ABSTRACT
Introduction: Mucormycosis is a life-threatening angio-invasive infection caused by fungi of the order Mucorales. In India, the second wave of the COVID pandemic, primarily driven by the delta variant, led to a surge in cases of mucormycosis. The majority of these cases occurred following recovery from COVID, and resulted in increased morbidity and mortality. Here we present a series of five kidney transplant recipients (KTR’s) who presented with COVID-related mucormycosis. Methods: This is a single-centre, prospective, observational study that included all KTRs who presented to Madras Medical College with COVID-related mucormycosis between May 2021 and August 2021. Relevant clinical details and laboratory data were collected, therapeutic interventions were recorded, and outcomes of hospitalization were noted. Results: Five patients developed COVID-related mucormycosis during the study period. Their clinical details and hospital course are summarized in Table 1. Only one patient had received COVID vaccination (2 doses of covishield). All patients had underlying post-transplant diabetes mellitus, with severe hyperglycemia at admission. They all received intravenous dexamethasone for COVID pneumonia. Mucormycosis developed 10-21 days after recovery from COVID in four patients;one patient developed both infections concurrently. All patients received liposomal Amphotericin B, with four patients also undergoing functional endoscopic sinus surgery (FESS). Acute graft dysfunction occurred in all five patients;three had complete renal recovery, one had partial renal recovery, and one patient died during hospitalisation. [Formula presented] Conclusions: All five KTR’s in our series who developed COVID-related mucormycosis had acute graft dysfunction. They all had multiple risk factors that included elements of hyperglycemia, sepsis and nephrotoxic drugs (amphotericin B). Four of our five patients recovered, with only one case succumbing to the infection No conflict of interest
ABSTRACT
Background: Organ transplant recipients are at increased risk of infections which may result in acute graft dysfunction and death. Coronavirus disease (COVID-19) is the ongoing global infectious challenge and little is known about the impact of this novel virus in kidney transplant recipients. We here describe the clinical presentations, laboratory profile, and outcomes of 42 such patients, from a large tertiary care center in south India. Materials and Methods: This prospective, observational study included all renal transplant recipients with confirmed COVID-19 by reverse transcription polymerase chain reaction from the start of the outbreak till August, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed. Results: Forty-two patients were included in the analysis. As many as, 86.7% patients of our cohort had symptoms at presentation, with the most common symptoms being fever (52.5%), breathlessness (50%), and cough (40.5%). Significant need for respiratory support was noted in individuals with longer duration posttransplant (P < 0.03). Acute worsening of allograft function was observed in 22 (52.4%) patients. Fourteen (65%) of them had acute on chronic graft dysfunction and acute graft dysfunction was noted in 8 (35%) patients. Six patients (14.5%) died due to the disease and none of the parameters were found to be an independent predictor of mortality in regression analytic models including acute graft dysfunction (P = 0.49) or acute on chronic graft dysfunction (P = 0.07). There was no correlation between disease severity and baseline immunosuppressive agents whether tacrolimus or cyclosporine (P = 0.57) and mycophenolate mofetil or azathioprine (P = 0.91). Conclusions: Our largest cohort of patients from India showed higher incidence of acute graft dysfunction and significant mortality in patients with COVID-19.
