<i>Notes from the Field:</i> COVID-19–Associated Mucormycosis — Arkansas, July–September 2021

Dulski, Theresa M.; DeLong, Megan; Garner, Kelley; Patil, Naveen; Cima, Maaike; Rothfeldt, Laura; Gulley, Trent; Porter, Austin; Vyas, Keyur; Liverett, Hazel K; Toda, Mitsuru; Gold, Jeremy A W; Kothari, Atul

doi:10.15585/mmwr.mm7050a3

Cited by 20 publications

(14 citation statements)

References 8 publications

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“…[34] COSMIC study on post COVID 19 ROCM conducted in multiple centers across India found orbit as the most common site of infection. [35] 87.2% of our patients had diabetes mellitus and 74.1%…”

Section: Discussionmentioning

confidence: 61%

Insulin and Early Debridement keys to survival of COVID 19 associated mucormycosis (CAM) patients- An Experience from tertiary care hospital In India

Thakur

Misra²,

Misra³

et al. 2022

Preprint

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Introduction: Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and Methods: An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results 367 COVID 19 associated mucormycosis (CAM )patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion: Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

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Section: Discussionmentioning

confidence: 61%

Insulin and Early Debridement keys to survival of COVID 19 associated mucormycosis (CAM) patients- An Experience from tertiary care hospital In India

Thakur

Misra²,

Misra³

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…COVID-19 may increase mucormycosis risk due to COVID-19-induced immunological dysregulation or associated treatments such as corticosteroids and immunomodulatory medications (e.g. tocilizumab or baricitinib) that decrease host defenses against molds [ 11 ]. This is an uncommon yet life-threatening fungal illness and was responsible for 41,512 cases and 3,554 deaths between May 5 and July 12, 2021.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Empyema Complicated With Bronchopleural Fistula Secondary to Mucormycosis in a Young Immunocompromised Diabetic Patient With COVID-19

Risal¹,

Jahir²,

Islam³

et al. 2022

Cureus

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Mucormycosis is an opportunistic fungal infection caused by the zygomycetes Mucor and Rhizopus. Most documented conditions and risk factors that predispose to mucormycosis are uncontrolled diabetes mellitus (DM), with or without ketoacidosis, hematological malignancies (HM), transplantation, immunosuppression, and chronic sinusitis. Pulmonary empyema secondary to Mucor in coronavirus disease 2019 (COVID-19)infected patients is rarely documented. Here we present an extremely rare case of pulmonary empyema secondary to Mucor infection complicated by bronchocutaneous fistula in a human immunodeficiency virus (HIV)-infected patient in the setting of acute COVID-19 infection.

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“…During the COVID-19 pandemic, the use of immunomodulatory drugs (e.g., systemic corticosteroids and tocilizumab) and COVID-19-induced immune dysregulation increased the risk of mucormycosis (9,10). Cases of COVID-19-associated mucormycosis (CAM) have been reported worldwide (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and have been mostly associated with underlying uncontrolled diabetes mellitus diseases. Nevertheless, cutaneous and soft-tissue mucormycosis has been observed in immunocompetent individuals (21,22), such as those induced by traumatic implantation of contaminated soil and water during tornadoes (23).…”

Section: Mucormycosis Is a Devastating Invasive Fungal Infection Pred...mentioning

confidence: 99%

Is the production of reactive oxygen and nitrogen species by macrophages associated with better infectious control in the experimental disseminated and pulmonary mucormycosis?

Santos

Fraga-Silva

Donanzam

et al. 2022

Preprint

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Different levels of resistance againstRhizopus oryzaeinfection have been observed between inbred (BALB/c) and outbred (Swiss) mice, with is associated with the genetic background of each mouse strain. Considering that macrophages play an important role in host resistance toRhizopusspecies, we use the different infectious outcomes observed in experimental mucormycosis to identify the most efficient macrophages responses pattern againstR. oryzae in vitroandin vivo. For this, we compared BALB/c and Swiss macrophage activity pre-and-post intravenous or intratrachealR. oryzaeinfections. Production of hydrogen peroxide (H2O2) and nitric oxide (NO) was determined in cultures of peritoneal (PMΦ) or alveolar macrophages (AMΦ) challenged, or not, with heat-killed spores ofR. oryzae. Levels of TNF-α and IL-10 were also measured to enhance our findings. Naïve PMΦ from BALB/c increased the production of H2O2, TNF-α, and IL-10 in the presence of heat-killed spores ofR. oryzae, while naïve PMΦ from Swiss mice was less responsive. Naïve AMΦ from two strains of mice were less reactive to heat-killed spores ofR. oryzaethan PMΦ. On 30 days ofR. oryzaeintravenous infection, lower fungal load in BALB/c strain of mice was accompanied by higher production of H2O2by PMΦ when compared with Swiss mice. Differently, AMΦ from BALB/c mice showed higher production of NO, TNF-α, and IL-10 after 7 days of intratracheal infection and after 30 days, lower fungal load, when compared with Swiss mice. According to the set of experiments performed, our findings reveal that independently of mice strain, PMΦ is more reactive againstR. oryzaein the first contact than AMΦ. In addition, increased PMΦ production of H2O2at the end of disseminated infection is related to efficient fungal clearance observed in resistant (BALB/c). Our findings provide new evidence to understand the parasite-hosts relationship in mucormycosis.

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Notes from the Field: COVID-19–Associated Mucormycosis — Arkansas, July–September 2021

Cited by 20 publications

References 8 publications

Insulin and Early Debridement keys to survival of COVID 19 associated mucormycosis (CAM) patients- An Experience from tertiary care hospital In India

Insulin and Early Debridement keys to survival of COVID 19 associated mucormycosis (CAM) patients- An Experience from tertiary care hospital In India

A Rare Case of Empyema Complicated With Bronchopleural Fistula Secondary to Mucormycosis in a Young Immunocompromised Diabetic Patient With COVID-19

Is the production of reactive oxygen and nitrogen species by macrophages associated with better infectious control in the experimental disseminated and pulmonary mucormycosis?

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