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1.
Int Arch Otorhinolaryngol ; 26(3): e470-e477, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1937482

ABSTRACT

Introduction Patients with a history of or active COVID-19 infection are predisposed to the development of opportunist bacterial and fungal infections. A rising incidence of a rare occurring fungal infection earlier, called mucormycosis, has been reported in abundance across the globe since March 2021, especially in India just as the second wave of COVID-19 began, caused by the trifecta of hyperglycemia (new-onset or exacerbation of pre-existing diabetes), oxygen therapy (invasive or noninvasive ventilation), and prolonged intake of steroids. Objective The present study aimed at assessing the prevalence of post-COVID mucormycosis in males of younger age group and spread of rhino-orbital-cerebral mucormycosis (ROCM). Methods A case-control study was performed over a period of 3 months among 60 male patients with confirmed diagnosis of mucormycosis. Individuals < 40 years old were included in the case group ( n = 30), while those > 40 years old were included as controls ( n = 30). Disease spread was assessed in three types of ROCM, that is, rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis. Results In the control group, the mean age was 48.47 years old, the mean HbA1c was 10.62 ± 1.88%, with most of them suffering from rhino-orbital mucormycosis. In the case group, the mean age was 31.57 years old, with a mean HbA1c of 10.11 ± 2.46%, and most patients had rhinomaxillary mucormycosis. The duration of steroid intake and mode of oxygen therapy were found to be significant in the severity of ROCM. Conclusion Rising cases of post-COVID mucormycosis have brought to light the fatal consequences of prolonged use of steroids and oxygen therapy towards the development and spread of ROCM among young and middle-aged males.

2.
Journal of Family Medicine and Primary Care ; 11(6):2573-2580, 2022.
Article in English | CAB Abstracts | ID: covidwho-1934395

ABSTRACT

Background: A significant surge of cases of mucormycosis is seen in individuals with COVID-19 with presence of diabetes mellitus (DM) and usage of corticosteroids. We aim to conduct a systematic analysis of the cases involving presence of mucormycosis and to find out its association with COVID-19, diabetes mellitus, and corticosteroids. Method: The electronic records of PubMed, Google Scholar, and Science Direct were searched for the case reports and case series that reported mucormycosis in association of COVID-19. The particulars of each case report and case series were retrieved, stored and analyzed.

3.
Journal of Liver Transplantation ; : 100113, 2022.
Article in English | ScienceDirect | ID: covidwho-1926762

ABSTRACT

Opportunistic infections, including fungal infections, are dreaded complications of liver transplantation, particularly early after transplant. We describe the case of a patient that presented 6 years after liver transplant with a Lichtheimia corymbifera-infected leg ulcer, following previous COVID-19 infection and moderate rejection requiring steroid pulses. The patient required long-term antifungal therapy, repeated surgical debridement and eventually wound coverage with meshed split-thickness skin graft. Our case illustrates the challenges in the treatment of cutaneous mucormycosis and highlights the difficulties in achieving an accurate balance between the risk of opportunistic infections and rejection in this population.

4.
Int J Infect Dis ; 121: 172-176, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1895081

ABSTRACT

BACKGROUND AND OBJECTIVES: Pneumocystis jirovecii pneumonia (PCP) still has substantial morbidity and mortality. For non-HIV patients, the course of infection is severe, and management guidelines are relatively recent. We collected all PCP cases (European Organization for Research and Treatment of Cancer criteria) diagnosed in HIV-negative adult inpatients in 2019-2020 at our center in northern Italy. RESULTS: Of 20 cases, nine had microbiologic evidence of probable (real-time polymerase chain reaction, RT-PCR) and 11 proven (immunofluorescence) PCP on respiratory specimens. Half were female; the median age was 71.5 years; 14 of 20 patients had hematologic malignancies, five had autoimmune/hyperinflammatory disorders, and one had a solid tumor. RT-PCR cycle threshold (Ct) was 24-37 for bronchoalveolar lavage (BAL) and 32-39 for sputum; Ct was 24-33 on BAL proven cases. Of 20 cases, four received additional diagnoses on BAL. At PCP diagnosis, all patients were not on anti-pneumocystis prophylaxis. We retrospectively assessed prophylaxis indications: 9/20 patients had a main indication, 5/9 because of prednisone treatment ≥ 20 mg (or equivalents) for ≥4 weeks. All patients underwent antimicrobial treatment according to guidelines; 18/20 with concomitant corticosteroids. A total of 4/20 patients died within 28 days from diagnosis. CONCLUSION: Despite appropriate treatment, PCP is still associated to high mortality (20%) among non-HIV patients. Strict adherence to prophylaxis guidelines, awareness of gray areas, and prompt diagnosis can help manage this frequently overlooked infection.


