Isolated cerebral mucormycosis in post-COVID-19 pneumonia

Background: Rhino-orbital-cerebral and isolated cerebral involvement of basal ganglia by mucormycosis are two different manifestations of CNS mucormycosis. The former variant caused by inhaled fungal spores and is common with immunosuppressive conditions. The latter form is caused by intravascular inoculation of spores as seen in intravenous drug abusers. Case report: Here we describe a case of young, non-addict patient with a history of recent mild COVID-19 pneumonia who presented with isolated cerebral mucormycosis involving bilateral basal ganglia. Discussion(s): The pulmonary vasculitis associated with COVID-19 is probably the cause of direct intravascular entry of inhaled fungal spores leading to direct isolated cerebral involvement. Such condition may rapidly turn fatal. Conclusion(s): This is the first reported case of isolated cerebral mucormycosis following post-COVID-19 infection. Early tissue diagnosis and intravenous amphotericin B is the key management.Copyright © 2022

White piedra: An uncommon cause of pseudonits in Northeast Mexico

Introduction: White piedra is a rare superficial mycosis caused by the genus Trichosporon. Its prevalence is higher among tropical climates and predominantly affects children and women. Less than 17 cases have been described in Mexico, none of them in the Northeast region. We present the first case reported in this zone. Case presentation: A 27-year-old otherwise healthy woman presented to our clinic with a 1-month history of asymptomatic pseudonits on her scalp hair. Physical evaluation revealed numerous small white concretions over the majority of the hair shafts. At trichoscopic inspection, multiple white-yellowish ovoid nodules were observed. Direct microscopic examination with 20% potassium hydroxide (KOH) and blue cotton showed nodules composed of arthroconidia and hyphae over the hair shaft. Additionally, fungal culture was positive for Trichosporon inkin, confirming the diagnosis of white piedra. Treatment was initiated with ketoconazole shampoo and systemic itraconazole with favorable response. Discussion(s): Since the first case description by Beigel in Germany, most white piedra cases have been reported in tropical and humid climates. This mycosis typically affects females and subjects under 15 years of age. Some risk factors include poor hygiene, excess humidity, diabetes, and long, curly hair. In our case, the patient had curly hair and she constantly tied her hair up wet as she worked as a full-time nurse in a COVID-19 reference center. In our country, 50% of previous reported cases are from nontropical regions. Although infrequent in cosmopolitan areas in Northeast Mexico, white piedra should be considered in the differential diagnosis of pseudonits. Copyright © 2022

