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
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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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Objectives: To examine the clinical characteristics, drug resistance, and factors influencing development of a pulmonary fungal infection in patients with severe respiratory diseases in order to provide a reference for clinical treatment.
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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.
ABSTRACT
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.
ABSTRACT
This special issue, consisting of 31 reviews and research articles, features the "complex roadmap" of the current state of anti-infectives to combat a range of pathogens from antivirals (e.g., severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), HIV, hepatitis B virus) to antibacterials (e.g., multidrug-resistant organisms and tuberculosis) to antifungals and antimalarials. This issue has articles covering topics that touch on leveraging real-world evidence for assessing pharmaceutical treatments in the context of COVID-19, tutorial on vaccines, and the US Food and Drug Administration (FDA) perspective on streamlined regulatory pathways providing knowledge and insights that can be leverage by those working outside the realm of infectious diseases. Several articles in this issue describe how the clinical pharmacology community have used its collective knowledge and expertise to address the ongoing global crisis. In contrast to the novelty of SARS-CoV-2, this issue also features clinical pharmacology approaches to a virus we have been fighting for over 40 years.
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The global COVID pandemic has impacted the world in ways and at a scale that few could have predicted, with many industries severely disrupted. Despite this, crops were sown and harvested, food was produced and agriculture continued to function, albeit it with many logistical challenges. Plant health lies at the heart of preventing crop losses through a combination of varietal resistance and agronomic practices. In the case of foliar plant diseases in wheat, varietal resistance plays a key role, but the use of synthetic fungicides is essential to minimize crop losses. European arable production faces a dilemma: how to contribute and maintain global food supplies but at the same time decrease emissions of greenhouse gases (GHGs), reduce inputs potentially harmful to biodiversity, society and the environment while ensuring no more land is brought into production. Throughout history, major disruptions in society have led to big steps in agricultural innovation. Presently, the major disruptive forces in Europe are not just a result of the COVID pandemic but the increasingly urgent need to address climate change. Within the European Green Deal, the Farm-to-Fork strategy is in place to help achieve climate neutrality by 2050, aiming for a reduction of GHG emissions of 55% by 2030. To achieve this, there will need to be a major adjustment to how food is produced, a realignment in plant health strategies and accelerated innovation across the agricultural sector. This paper aims to evaluate how synthetic fungicides presently contribute to plant health (mainly wheat) and food production as well as the management of GHG emissions. In addition, it explores the future challenges and prospects for their positive contribution in achieving global food security alongside emerging innovative technologies.
ABSTRACT
In present investigation, the morphological variability were studied by collecting seventeen isolates of V. fungicola from different mushroom farms of Haryana state and out of these eight were isolated, purified on PDA medium and which coded as MHS (Hisar), BFT (Fatehabad), NJN (Jind), RHT (Rohtak), TPN (Panipat), BSN (Sonipat), FDB (Fridabad) and SKK (Kurukshetra) and pathogenicity was proved on host A. bisporus. Regarding morphological variability, the radial growth was fastest in isolate BSN (44.66 mm), followed by TPN (43.86 mm), FDB (43.33 mm), SKK (42.16 mm) and RHT (41.50 mm), while isolates MHS, BFT and NJN had slow growth i.e. 35.83, 34.50 and 38.00 mm, respectively after 12 days of incubation. Isolates MHS, BFT and NJN showed uneven and less feathery colony growth, while rest of isolates had even, profuse feathery and raised colony. Colony pigmentation of V. fungicola isolates was white and underside light yellow in MHS, BFT, NJN and RHT, whereas, isolates TPN, BSN, FDB and SKK having dark yellow colour. The size of conidia also varied among the isolates and it ranges from 2.4-5.1x1.2-2.1m (BFT) to 3.0-7.9x1.1-2.5m (BSN) whereas, isolates MHS (2.8- 4.1x1.0-2.1 m), BFT (2.4-5.1x1.2-2.1m) and NJN (2.6-3.1x1.0-2.4 m) having small size conidia and rest one i.e. RHT (2.9-5.5x1.0-2.1m), TPN (2.9-6.5x1.1-2.3 m), BSN (3.0-7.9x1.1-2.5 m), FDB (3.0-6.5x1.0-2.2 m) and SKK (2.8-4.1x1.0-2.1 m) had large sized conidia.