Subject(s)
HIV Infections , Pneumocystis carinii , Pneumonia, Pneumocystis , Adult , Aged , Bronchoalveolar Lavage Fluid/microbiology , Female , HIV Infections/complications , Humans , Immunocompromised Host , Male , Pneumocystis carinii/genetics , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , Pneumonia, Pneumocystis/epidemiology , Real-Time Polymerase Chain Reaction , Retrospective Studies
5.
Cureus ; 14(3), 2022.
Article in English | ProQuest Central | ID: covidwho-1871456

ABSTRACT

The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients.This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval.We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome.Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Hemophilus influenza, and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients.

6.
Revista Espanola de Salud Publica ; 95(e202103043), 2021.
Article in Spanish | GIM | ID: covidwho-1870611

ABSTRACT

Background: People with Kidney Transplantation require immunosuppressant treatments and this classifies them as a population at risk for virus and/or bacterial infections. The objective of the study was to describe the follow- up of transplanted people with suspected COVID19 infection.

7.
Hematol Rep ; 14(2): 135-142, 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1862765

ABSTRACT

The present paper reports, to the best of our knowledge for the first time, the efficacy and tolerability of the combination of interferon (IFN)α-2a in pegylated formulation and rituximab after a "priming" phase with IFN in the frontline treatment of hairy cell leukemia (HCL) in a profoundly immunosuppressed patient with a Mycobacterium abscessus infection at onset. This immunotherapy combination may represent a potential therapeutic option in patients with active severe infection and for whom the use of purine nucleoside analogues (PNA) is contraindicated. The benefits and drawbacks of remarkably rapid immune reconstitution in the context of opportunistic infections are highlighted as well, as the potentially paradoxical effects of immune recovery as a result of effective immunotherapy strategies, known as immune reconstitution inflammatory syndrome (IRIS), have to be taken into account when dealing with patients with opportunistic infections.

8.
Italian Journal of Mycology ; 51(11-22):11-22, 2022.
Article in English | CAB Abstracts | ID: covidwho-1841671

ABSTRACT

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.

9.
Journal of Clinical and Diagnostic Research ; 16(3):DD03-DD04, 2022.
Article in English | Web of Science | ID: covidwho-1771750

ABSTRACT

As the second wave of Coronavirus Disease 2019 (COVID-19) swept through India, many patients developed serious bacterial secondary infections such as pneumonia, sepsis and fungal infections such as mucormycosis. Among the bacterial infections, the most common organisms associated with secondary bacterial infections were Pseudomonas aeruginosa, Acinetobacter baumannil and Stenotrophomonas maltophilia. Here, authors present a rare case of 31-year-old COVID-19 positive male patient with sepsis who developed palatal necrosis due to infection caused by a non fermenting Gram negative bacillus resembling the lesions seen in mucormycosis. The necrotic tissue, bronchoalveolar lavage fluid and blood samples were sent for culture. Blood cultures yielded Elizabethkingella meningosepticum and necrotic tissue yielded Stenotrophomonas maltophilia.

10.
Infez Med ; 30(1): 119-123, 2022.
Article in English | MEDLINE | ID: covidwho-1772295

ABSTRACT

The impact of current SARS-CoV-2 pandemic on the healthcare services had serious consequences, especially for the most fragile populations such as HIV-positive subjects. In the period April to September 2020 we reported four cases of HIV-infected late presenters with an AIDS-defining life-threatening condition that, due to the difficult access to the hospital during the pandemic, were characterized by a delayed HIV recognition and institution of correct treatment. Even after two decades of highly active antiretroviral therapy late presenters HIV-infected patients still represent a serious clinical challenge.

