Mucormycosis as SARS-CoV2 sequelae in kidney transplant recipients: a single-center experience from India

Meshram, Hari Shankar; Kute, Vivek; Chauhan, Sanshriti; Dave, Ruchir; Patel, Himanshu V.; Banerjee, Subho; Desai, Sudeep; Kumar, Deepak; Navadiya, Vijay; Mishra, Vineet

doi:10.1007/s11255-021-03057-5

Cited by 10 publications

(6 citation statements)

References 46 publications

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“…In general, in transplant recipients receiving immunosuppression who develop CAPM, low-dose glucocorticoids could be continued to avoid graft rejection. 93 …”

Section: Resultsmentioning

confidence: 99%

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

Muthu

Agarwal

Patel

et al. 2022

The Lancet Infectious Diseases

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“…In general, in transplant recipients receiving immunosuppression who develop CAPM, low-dose glucocorticoids could be continued to avoid graft rejection. 93 …”

Section: Resultsmentioning

confidence: 99%

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

Muthu

Agarwal

Patel

et al. 2022

The Lancet Infectious Diseases

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“…There was a sudden surge in “black fungus” mucormycosis across India in non‐transplant recipients 29,30 . A similar study by Kute and coworkers 31 also reported 11 cases of post‐COVID mucormycosis among RTRs, and an approximately equal mortality of 27% was reported within that cohort. To our surprise, we did not observe a significant association with DM and other induction regimens associated with a substantial risk of these fungal infections in the post‐COVID period.…”

Section: Discussionmentioning

confidence: 79%

The adverse effects of high‐dose corticosteroid on infectious and non‐infectious sequelae in renal transplant recipients with coronavirus disease‐19 in India

Veeranki

Prasad

Meyyappan

et al. 2022

Transplant Infectious Dis

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Introduction The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease‐19 (COVID‐19) is not well defined. We aimed to analyze the outcomes and infectious and non‐infectious sequelae in RTR with COVID‐19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID‐19. Materials and methods This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID‐19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non‐infectious sequelae with reference to high‐dose and standard‐dose corticosteroids. Results A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high‐dose steroids was also significantly high in non‐survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID‐19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6‐month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post‐COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high‐dose corticosteroid group than in the standard‐dose group. Conclusion High‐dose corticosteroid dosing in RTRs with COVID‐19 was associated with increased infections, particularly fungal infections, and non‐infectious sequelae with higher mortality on subsequent follow‐up.

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“…[ 12 ] (N = 2,826) was excluded because this study included probable/possible cases of CAM as well as microbiologically or histopathologically confirmed CAM; we were unable to extract data of proven CAM separately from their report. Of the remaining 53 studies, we excluded 2 case series [ 18 , 19 ] because observational studies with larger sample sizes have been published by the same authors. Eventually, 36 observational studies and 15 case series with a total of 2,312 proven CAM cases were included in our meta-analysis [ 7 , 9 , 20 – 68 ](Fig.…”

Section: Resultsmentioning

confidence: 99%

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Watanabe

Mitaka

et al. 2022

Mycopathologia

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The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12–21%, I 2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22–36%, I 2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.

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Mucormycosis as SARS-CoV2 sequelae in kidney transplant recipients: a single-center experience from India

Cited by 10 publications

References 46 publications

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

The adverse effects of high‐dose corticosteroid on infectious and non‐infectious sequelae in renal transplant recipients with coronavirus disease‐19 in India

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

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