Invasive Mucormycosis and Aspergillosis Coinfection Associated with Post-COVID-19 Pneumonia in a Tertiary Care Hospital

Paul, Mousumi; Sasidharan, Jaseetha; Taneja, Juhi; Chatterjee, Kuhu; Abbas, Shahid; Chowdhury, Veena; Das, Asim

doi:10.3314/mmj.21-00019

Cited by 9 publications

(3 citation statements)

References 17 publications

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“…All their patients had DM as an associated comorbid condition and were treated with systemic liposomal amphotericin B and surgical debridement. 14 Rai and Kumar reported a case of dual pulmonary invasive fungal infection comprising of Aspergillus and Mucor in COVID-19 patients; the imaging findings were highly suggestive of post-COVID-19 pulmonary fungal disease. The diagnosis was confirmed by the galactomannan antigen test for Aspergillus and PCR for Mucorales on bronchoalveolar lavage fluid.…”

Section: Discussionmentioning

confidence: 99%

Invasive mixed fungal disease after covid-19: A series of seven cases

Walke,

Jayashankar,

Karuna

et al. 2023

JLP

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Coronavirus disease 2019 (COVID-19) is a recent global pandemic that is caused by the novel severe acute respiratory syndrome coronavirus 2. The patients of COVID-19 are susceptible to a diverse range of secondary infections, fungal being the most common. The increased risk is proposed to be due to the generous use of steroids for the treatment of COVID-19 infection and the presence of comorbidities, such as diabetes mellitus, hypertension, preexisting lung diseases, and/or old age. Invasive mixed fungal disease is potentially life-threatening to the patients of COVID-19. In the present series of seven cases, the authors intend to discuss the clinicopathological profile and gamut of histopathological findings in invasive mixed fungal infection comprising of Mucor and Aspergillus in treated patients of COVID-19. Six patients had a clinical diagnosis of sinonasal–orbital invasive fungal disease, while there was a case of lung infection. The acquaintance and knowledge about histomorphology of invasive fungi and the multidisciplinary diagnostic approach not only will aid in early and accurate diagnosis but can guide the clinician for necessary surgical intervention and initiation of appropriate antifungal medications in patients of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Invasive mixed fungal disease after covid-19: A series of seven cases

Walke,

Jayashankar,

Karuna

et al. 2023

JLP

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“…Such coinfections are rare; Paul et al have reported a series of 12 cases of mucormycosis and aspergillus infection. 20 In the present study predominantly, the histopathological spectrum was analysed, however there are other tests which can used for diagnosis of mucormycosis. Microbiological tests such as KOH (Potassium Hydroxide) wet mount reveals fungal hyphae, Calcofluor white (CFW) stain (a non-specific fluorochrome dye), culture using Sabouraud's Dextrose agar (SDA) is most common.…”

Section: Discussionmentioning

confidence: 99%

Histopathological spectrum of fungal infections in COVID 19 cases – A retrospective observational study

Mishra,

Patkar

2023

ACHR

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A wide range of fungal and bacterial infections are associated with Corona virus disease (COVID19). There was a surge of mucormycosis during COVID19 pandemic in 2021. This study elaborates the histopathological findings observed in fungal infections of head and neck in COVID 19 patients. A retrospective observational study of histopathological findings of invasive fungal infection in COVID 19 case was conducted in our laboratory. All the tissue samples diagnosed as post COVID fungal infections during January 2021 to June 2021 were analyzed. Representative sections were taken and slides were stained with Hematoxylin & Eosin, Periodic Acidic Schiff (PAS) and Gomori Methenamine silver (GMS) stains. Histopathological features were studied. There were total 32 cases which had invasive fungal infections associated with COVID 19. The most affected age group was 31 to 50 years of age (50%), with male preponderance (87.5%). Diabetes was present in 62.5% cases, and steroid use during the treatment was present in 31.3% of the cases. The most common site was maxillary sinus (53.1%) followed by nasal cavity (34.4%). Isolated infection by mucor was seen in 68.8% cases, there were cases of secondary bacterial infection and candida with aspergillus infection. Angioinvasion was present in 56.3% cases and bone destruction in 15.6% cases.COVID 19 infection results in immune dysregulation and background of diabetes and over use of steroids increases risk of mucormycosis. An early histopathological diagnosis provides early diagnosis.

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“…Based on our literature review, we encountered six cases of HLH secondary to aspergillosis with a mean age of ~47 years (Table 3) [8][9][10][11][12][13]. On her follow-up appointment after discharge, she was sent for HLH genetic analysis which tests for many genes involved in the pathogenesis of primary HLH, she did not have the test done (possibly due to the cost), and she did not follow up afterward.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review

Ali¹,

Sen²,

Tan³

2022

Cureus

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Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE.HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications.Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.

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Invasive Mucormycosis and Aspergillosis Coinfection Associated with Post-COVID-19 Pneumonia in a Tertiary Care Hospital

Cited by 9 publications

References 17 publications

Invasive mixed fungal disease after covid-19: A series of seven cases

Invasive mixed fungal disease after covid-19: A series of seven cases

Histopathological spectrum of fungal infections in COVID 19 cases – A retrospective observational study

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review

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