ABSTRACT
In recent times, numerous reports of systemic fungal infections have been a major concern. The angioinvasive fungal infection, mucormycosis has surged in patients with COVID-19 due to various factors, mainly uncontrolled diabetes and inappropriate corticosteroid use. The prevalence of this acute and fatal fungal infection caused by Mucorales-related fungal species has been highest in the Indian population. COVID-associated mucormycosis (CAM) has a propensity for contiguous spread, and exhibits high morbidity as well as mortality. Unless promptly detected and treated, it is associated with a poor prognosis. A high index of suspicion, aggressive surgical debridement and use of systemic antifungal agents continue to be the standard of care for CAM. Moreover, there is an imperative need to address this public health issue by increasing public awareness and education. This article provides a comprehensive overview on the emergence of CAM during the pandemic, the current burden, pathophysiology, diagnostic interventions and management of CAM in Indian clinical practice.
ABSTRACT
Regarding the investigation of the factors related to the hospitalization of patients with Mucormycosis after being infected with Covid-19, several preliminary studies have been conducted in the hospital, but these studies were conducted in a small environment and have a smaller sample size. Therefore, the aim of the present systematic review study is to examine the factors affecting the hospitalization of patients with mucormycosis after being infected with covid-19. Methods: The current systematic review study was conducted according to PRISMA guidelines (preferred reporting items for systematic seviews and meta-analyses). For this study, the keywords "2019-nCoV", "COVID-19", "SARS-CoV-2", "Coronaviruses", "Hospitaliz", "Factor" and "Mucormycosis" in MagIran, SID, ISI, embase databases, ProQuest, PubMed, scopus were searched. Results: diabetes mellitus, old age, high body mass index, kidney disease, high blood pressure and smoking significantly increase the need for hospitalization in patients with mucormycosis after contracting covid-19. Conclusion: The results of the present study showed that the risk of hospitalization due to Mucormycosis after the covid-19 disease is significantly related to obesity, old age and underlying diseases..
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Background : Mucormycosis is a life threatening fungal disease caused by the filamentous fungi mucormycetes. Though a known entity for decades, it began to manifest in an unprecedented manner in the COVID scenario specially with the second wave in India. The objectives were to describe the demographic characteristics, clinical presentations, risk factors, therapy and in-hospital mortality of patients with Mucormycosis. Material and Methods : We conducted a retrospective observational study for a period of six months from March 2021 to August 2021. The data was collected for cases of mucormycosis from multiple centres all over West Bengal and analysed. All consecutive individuals with confirmed mucormycosis were enrolled in this study. The data documenting demographic particulars, presentation, predisposing factors and comorbiditieswere recorded in a pre validated case report form Details of investigation recording site and extent of disease, therapeutic intervention and outcome was mentioned . Statistical analysis was done using SPSS 21.0 for MS-Windows. Results : The total number of cases from March to August 2021 was 263 . There were 171 males and 92 females and the mean age of occurrence was 50.8+or-0.4 years .In West Bengal clusters of cases were being reported most commonly from the districts of North 24 Parganas, Kolkata, Jalpaiguri, Darjeeling and Hooghly. Some cases admitted here hailed from outside states like Bihar, Jharkhand, Odisha and Assam. The majority of the cases 74.22% (196)were COVID Associated Mucormycosis (CAM) while only 25.78% were non COVID associated. Diabetes mellitus was associated in 78.7% and history of prolonged steroid therapy in 57.4% of cases. We encountered rhino orbital mucormycosis in 99.24% of cases and cerebral involvement in 47.3%. They were treated with Amphotericin B deoxycholate along with endoscopic debridement. The most common side effects of Amphotericin B Deoxycholate were hypokalemia (93%), hypomagnesemia (32%) and AKI (74%) of the cases . The number of patients discharged was 16.7% and 10 left against medical advice (LAMA) . In hospital deaths were recorded to be 26.7%. Cause of death was commonly -AKI, septic shock and multiorgan failure . Conclusion : Prevention is better than cure of this devastating disease which is difficult todiagnose and treat . Awareness about mucormycosis and careful clinical evaluation of post-COVID patients is mandatory in this era in order to rapidly diagnose and treat mucormycosis.