Vaccine History: From Smallpox to Covid-19

In the early seventeenth century, smallpox was one of the most fearsome communicable diseases in the world. Lady Mary Montagu noted that the disease could be prevented by introducing liquid extracted from smallpox scabs from an infected patient into the skin of healthy individuals. This process, known as “variolation” was used in England and in USA until the first investigations by the English physician Edward Jenner appeared. Jenner created the vaccine for an animal poxvirus from the pustule formed by the vaccinia virus in the teats of cows, where the technique was essentially based on the idea that a virulent agent for animals could be attenuated in humans. In 1885, Louis Pasteur, through a fixed virus which was obtained by successive passages in the nervous tissue of rabbits with the dissecting action of potassium hydroxide, developed the vaccine against rabies, in which similar procedures were adopted in the development of several vaccines of live attenuated viruses. Already in the 1940s, a revolution occurred with the discovery that cells could be cultured in vitro and used as substrates for viral growth. Oral polio vaccine and vaccines against measles, rubella, mumps and chickenpox were made possible by selecting clones by passage in in vitro cell culture. Some RNA virus have segmented genomes that can be manipulated. Co-cultivation of two virus in cell culture with clone selection by plaque formation allows the isolation of virus with segments from both. This regrouping planned to create three main vaccines: live and inactivated influenza as well as one of two rotavirus vaccines. Another discovery in the late nineteenth century was that immunogenicity could be maintained as the substance contained in those killed by heat or chemical treatment. This type of inactivation was first applied to pathogens of typhoid fever, plague and cholera bacilli. In the twentieth century, chemical inactivation was also applied to a virus. The influenza vaccine was the first successful inactivated virus vaccine, developed against Polio and Hepatitis A. Besides, several vaccines consist of partially or fully purified proteins. Most of the inactivated flu vaccines used are created by growing the virus in embryonated eggs and then breaking down the entire virus with detergents. The viral hemagglutinin protein is purified to serve as the vaccine antigen, although other influenza virus components may be part of the final product. Early in the history of bacteriology, morphological studies and chemical analyzes showed that many pathogens were surrounded by a polysaccharide capsule and that antibodies against the capsule could promote phagocytosis. The first use of this information to create a vaccine was the development of the meningococcal polysaccharide vaccine. After years of study and development in bacterology, the scientific community faced the Covid-19 pandemic in 2020, marked by the race against time in the invention of effective vaccines against the SARS-CoV-2 virus. After all, most of vaccines take more than a decade to be formulated and, in the case of the vaccine against the new coronavirus, in less than a year, at least 34 candidate vaccines appeared in clinical analysis. New vaccine production techniques using DNA and RNA recombination techniques are being implemented in this race. In Brazil, the most widely distributed vaccines approved by Anvisa are AstraZeneca, CoronaVac and Pfizer-BioNTech. The AstraZeneca/Oxford vaccine is composed of a non-replicating viral vector, which consists of a defective chipamzee virus (adenovirus), with a segment of the SARS-CoV-2 genome, responsible for producing the structure present on the viral surface (protein S), being recognized by human cells, triggering an immune response against Coronavirus. The CoronaVac vaccine is composed by the inactivated SARS-CoV-2 virus, along with its complete structure. It is unable to multiply, although it can stimulate the response to produce antibodies. The Pfizer-BioNTech vaccine, on the other hand, consists of a formulated lipid nanoparticle of nucleoside-modified mRNA that encodes the pre-fusion peak glycoprotein of SARS-CoV-2. Despite the small amount of dose applications in Brazil, the Janssen vaccine has recently started its distribution in the country. This is the only vaccine, so far, with a single dose application. It is an adenovirus 26 (Ad26) vector vaccine that contains in its interior genetic material of the S protein contained in the surface spikes of SARS-CoV-2, and that stimulates, after application, the cellular responses of T CD4 + and T CD8 + antibodies. Here, we propose a detailed review of the entire history of vaccination, from Smallpox to Covid-19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Cranial nerve involvement in mucormycosis in post-COVID patients: a case series

Background: One of the largest outbreaks of rhinosinocerebral mucormycosis (RSCM) occurred in India close to the second wave of the SARS-CoV-2 infection. RSCM is a rare infection caused by several fungal species occurring in immunocompromised subjects. Mucor shows a high propensity to invade the central nervous system. There have been limited studies, mostly isolated case reports, on the neurological manifestations of RSCM. The outbreak of mucormycosis infection was thus the most opportune to study the neurological manifestations and cranial nerve involvement in mucormycosis in greater depths. Aim of the study: The purpose of the study was to investigate and review the involvement of cranial nerves in a series of cases of rhinosinocerebral mucormycosis associated with the novel coronavirus disease caused by SARS-CoV-2. Results: It was a retrospective cross-sectional study of seven patients who were undergoing treatment of RSCM with a recent history of coronavirus disease caused by SARS-CoV-2 infection within the last 3 months. Patients with cranial nerve involvement were identified by magnetic resonance imaging (MRI) at a single institution. Demographic details of the patients, clinical presentation, imaging, microbiological and pathological findings were recorded. All subjects had two or more cranial nerves affected by fungal infection. The most commonly involved cranial nerve was found to be the optic nerve followed by the trigeminal nerve and its branches. We document three cases with extensive involvement of the inferior alveolar branch of the mandibular division of the trigeminal nerve (V3), a previously unreported finding. In one case, in addition to the second and fifth cranial nerves, the third, fourth, sixth, seventh, eighth, and twelfth cranial nerves were involved without any sensory or motor long tract involvement, suggestive of Garcin syndrome secondary to intracranial abscesses and skull base osteomyelitis due to invasive fungal infection. This case is of rare occurrence in the literature, and our study provides one such example. Conclusion: Cranial nerve involvement in patients of mucormycosis tends to have a poor prognosis, both cosmetic and functional. Radical surgeries and aggressive medical management is needed in such cases to improve the outcome.

Deferring Nail Mycological Sampling during the COVID-19 Pandemic: Recommendations from a Multidisciplinary Panel of Nail Specialists.

Onychomycosis is the most common nail condition seen in clinical practice, with significant impact on quality of life. Clinical examination alone is insufficient for accurate diagnosis, but mycological confirmation can be challenging during the COVID-19 pandemic. In this letter, a multidisciplinary panel of dermatologists, a podiatrist, dermatopathologists, and a mycologist, discuss considerations for mycological sampling during the pandemic.