ABSTRACT
Mucormycosis or 'Black Fungus' has been known to target immunocompromised individuals even before the emergence of COVID-19. Nevertheless, the present circumstances provide the best opening for Covid Associated Mucormycosis (CAM), as the global pandemic is engulfing a large part of human population making them immunocompromised. This drastic increase in Mucormycosis infections has to be addressed as early as possible. There is a growing tendency of relying upon herbal drugs that have minimal side effects and does not compromise our immune system. Recently, the concept of network pharmacology has grabbed the attention of modern science, especially advanced medical sciences. This is a new discipline that can use computational power to systematically catalogue the molecular interactions between botanical formulations and the human body. In this study, Neem and Turmeric was considered as the target plants and an attempt was made to reveal various aspects through which phytocompounds derived from them may effectively manage CAM menace. We have taken a step-by-step approach for identifying the target proteins and ligands associated with Mucormycosis treatment. Functional network analysis and Molecular docking approaches were applied to validate our findings. Quercetin derived from both Neem and Turmeric was found to be one of the main phytocompounds working against Mucormycosis. Along with that, Caffeic acid, Curcumin, Kaempferol, Tetrahydrocurcumin and Myricetin also play a pivotal role in fighting against Black-Fungus. A thorough analysis of our result suggested a triple-front attack on the fungal pathogens and the approaches are necrosis inhibition, iron chelation and immuno-boosting.Communicated by Ramaswamy H. Sarma.
ABSTRACT
Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study: To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Material(s) and Method(s): An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of Rhino-Orbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Result(s): Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion(s): The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality.Copyright © 2022 Indian Medical Association. All rights reserved.
ABSTRACT
Background: Covid-19 infection time and again has been causing major morbidities and mortalities. Increased vulnerability of Covid-19 recovered patients was seen towards mucormycosis infection. Mucormycosisis is an aggressive, angioinvasive fungal disease caued by fungi of order Mucorales. This increase in cases may be attributed to a weakened immune system, pre-existing comorbidities such as diabetes, overzealous use of steroids. We conducted a study on 25 cases admitted in mucor ward in a tertiary care setting to highlight this association and focusing on possible causes so that we can be prepared to handle any such catastrophe in future in a better way. Methods and Results: We did a retrospective study on 25 cases admitted in a tertiary care center catering to large population of Covid -19 patients with varying severity.Covid-19 associated mucormycosis(CAM) was found to be more common in males(76%).Diabetes mellitus was the most common underlying condition(72%).68% patients had received steroids and antibiotics, 28% patients had history of receiving Oxygen. In CAM predominant presentation was rhino-orbital mucormycosis. Unilateral orbit involvement was seen in (88%) cases. Conclusion(s): As severe acute respiratory syndrome coronavirus-2 is highly susceptible to mutations and is causingseries of waves, its association with opportunistic fungal infection is a serious concern. Incidences of mucormycosis were increased in Covid-19 patients due to immune modulation and coexistence of immunosuppressive conditions such as diabetes. Concurrent glucocorticoid therapy further heightens the risk. Early diagnosis and prompt intervention can help improve outcome. Copyright © 2023 Ubiquity Press. All rights reserved.
ABSTRACT
Mucormycosis is a rare and invasive fungal disease with potentially fatal outcome. It most commonly affects patients with compromised immunity, especiallly those with poorly controlled diabetes. The incidence of mucormycosis has increased after the COVID-19 pandemic and both COVID-19 and mucormycosis are associated with an increased incidence of stroke. We present a report of two cases of COVID associated mucormycosis who had stroke. A 50-year-old patient with uncontrolled diabetes developed swelling of left eye and face ultimately leading to complete ophthalmoplegia of left eye. Imaging studies of brain revealed infarcts. MRI/MRA brain showed left internal carotid artery thrombosis, cavernous sinus thrombosis and a brain abscess in left temporal lobe. A second patient was a 65-year-old diabetic and hypertensive male who had COVID and then developed right MCA territory infarct and right sided cavernous sinus thrombosis. Diagnostic nasal endoscopy and biopsy was suggestive of mucormycosis in both the cases. Both these cases were managed with combination of tight glycemic control, antifungal therapy, and surgery. Clinicians should be aware of the association of stroke with COVID and COVID associated mucormycosis (CAM). Copyright © 2022 International Medical Sciences Academy. All rights reserved.
ABSTRACT
Background: Covid-19 infection time and again has been causing major morbidities and mortalities. Increased vulnerability of Covid-19 recovered patients was seen towards mucormycosis infection. Mucormycosisis is an aggressive, angioinvasive fungal disease caued by fungi of order Mucorales. This increase in cases may be attributed to a weakened immune system, pre-existing comorbidities such as diabetes, overzealous use of steroids. We conducted a study on 25 cases admitted in mucor ward in a tertiary care setting to highlight this association and focusing on possible causes so that we can be prepared to handle any such catastrophe in future in a better way. Methods and Results: We did a retrospective study on 25 cases admitted in a tertiary care center catering to large population of Covid -19 patients with varying severity.Covid-19 associated mucormycosis(CAM) was found to be more common in males(76%).Diabetes mellitus was the most common underlying condition(72%).68% patients had received steroids and antibiotics, 28% patients had history of receiving Oxygen. In CAM predominant presentation was rhino-orbital mucormycosis. Unilateral orbit involvement was seen in (88%) cases. Conclusion(s): As severe acute respiratory syndrome coronavirus-2 is highly susceptible to mutations and is causingseries of waves, its association with opportunistic fungal infection is a serious concern. Incidences of mucormycosis were increased in Covid-19 patients due to immune modulation and coexistence of immunosuppressive conditions such as diabetes. Concurrent glucocorticoid therapy further heightens the risk. Early diagnosis and prompt intervention can help improve outcome. Copyright © 2023 Ubiquity Press. All rights reserved.
ABSTRACT
Diabetes Mellitus predisposes patients to invasive fungal infections. There has been a recent surge of Mucormycosis with COVID 19 infection particularly in patients with diabetes. This study aims to study the clinical spectrum of CAM (COVID-associated Mucormycosis) with diabetes and subsequent outcomes. Material(s) and Method(s): Descriptive study was conducted among the patients attending Ophthalmology OPD in a Tertiary Care Centre in Telangana with COVID Associated Mucormycosis(CAM) from March 2021 to June 2021. Result(s): Among 200 patients who attended OPD with CAM, Diabetes Mellitus was the most common co-morbidity. The majority of the patients had poor glycaemic control with a mean HbA1c of 9.06%. Pre-existing diabetes mellitus (DM) was present in 84% of cases. Out of the total study population, 89% had prior exposure to high dose corticosteroids. Conclusion(s): The disease has surged in COVID 19 pandemic due to uncontrolled diabetes and improper corticosteroid use. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
ABSTRACT
Purpose: An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.