Abstract:Pulmonary mucormycosis (PM) is a rare disease. Literature about the surgical management of PM in India is sparse. Recently, there has been a surge in the number of cases of mucormycosis in association with the coronavirus disease 2019 (COVID-19) pandemic, igniting the interest in PM. Hence, we endeavoured to analyse our surgical experience in treating PM prior to the pandemic, in a tertiary care centre, to provide insight into this disease. Data of 10 adult patients with isolated PM, who underwent surgery betw… Show more
“… 94 A few patients with potentially resectable disease might not be operable due to multiple comorbidities or frailty. 95 , 96 The treatment decision for these patients needs to be individualised, ideally after a discussion involving a multidisciplinary team, consisting of thoracic surgeons, clinicians, and radiologists. Figure 2 Proposed algorithm for treating CAPM CAPM=COVID-19-associated pulmonary mucormycosis.…”
“… 94 A few patients with potentially resectable disease might not be operable due to multiple comorbidities or frailty. 95 , 96 The treatment decision for these patients needs to be individualised, ideally after a discussion involving a multidisciplinary team, consisting of thoracic surgeons, clinicians, and radiologists. Figure 2 Proposed algorithm for treating CAPM CAPM=COVID-19-associated pulmonary mucormycosis.…”
“…There was a total of 951 positions in the final dataset. Evolutionary analyses were conducted in MEGA7 (16).…”
Section: Discussionmentioning
confidence: 99%
“…pandemic brought mucormycosis back into the limelight due to its increased incidence in several Asian countries. For example, the number of case reports and case series published on mucormycosis in COVID-19 patients in India has increased dramatically in the last 2-3 years[4,[15][16][17].…”
Introduction. Mucormycosis is a severe angio-invasive fungal infection caused by mucormycetes, a group of fungi that are ubiquitous in the environment. The incidence of mucormycosis has been surging rapidly due to the global corona virus disease 2019 (COVID-19) pandemic.
Gap Statement. The complete picture of the causative fungi associated with mucormycosis and their phylogenetic relationships are not well defined.
Aim. This meta-analysis aimed to collate all confirmed fungal pathogens that cause mucormycosis, and assess their taxonomic relationships.
Methodology. All types of articles in the PubMed database that report fungi as a cause of mucormycosis were reviewed. We summarized the fungal morphological characteristic up to the genus level. The internal transcribed spacer (ITS) nucleotide sequences of these fungi were retrieved from the National Center for Biotechnology Information (NCBI) and UNITE databases whenever available, and multiple sequence analysis was conducted using Clustal W. The phylogenetic tree was constructed using mega version 7.
Results. Forty-seven fungal species were identified as pathogens causing mucormycosis in humans. Thirty-two fungal species were phylogenetically grouped into three clades, and it was evident that the ITS sequences have well-conserved regions in all clades, especially from the 400th to 500th base pairs.
Conclusion. The findings of this work contribute to the descriptive data for fungi that cause mucormycosis, emphasizing the need for robust phylogenetic approaches when identifying clinical isolates from infected patients.
“…Surgical resection was a major factor associated with survival in multivariate analysis in a subgroup of patients with hematologic malignancies (odds ratio = 0.71) [ 50 ]. Chronic steroid intake or hypoproteinemia has been found to be associated with adverse surgical outcome as either a post-operative complication or in-hospital mortality [ 51 ]. While emergent surgery is warranted in those presenting with massive hemoptysis, in most cases, surgery should ideally be timed within 1–2 weeks of appropriate medical therapy, once metabolic abnormalities such as dysglycemia and dyselectrolytemias are corrected [ 8 ].…”
COVID-19-associated mucormycosis (CAM) emerged as an epidemic in certain parts of the world amidst the global COVID-19 pandemic. While rhino–orbital mucormycosis was well reported during the pandemic, in the absence of routine diagnostic facilities including lower airway sampling, pulmonary mucormycosis was probably under-recognized. In this review, we have focused on the epidemiology and management of COVID-19-associated pulmonary mucormycosis (CAPM). CAPM is a deadly disease and mortality can be as high as 80% in the absence of early clinical suspicion and treatment. While histopathological examination of tissue for angio-invasion and cultures have remained gold standard for diagnosis, there is an increasing interest in molecular and serological methods to facilitate diagnosis in critically ill patients and often, immune-suppressed hosts who cannot readily undergo invasive sampling. Combined medical and surgical treatment offers more promise than standalone medical therapy. Maintaining adequate glycemic control and prudent use of steroids which can be a double-edged sword in COVID-19 patients are the key preventative measures. We would like to emphasize the urgent need for the development and validation of reliable biomarkers and molecular diagnostics to facilitate early diagnosis.
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