Multidisciplinary approach in diagnosis and treatment of COVID-19-associated mucormycosis: a description of current reports

Abstract

Background We reviewed the epidemiology, risk factors, pathophysiology, and clinical presentations of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM), then discussed the importance of rapid diagnosis and treatment facilitated by multidisciplinary approach. Main body India has reported world’s highest number of CAM cases where Rhizopus arrhizus was the most predominant etiology. CAM caused by Rhizopus microsporus was the most common from the rest of the world. Multiple risk factors for CAM were identified including diabetes mellitus, inappropriate corticosteroid use, COVID-19-related hypoxia, and lung damage. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for almost 90% of CAM in India while 64% of global cases were ROCM. Less than 10% of CAM from India were pulmonary while the rest of the world reported 21% of pulmonary CAM. CAM is diagnosed by confirmed SARS-CoV2 infection along with clinical, radiological, histopathological, and/or microbiological evidence of mucormycosis. In patients with risks of CAM and associated symptoms, CT or MRI are recommended. If ROCM is suspected, endoscopy and biopsy are recommended. If pulmonary CAM is suspected, tissue biopsies, nasal samples, or bronchoalveolar lavage is recommended with histopathological exams. Early diagnosis, surgical, and pharmaceutical interventions are key to treat mucormycosis. Upon diagnosis, antifungal therapy with liposomal amphotericin B (IV) is considered first-line of therapy. Alternatively, posaconazole (PO/IV) or isavuconazole (PO/IV) can be used. Conclusion Treating CAM requires a multidisciplinary approach for early diagnosis and prompt initiation of interventions to maximize patient’s chance of survival.

The First Fungal Identification from Mini-BAL of Critical COVID-19 Patients

“…Mucor spp., which belongs to the order Mucorales, can cause invasive fungal infections (16). Although a study conducted before the COVID-19 pandemic showed an almost 2.5-fold increase in the incidence of mucormycosis in Iran from 2008 to 2014, the prevalence of this fungal infection has grown 50 times globally after the COVID-19 pandemic (3).…”

The Mucormycosis Crisis: An Epidemic Within a Pandemic

“…But these are generally recommended as prophylaxis of mucormycosis infections. 35 In case of unavailability of Isavuconazole and posaconazole, Itrocanzole; another azole derivative may be recommended for mucormycosis management. However, its efficacy against Mucorales requires further trials and research.…”

Diabetic post-covid mucormycosis: A dermatoglyphic prediction

“…Due to the challenges and complexity associated with early diagnosis and management of covid-associated mucormycosis, it would be best handled by a multidisciplinary team. [ 9 ] Several studies have been done around the globe on the dermatoglyphic pattern in patients with diabetes mellitus. This study is an attempt to identify the characteristic pattern/parameter among the post-covid mucormycosis diabetic patients which may further help in identifying such susceptible patients in a much earlier course of the disease.…”