The potential for rapid antigen testing for mucormycosis in the context of COVID-19

The mutual value of histopathology and ITS sequencing in the diagnosis of mucormycosis

“…1,2 However, individual prognosis varies, and is largely dependent upon early and accurate diagnosis. 3 In contrast to aspergillosis there are currently no routine antigen tests available for mucormycosis, 4 although promising serological tests have been described recently. 5,6 Furthermore, fungal culture has a low sensitivity in detecting Mucorales.…”

Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker

“…Mucoromycosis (Borman and Johnson, 2023) is a highly destructive angio-invasive disease of humans caused by zygomycete fungi in the order Mucorales (Thornton, 2020), recently characterised as a high priority group in the World Health Organisation's fungal priority pathogens list (WHO, 2022). The disease encompasses debilitating rhino-orbital-cerebral mucoromycosis (ROCM), and pulmonary, cutaneous, gastro-intestinal and disseminated infections (Petrikkos et al, 2012;Ganesan et al, 2019;Jeong et al, 2019;Thornton, 2023) which, prior to the COVID-19 pandemic, were typically seen in patients with haematological malignancies (Miller et al, 2020), in bone marrow and solid organ transplant recipients (Roden et al, 2005;Song et al, 2017;Miller et al, 2020;Skiada et al, 2020) and in individuals with poorly controlled diabetes mellitus (DM), a major independent risk factor for the disease (Corzo-Leoń et al, 2018;Skiada et al, 2020;Thornton, 2023). However, during the second wave of the pandemic in India, there was a dramatic increase in ROCM in patients with severe SARS-CoV-2 infection, exacerbated by a high background prevalence of DM and the overuse of antiinflammatory corticosteroids (John et al, 2021;Rodriguez-Morales et al, 2021;Sen et al, 2021).…”

“…However, during the second wave of the pandemic in India, there was a dramatic increase in ROCM in patients with severe SARS-CoV-2 infection, exacerbated by a high background prevalence of DM and the overuse of antiinflammatory corticosteroids (John et al, 2021;Rodriguez-Morales et al, 2021;Sen et al, 2021). While Rhizopus arrhizus is the principal cause of mucoromycosis worldwide (Prakash and Chakrabarti, 2019;Davies and Thornton, 2022), and was responsible for a large number of cases of COVID-19-associated mucoromycosis (CAM) in India and other countries worldwide (Prakash and Chakrabarti, 2019;Prakash and Chakrabarti, 2021;Hoenigl et al, 2022), Mucorales fungi other than R. arrhizus are able to cause mucoromycosis, including species in the genera Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor, Saksenaea, and Syncephalastrum (A ́lvarez et al, 2009;Gomes et al, 2011;Zaki et al, 2014;Jeong et al, 2019;Walther et al, 2019;Skiada et al, 2020;Thornton, 2023).…”

“…Furthermore, survivors of ROCM are often left with severe facial disfigurement due to the aggressive surgery needed to contain rapidly progressive infections (Sen et al, 2021). The disease is especially problematic in low-to middle-income countries (LMIC), where limited access to well-resourced and appropriately-equipped diagnostic facilities delays diagnosis and treatment (Rudramurthy et al, 2021;Thornton, 2023). There is therefore an urgent need for simple, rapid and accurate diagnostic tests for the disease that can be performed at point-of-care.…”

“…There is therefore an urgent need for simple, rapid and accurate diagnostic tests for the disease that can be performed at point-of-care. Lateralflow immunoassays are ideally suited to point-of-care detection of fungal infections in resource-limited settings (Thornton, 2020;Osaigbovo and Bongomin, 2021;Thornton, 2023), and might help to improve the speed and accuracy of mucoromycosis detection compared to insensitive and time-consuming culture and histopathology, the cornerstones of detection in LMIC countries (Rudramurthy et al, 2021;Thornton, 2023).…”