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Objectives: COVID-19 pandemic has shown a substantial impact on the entire world both physiologically and psychologically. By the hit of the second wave, which opened dangerous gates for secondary infections, apprehension was carried among health-care sectors. These secondary infections were due to decreased immunity. On the other hand, risk modifiers, such as diabetes and hypertension played a leading role in the mortality rate. A substantial number of studies have not been conducted so far regarding the impact of this second wave on dental healthcare professionals. The present study aimed to evaluate the dental healthcare professionals' perspective levels during the second wave of the COVID-19 pandemic through a web-based survey. Material and Methods: A total of 853 responses were gathered by sending 15 questions in Google forms. Data collected were gathered and subjected to statistical analysis, expressed in frequency distribution and Pearson's Chi-square test was performed. Results: Data obtained and projected that the study population expressed higher anxiety and stress levels, despite which was many of them showed an inclination to work during these tough times. The knowledge about secondary fungal infections like Mucormycosis, which was caused due to immune suppression, was abundant among the participants. A significant proportion conveyed the ill effect of COVID-19 on clinical practice and academics as well. Conclusion: Dental professionals have shown a positive perspective despite of higher stress levels and being a part of frontline workers, they are much primed to assure, educate, and treat the patients amidst the COVID-19 pandemic.
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A prospective study was done during mid-April to mid-June 2021 to analyze the sudden rise in cases of Mucormycosis. We assessed characteristics, related comorbidities, disease locale, steroid administration and disease outcome in patients. Cases of Mucormycosis associated with RTPCR positive for Coronavirus disease (COVID-19) and Mucormycosis occurring in patients with negative RTPCR for COVID-19 were compared. A total of 103 Mucormycosis patients were analyzed, 84 (81.55%) were RTPCR positive. Uncontrolled Diabetes Mellitus (70.87%) was the most common comorbidity present among RTPCR positive and negative Mucormycosis patients. Rhino-orbital and Rhino-sinusoidal sites were equally involved (44.0%), followed by Rhino-orbital-cerebral (11.9%) region. We ascribe the spike in Mucormycosis episodes to the trio of diabetes, excessive corticosteroid usage in the face of the COVID-19 Pandemic.
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Mucormycosis is a rare type of fungal infection commonly known as zygomycosis, the infection tends to crop up more commonly in individuals with low and weakened immunity level, if left untreated, the mucormycosis can be life-threatening and fatal. Mucormycosis previously known as zygomycosis is a consequential type of infection caused by several mildews known as micromycetes. The revised taxonomical studies revealed that the micromycetes causing the infections are classified as the species of phylum Glomeromycota, class Glomeromycetes, subphylum Mucoromycotina, order Mucorales. The genera of Rhizopus, Mucor, Lichtheimia, Cunninghamella, Rhizomucor, and Apophysomyces, constitute the causative agents of the majority of cases of mucormycosis. The angioinvasive type of disorder caused by mucormycosis is further classified as Mucorales. The patients with Diabetes ketoacidosis and diabetes mellitus are at high-risk factors, followed by the patients with organ transplant, immunocompromised disease, and malignancy. The route of exposure to Mucormycosis may be through the wounded infection that can be pneumonic, or dermal in origin. In the ectodermal form, the fungal organism can invade the skin through open or puncture wounds, or the laceration on the skin. However, the infection has a high mortality rate, the key to successful treatment is early diagnosis, and administration of antifungal drugs, with extensive therapy, followed by surgical debridement of the infection. The morbidity and mortality rate are still at a high number, due to the negligence of the patient to seek medical treatment. Hence the early diagnosis and treatment with antifungal drugs with surgical debridement is a must. The efficacy of oral and venous formulations in the treatment of mucorales is still under debate. Despite the aggressive therapy, the mortality rate is increasing worldwide. The studies have to be conducted to invent the fastest treatment protocol for the treatment of Mucormycosis.
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Rhino-orbital mucormycosis (ROM) is an acute and fulminant infection. The number of ROM cases developing after coronavirus disease 2019 (COVID-19) is increasing. A 62-year-old male patient was admitted to the emergency department in northern Syria complaining of new-onset vision loss, swelling, and severe swelling of the left eye. It was noted that a 3-day course of prednisolone 250 mg was given to treat COVID-19. We found that he had a history of diabetes mellitus (DM) for 10 years. Physical examination revealed ptosis, proptosis, and ocular movement restriction in all directions in the left eye. All other systemic examinations were normal. A cranial and orbital magnetic resonance imaging scan performed after hospitalization for further evaluation and treatment showed an increase in the density of the sphenoid, ethmoid, and frontal sinus walls in the left orbit. Despite antifungal and surgical treatment, the patient died on day 14. The use of steroids in treatment and the presence of concomitant DM are the main predisposing factors. The prognosis of this disease, which has a high mortality and morbidity, is adversely affected in geographic regions where health care is inadequate.
