Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study

Çağ, Yasemin; Erdem, Hakan; Gündüz, Mehmet; Kömür, Süheyla; Ankaralı, Handan; Ural, Serap; Taşbakan, Meltem; Tattevin, Pierre; Tombak, Anıl; Öztürk-Engin, Derya; Tartar, Ayşe Sağmak; Batırel, Ayşe; Tekin, Recep; Duygu, Fazılet; Çaşkurlu, Hülya; Kurtaran, Behice; Durdu, Bülent; Hacıseyitoğlu, Demet; Rello, Jordi; Sırmatel, Fatma; Lakatos, Botond; Öncü, Serkan; Willke, Ayşe; Puca, Edmond; Koç, Meliha Meriç; Korkmaz, Pınar; Karabay, Oğuz; Güner, Rahmet; Çaylak, Selmin Dirgen; Keçeli, Sema Aşkın; Cesur, Salih; Menekşe, Şirin; Ergen, Pınar; Taşbakan, Mehmet Sezai; Erdem, Ayşegül; Çağ, Yakup; Akçay, Emine; Fasciana, Teresa; Giammanco, Anna; Girgin, Rabia Burçin; Agalar, Canan; Vahaboğlu, Haluk

doi:10.1016/j.ejim.2022.03.008

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…High-dose liposomal amphotericin B is the first line treatment for mucormycosis [ 6 ]. It is well established that antifungals are insufficient alone in treating ROCM and surgical debridement is needed, as the removal of necrotic tissues is necessary to allow antifungal penetration and is associated with better prognosis [ 128 ]. Lipid formulation of amphotericin B is preferred over Amphotericin B deoxycholate due to less nephrotoxicity and better CNS penetration.…”

Section: Treatmentmentioning

confidence: 99%

“…Early initiation of antifungal therapy and surgical removal of operable lesions are the mainstay of management for mucormycosis [ 39 ]. Surgical debridement of necrotic tissues is required among ROCM infections and multiple sessions may be needed to treat residual and recurrent disease [ 128 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Delay in identification of CAM may be an important prognostic factor [ 128 ], as in studies where both mortality rates and the time period between COVID-19 and CAM diagnosis were recorded, median mortality was 33.7% (Q1:16.7, Q3:51, IQR 34.3%) when CAM diagnosis was performed after 15 days from COVID-19 diagnosis and 23.4% (Q1:15.5, Q3:50, IQR 34.5%) when it was performed ≤15 days post COVID-19 diagnosis.…”

Section: Outcomementioning

confidence: 99%

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Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

et al. 2022

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A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

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Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

et al. 2022

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“…Albeit relatively rare, IM is one of the deadliest infection among patients with hematologic cancer [ 1 , 2 , 3 •, 4 ]. It may also affect patients with other immunosuppressive conditions, such as solid-organ transplant recipients and apparently immunocompetent individuals, such as those with uncontrolled diabetes mellitus and ketoacidosis [ 1 , 2 , 5 , 6 ]. Recently, a high incidence of IM has been reported among patients with severe Coronavirus disease 2019 (COVID-19), in particular those with diabetes [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…A similar poor outcome has been reported among patients with COVID-19–associated mucormycosis (CAM) [ 7 , 8 , 17 ]. A lower mortality rate has been reported among diabetic patients with ROC compared to that in hematologic patients with other localizations of the disease (mainly pulmonary) in some studies, but not all [ 3 •, 5 , 19 , 20 ]. Disseminated forms and cerebral mucormycosis are associated with the worst outcome with up to 80% mortality rates [ 3 •, 20 ].…”

Section: Introductionmentioning

confidence: 99%

Novel Approaches in the Management of Mucormycosis

Lamoth

2023

Curr Fungal Infect Rep

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Purpose of Review Invasive mucormycosis (IM), caused by fungi of the order Mucorales, is one of the deadliest fungal infection among hematologic cancer patients. Its incidence is also increasingly reported in immunocompetent individuals, notably with the COVID-19 pandemic. Therefore, there is an urgent need for novel diagnostic and therapeutic approaches of IM. This review discusses the current advances in this field. Recent Findings Early diagnosis of IM is crucial and can be improved by Mucorales-specific PCR and development of lateral-flow immunoassays for specific antigen detection. The spore coat proteins (CotH) are essential for virulence of the Mucorales and may represent a target for novel antifungal therapies. Adjuvant therapies boosting the immune response, such as interferon-γ, anti-PDR1 or fungal-specific chimeric antigen receptor (CAR) T-cells, are also considered. Summary The most promising perspectives for improved management of IM consist of a multilayered approach targeting both the pathogen and the host immune system.

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Amphotericin B/amphotericin B liposomal

2023

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Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study

Cited by 11 publications

References 29 publications

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

Novel Approaches in the Management of Mucormycosis

Amphotericin B/amphotericin B liposomal

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