ABSTRACT
The coronavirus disease - 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus virus - 2 (SARS-CoV-2), set it foots in China during December 2019 as a high-alert public health emergency. This malady had thereafter spread rapidly across the globe in more than 215 countries, affecting more than 50 million people and causing the death of nearly 1.3 million as of 9th November, 2020 and resulted in a massive panic, fear, and economic crashes in most of the world. A better understanding of the disease, the virus, structural biology, clinical manifestations, risk factors, transmission, diagnosis, treatment, and management can be extrapolated from the literature review of the research up to date. In addition, deliberations on animal linkages, spillover and zoonotic implications for exploring the actual origin of the disease and all possible animal-human interfaces, intermediate host;diagnosis for devising specific and sensitive tests of ease, accessibility and affordability;advances in the development of safe and effective vaccines and therapeutics for prevention and treatment;management of COVID-19 practicable in all countries;application of traditional or regularly used modalities including plant-based products and medicinal herbs against SARS-COV-2;nutritious dietary foods against this disease;and socio-economic impacts of COVID-19 can provide valuable information on these various aspects. Most of the research currently focuses on disease, development of a vaccine or therapeutic modalities. But the future mortality rate and virulence of virus not only depends on the evolution of the virus, but also on how we develop preventive measures and effective treatment as well as in advance preparedness. The present review highlights salient aspects of SARS-CoV-2/COVID-19, pathology, risk factors, transmission, diagnosis, potential treatment, and alternative/supportive therapeutic options.
ABSTRACT
The coronavirus disease – 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus virus – 2 (SARS-CoV-2), set it foots in China during December 2019 as a high-alert public health emergency. This malady had thereafter spread rapidly across the globe in more than 215 countries, affecting more than 50 million people and causing the death of nearly 1.3 million as of 9th November, 2020 and resulted in a massive panic, fear, and economic crashes in most of the world. A better understanding of the disease, the virus, structural biology, clinical manifestations, risk factors, transmission, diagnosis, treatment, and management can be extrapolated from the literature review of the research up to date. In addition, deliberations on animal linkages, spillover and zoonotic implications for exploring the actual origin of the disease and all possible animal-human interfaces, intermediate host;diagnosis for devising specific and sensitive tests of ease, accessibility and affordability;advances in the development of safe and effective vaccines and therapeutics for prevention and treatment;management of COVID-19 practicable in all countries;application of traditional or regularly used modalities including plant-based products and medicinal herbs against SARS-COV-2;nutritious dietary foods against this disease;and socio-economic impacts of COVID-19 can provide valuable information on these various aspects. Most of the research currently focuses on disease, development of a vaccine or therapeutic modalities. But the future mortality rate and virulence of virus not only depends on the evolution of the virus, but also on how we develop preventive measures and effective treatment as well as in advance preparedness. The present review highlights salient aspects of SARS-CoV-2 / COVID-19, pathology, risk factors, transmission, diagnosis, potential treatment, and alternative / supportive therapeutic options. © 2020, Editorial board of Journal of Experimental Biology and Agricultural Sciences. All rights reserved.
ABSTRACT
Newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) pandemic has now spread across the globe in past few months while affecting 26 million people and leading to more than 0.85 million deaths as on 2nd September, 2020. Severity of SARS-CoV-2 infection increases in COVID-19 patients due to pre-existing health co-morbidities. This mini-review has focused on the three significant co-morbidities viz., heart disease, hypertension, and diabetes, which are posing high health concerns and increased mortality during this ongoing pandemic. The observed co-morbidities have been found to be associated with the increasing risk factors for SARS-CoV-2 infection and COVID-19 critical illness as well as to be associated positively with the worsening of the health condition of COVID-19 suffering individuals resulting in the high risk for mortality. SARS-CoV-2 enters host cell via angiotensin-converting enzyme 2 receptors. Regulation of crucial cardiovascular functions and metabolisms like blood pressure and sugar levels are being carried out by ACE2. This might be one of the reasons that contribute to the higher mortality in COVID-19 patients having co-morbidities. Clinical investigations have identified higher levels of creatinine, cardiac troponin I, alanine aminotransferase, NT-proBNP, creatine kinase, D-dimer, aspartate aminotransferase and lactate dehydrogenase in patients who have succumbed to death from COVID-19 as compared to recovered individuals. More investigations are required to identify the modes behind increased mortality in COVID-19 patients having co-morbidities of heart disease, hypertension, and diabetes. This will enable us to design and develop suitable therapeutic strategies for reducing the mortality. More attention and critical care need to be paid to such high risk patients suffering from co-morbidities during COVID-19 pandemic.