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Background: Rhino-orbito-cerebral mucormycosis was seen in increasing severity in the recent second wave of COVID-19 in India. The incidence of mucormycosis is increased significantly in patients with diabetes. The most common cause attributed to the rise of mucormycosis in COVID-19 patients are uncontrolled diabetes. Lymphopenia and increased levels of certain cytokines, such as IL-6, have been closely associated with the disease severity. Aims and Objectives: The aims of this study were to analyze risk factors involved in Mucormycosis in 2nd wave of COVID-19. Materials and Methods: The study was done in the Mucormycosis ward, Department of ENT, Patna Medical College and Hospital, Patna, between May 2021 and July 2021. A total of 100 patients of both gender and all age groups were taken into the study. Results: Out of 100 patients included in the study, 57% (n=57) of patients had history of steroid intake, while 43% (n=43) had no history. About 41% (n=41) of patients needed oxygen support during treatment, while 59% (n=59) had no history of oxygen inhalation. About 88% (n=88) of patients had prior history of diabetes or detected during treatment, while 12% (n=12) had no prior history of diabetes or detected during treatment. About 91% (n=91)of patients had uncontrolled hyperglycemia, while 9% (n=9) had controlled blood sugar level. Conclusion: Uncontrolled hyperglycemia and delta strain are mainly associated major risk factors that lead to such high number of mucormycosis cases in India (post 2nd wave of COVID-19). Steroid role is not that much significant in our study and oxygen inhalation is not associated with mucormycosis.
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Background: There has been a tremendous increase in number of cases of rhino-orbitocerebral involvement with mucor in the COVID era, as reported from India. It is well established that management of ROCM involves early clinical and radiological diagnosis, reversal of underlying risk factors, prompt antifungal therapy and surgical debridement when indicated. Materials &Methods: Multiplanar MR imaging and CT scan were performed for brain, orbit and paranasal sinuses. All the cases were assessed for involvement of the paranasal sinuses, nasal cavities, orbits and brain. Results: 25 cases with ROCM were identified over 8 months. The mean age of the cases was 56.1 years. 18 of the 25 cases had a positive RT-PCR test result at the time of diagnosis with ROCM. 20 cases had poorly controlled diabetes mellitus, 2 had a hematological malignancy, 2 had chronic kidney disease and 1 had ischemic heart disease. There was involvement of the paranasal sinuses, nasal cavities, orbits and brain inclusing necrosis in most of the cases. The number of cases identified during the interval is much higher than the numbers presenting in the prior 2 years during equivalent intervals than those reported in the literature in different settings in the pre-pandemic era. Conclusions: Rhino-orbito mucormycosis can have aggressive necrosis of the involved paranasal sinuses and orbits with or without cerebral extension. Hence, the correct diagnosis is imperative as prompt antifungal drugs and surgical debridement can significantly reduce mortality and morbidity.
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Introduction: Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the Coronavirus disease 2019 (COVID-19) pandemic. Case Presentation: Three patients with stroke and subarachnoid hemorrhage presented due to ICA aneurysm after the involvement of adjacent paranasal sinuses (PNS) with mucormycosis. They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of the three patients were infected with SARS-CoV-2 before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling and only survived this patient. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions: In patients with rhino-cerebral mucormycosis, aneurysm evolution should be promptly and meticulously investigated by Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA). As this type of aneurysm is very fast-growing, as soon as the involvement of the sphenoid sinus is detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient develops an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
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In the southeast India, post-COVID-19 black fungus is increasingly being reported in medically compromised individuals. Diabetes and systemic steroids in COVID-19 patients constitute the double-edged sword that results in post-COVID-19 fungal infections. Black fungus is a part of normal flora that thrives in an immunocompromised state, resulting in rhino-orbital-cerebral mucormycosis. Majority of patients, suffering from black fungus, have uncontrolled diabetes and have undergone steroid therapy. Intra-oral signs are the earliest warning signs in black fungus and dentists should be on the lookout for these, so as to prevent the development of deadly infection. Comprehensive intra-oral signs are enlisted in this review for dentists that include tooth mobility and periodontal clinical attachment loss amongst others. Evidence-based preventive approaches are highlighted in this review to reduce morbidity and mortality, associated with black fungus. Regular dental check-ups are vital to prevent and diagnose early the secondary fungal infections in post-COVID-19 patients, reducing morbidity significantly.
