horiguchi, Tomoya; Tsukamoto, Tetsuya; Toyama, Yoko; Sasaki, Teikichi A.; Nakamura, Tomoyuki; Sakurai, Aki; Kuriyama, Naohide; Komatsu, S; Shigeyasu, Yoshiko; Ina, Takuma; Sakurai, Eiko; Nakajima, N.; TSUCHIMORI, Arisa; Yamada, Seiji; Suzuki, Tadaki; Imaizumi, Kazuyoshi

doi:10.1002/rcr2.912

Cited by 12 publications

(8 citation statements)

References 5 publications

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“…We first assessed the lung autopsy material from three individuals with COVID-19 to investigate the pathological impact of SARS-CoV-2 infection in the lungs (cases #1 to #3) ( Table 1 ). Notably, case #2 suffered from mucormycosis, which has been described in several other studies, especially in India ( 27 – 29 ). A representative figure from a computed tomography (CT) analysis of case #2 showed pneumonia characteristic of COVID-19 ( SI Appendix , Fig.…”

Section: Resultsmentioning

confidence: 53%

Elevated Myl9 reflects the Myl9-containing microthrombi in SARS-CoV-2–induced lung exudative vasculitis and predicts COVID-19 severity

Iwamura

Hirahara

Kiuchi

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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The mortality of coronavirus disease 2019 (COVID-19) is strongly correlated with pulmonary vascular pathology accompanied by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection–triggered immune dysregulation and aberrant activation of platelets. We combined histological analyses using field emission scanning electron microscopy with energy-dispersive X-ray spectroscopy analyses of the lungs from autopsy samples and single-cell RNA sequencing of peripheral blood mononuclear cells to investigate the pathogenesis of vasculitis and immunothrombosis in COVID-19. We found that SARS-CoV-2 accumulated in the pulmonary vessels, causing exudative vasculitis accompanied by the emergence of thrombospondin-1–expressing noncanonical monocytes and the formation of myosin light chain 9 (Myl9)–containing microthrombi in the lung of COVID-19 patients with fatal disease. The amount of plasma Myl9 in COVID-19 was correlated with the clinical severity, and measuring plasma Myl9 together with other markers allowed us to predict the severity of the disease more accurately. This study provides detailed insight into the pathogenesis of vasculitis and immunothrombosis, which may lead to optimal medical treatment for COVID-19.

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Section: Resultsmentioning

confidence: 53%

Elevated Myl9 reflects the Myl9-containing microthrombi in SARS-CoV-2–induced lung exudative vasculitis and predicts COVID-19 severity

Iwamura

Hirahara

Kiuchi

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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“…Anti-IL-6-directed therapies and corticosteroid treatment that are used for the treatment of COVID-19 patients lead to immune suppression. Additionally, other risk factors such as mechanical ventilation, invasive procedures, industrial-grade oxygen administration, as well as prolonged hospital stays provide the perfect setting for invasive mucormycosis ( 56 , 64 , 73 ). Collectively, during COVID-19, systemic steroid treatments and uncontrolled diabetes are the main risk factors for RM.…”

Section: Discussionmentioning

confidence: 99%

“…Collectively, during COVID-19, systemic steroid treatments and uncontrolled diabetes are the main risk factors for RM. Thus, physicians should always be cautious of this infection in patients suffering from severe COVID-19 who are treated with extensive immunosuppressive therapy ( 64 ). Notably, Mucorales have an ability for blood invasion; thus, these fungi are associated with infarction and embolism.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

et al. 2022

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BackgroundRenal mucormycosis (RM) is a rare presentation of invasive mucormycosis with a high mortality rate. There is no single systematic review of the literature that indicates the different clinical aspects of RM.MethodsA systematic search of PubMed/Medline was performed to collect individual case reports of RM in patients of all ages published between 2010 and April 2022.ResultsSeventy-one individual cases were detected through PubMed bibliographic database searches, with a final assessment performed on 60 patients with RM. India and Asia had the largest number of reported cases, with 30 (50%) and 42 (70%) reports, respectively. Also, 74 and 26% of the patients with a mean age of 33 years were male and female, respectively. RM showed 44% mortality rate in the analyzed cases. Immunosuppressive agent therapy followed by tissue transplantation (kidney and liver) and diabetes were the most remarkable risk factors in patients. Nevertheless, 22% of the patients were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in eight adult patients with an 87% mortality rate. The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases. In 55% of the patients, histopathologic examination alone was sufficient to diagnose RM, whereas molecular methods and culture were used in only 18 and 35% of patients, respectively. Surgery alone, surgery plus anti-infection therapy, and anti-infection therapy alone were used in 12, 60, and 13% of patients, respectively. Furthermore, 15% of the patients died before any treatment.ConclusionThe early diagnosis of RM is necessary. In this regard, the use of molecular-based diagnostic assays can help identify the fungus at the genus and species levels and use an appropriate treatment in the shortest possible amount of time. Because of the increase in antibiotic resistance in recent years, determining microbial susceptibility tests can lead to the better infection management. Additionally, withdrawal of immunosuppressant, appropriate surgical intervention, and antifungal therapy are the main factors associated with a successful outcome in RM.

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“…Unfortunately, the rare nature of disseminated disease combined with its atypical presentation led to a brief and potentially fatal delay in diagnosis and appropriate care. We hope to raise the index of suspicion for this disease entity, especially given the increased incidence of both localized and disseminated disease during the COVID19 pandemic [8] .…”

Section: Discussionmentioning

confidence: 99%

An unexpected case of disseminated mucormycosis following pacemaker placement and brief course of oral corticosteroids

Froes¹,

Gellatly²,

Watson³

2022

IDCases

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Fatal disseminated mucormycosis associated with COVID‐19

Cited by 12 publications

References 5 publications

Elevated Myl9 reflects the Myl9-containing microthrombi in SARS-CoV-2–induced lung exudative vasculitis and predicts COVID-19 severity

Elevated Myl9 reflects the Myl9-containing microthrombi in SARS-CoV-2–induced lung exudative vasculitis and predicts COVID-19 severity

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

An unexpected case of disseminated mucormycosis following pacemaker placement and brief course of oral corticosteroids

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