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The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections. Three case reports are presented, all from India. Altered immunity is an important risk factor for mucormycosis. In addition, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the Candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention.
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The burden of COVID-19 is not only represented by pneumonia and acute respiratory failure, but also by its numerous complications, especially those unexpected or less reported. In view of this, we present the case of a 71 years old male patient admitted for severe acute respiratory failure and sudden alteration of the general condition who was tested positive for SARS-CoV-2 infection 12 day before. Native chest CT scan result was suggestive of a severe COVID-19 pneumonia. Shortly after admission, the patient accused persistent headache located in the right frontal area which evolved bilaterally and it associated periorbital edema later. Based on the cranial CT scan he was diagnosed with acute pansinusitis and periorbital cellulitis. Despite broad spectrum antibiotic and antifungal therapy the inflammatory syndrome was rising and his clinical condition was getting worse. Considering the inflammatory recurrence, his immunosuppressed status caused by COVID-19 and the corticosteroid therapy, his history of diabetes, the cranial CT scan and the extemporaneous histopathological examination, we suspected mucormycosis. So, the patient underwent surgical transosseus drainage of the right sinus and nasal endoscopy with further recommendation of functional endoscopic sinus surgery. The extemporaneous histopathological examination of the samples collected during surgery suggested a presumptive diagnose of mucormycosis. Although right after surgical debridement we started targeted antifungal therapy, his impaired condition required transfer to the intensive care unit.
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Background: Mucormycosis is an invasive fungal infection that has shown a surge during the COVID-19 pandemic. A comprehensive assessment of COVID-19 associated mucormycosis (CAM) research is lacking.
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While combating the second wave of COVID-19, India has now been afflicted by another epidemic caused by mucormycosis, a life-threatening opportunistic infection. Due to their immune-suppressed status, COVID-19 patients in India are now more likely to develop mucormycosis during or after treatment. Uncontrolled diabetes, irrational use of steroids, as well as the severity of COVID-19 can all contribute to the growth of mucormycosis. Risk mitigation strategies that could be used to control the rise of mucormycosis-related COVID-19 patients should be evaluated. The purpose of this article is to explore the modifiable risk variables that are involved in the medical management of COVID-19 patients, as well as the mechanisms through which they raise the risk. This overview also includes a brief discussion of mycology and how the disease pattern varies depending on the regions of the body affected. In this article, we detailed about the early detection and treatment of mucormycosis in COVID-19 patients.
ABSTRACT
The whole world was fighting the danger of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since 2019. The SARS-CoV-2 virus was mutating with great speed, and putting new challenges in front of the world. In India, the whole healthcare system was engaged in tackling the second wave of COVID-19 as a result of virus mutation. Additionally, a fungal co-infection, mucormycosis started to invade the COVID-19 patients. Mucormycosis is an acute infection, caused by an opportunistic fungus, mostly attacks the immunosuppressed, diabetic, and neutropenia patients. The other causes of infection include inappropriate use of immunosuppressive drugs, entry of Mucorales through open wounds, cancer, acquired immune deficiency syndrome, organ transplant, and malnutrition. In the recent mucormycosis outbreak in India, all the mucormycosis cases included eyesight damage, facial deformities, and even death in critical conditions. These reported mucormycosis cases in India were mostly diabetes, which were treated with immunosuppressive drugs. The mucormycosis fungus was probably invading the recovered, or near to recovery the second wave COVID-19 patients. In this review, we discussed the important risk factors responsible for the sudden outbreak of mucormycosis, and its severity linked to second wave COVID-19 patients in India.
ABSTRACT
Mucormycosis, usually called dark parasite, is an uncommon yet serious contagious contamination brought about by a fungal organism called mucormycete, which is abundant in the environment. It primarily influences individuals who have medical issues or take prescriptions that bring down the body's capacity to battle germs and ailments. It is attracting sudden attention as it is diagnosed among Covid-19 patients in certain regions of India. The sickness frequently appears in the skin and furthermore affects sinuses, lungs and brain. Individuals who are infected with COVID-19 virus have compromised immune system and are susceptible to mold contamination. The individuals who were hospitalized with extreme COVID-19 sickness were recommended steroids to treat the corona infection but as a side effect gets diminished immunity that facilitates the spread of black fungus. It is a matter of great concern and the Covid management team has given a warning with respect to this illness. This review is an attempt to understand the fungus as an organism, its pathogenesis, and how it is linked with the covid-19 patients.