11.
HIV Med ; 23(8): 849-858, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1764940

ABSTRACT

BACKGROUND: The European AIDS Clinical Society (EACS) Guidelines were revised in 2021 for the 17th time with updates on all aspects of HIV care. KEY POINTS OF THE GUIDELINES UPDATE: Version 11.0 of the Guidelines recommend six first-line treatment options for antiretroviral treatment (ART)-naïve adults: tenofovir-based backbone plus an unboosted integrase inhibitor or plus doravirine; abacavir/lamivudine plus dolutegravir; or dual therapy with lamivudine or emtricitabine plus dolutegravir. Recommendations on preferred and alternative first-line combinations from birth to adolescence were included in the new paediatric section made with Penta. Long-acting cabotegravir plus rilpivirine was included as a switch option and, along with fostemsavir, was added to all drug-drug interaction (DDI) tables. Four new DDI tables for anti-tuberculosis drugs, anxiolytics, hormone replacement therapy and COVID-19 therapies were introduced, as well as guidance on screening and management of anxiety disorders, transgender health, sexual health for women and menopause. The sections on frailty, obesity and cancer were expanded, and recommendations for the management of people with diabetes and cardiovascular disease risk were revised extensively. Treatment of recently acquired hepatitis C is recommended with ongoing risk behaviour to reduce transmission. Bulevirtide was included as a treatment option for the hepatitis Delta virus. Drug-resistant tuberculosis guidance was adjusted in accordance with the 2020 World Health Organization recommendations. Finally, there is new guidance on COVID-19 management with a focus on continuance of HIV care. CONCLUSIONS: In 2021, the EACS Guidelines were updated extensively and broadened to include new sections. The recommendations are available as a free app, in interactive web format and as an online pdf.

12.
Journal of Applied Biology and Biotechnology ; 9(6):41-50, 2021.
Article in English | CAB Abstracts | ID: covidwho-1761110

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.

13.
Infection ; 50(4): 1007-1012, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1756953

ABSTRACT

BACKGROUND: Cryptococcal infection has been increasingly reported in patients with COVID-19 infection, but the epidemiological factors, presentation, diagnostic certainty, and outcome have not been well-described. METHODS: We reviewed the published cases of COVID-19-associated Cryptococcus infections (CACI) to shed the light on the burden of this infection. RESULTS: We identified 13 patients with confirmed cryptococcal infection. Cryptococcus infection was primarily seen in patients with severe COVID-19 disease who received corticosteroids therapy and admitted to the intensive care unit. Pulmonary CACI was the most common reported infection followed by cryptococcal meningitis. CONCLUSION: In light of the high mortality rate, clinicians should maintain a high clinical suspicion of CACI in critically ill patients.


Subject(s)
COVID-19 , Cryptococcosis , Cryptococcus , Meningitis, Cryptococcal , Cryptococcosis/complications , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Humans , Meningitis, Cryptococcal/drug therapy
14.
Chinese Journal of Biologicals ; 35(1):68-73, 2022.
Article in Chinese | GIM | ID: covidwho-1744598

ABSTRACT

Objective: To explore the influencing factors of medical staff's vaccination opinions on immune-compromised children and provide a scientific basis for formulating vaccination policies for immune-compromised children during the SARS-CoV-2 pandemic.

15.
JK Science ; 23(4):170-174, 2021.
Article in English | CAB Abstracts | ID: covidwho-1733420

ABSTRACT

Mucormycosis is a serious, but rare opportunistic, invasive and life-threatening fungal infection primarily caused by Rhizopus arrhizus with very high case fatality. Recently, its alarming rise in the number among COVID-19 patients mostly with uncontrolled diabetes and those who received excessive administration of steroids for the treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has raised interest among the scientific community to learn more about the said disease. The current review describes, its epidemiology, clinical presentation, risk factors, warning signs, diagnostic test and available preventive and treatment modalities for its effective management.

16.
Indian Journal of Community Health ; 33(3):515-518, 2021.
Article in English | CAB Abstracts | ID: covidwho-1623062

ABSTRACT

Background: Mucormycosis is an opportunistic fungal infection with a high fatality rate and is the third most common fungal infection that is invasive in nature, next to candidiasis and aspergillosis. It is attributed to the poor socio-economic status and triggered by the local trauma due to unhygienic setup or poor health care. The pathway of pathogenesis is not clearly understood in immunocompetent patients and therefore becomes a matter of great concern. Aim& Objective: To explore the pathway of mucormycosis in a case of post SARS-CoV-2 infection Settings and Design: Tertiary Care hospital of Jabalpur DistrictMethods and Material: Interview with the case and care taker and case file review.

17.
Gene Rep ; 26: 101495, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1620681

ABSTRACT

Diabetes mellitus is a metabolic disease that causes hyperglycemia. In COVID-19 patients the severity of the disease depends on myriad factors but diabetes mellitus is the most important comorbidity. The current review was conducted to investigate the virulence of SARS-CoV-2 and disease severity of COVID-19 in type 2 diabetes mellitus patients and relevant treatment. The literature published in PubMed, Scopus, Web of Science, and Google Scholar was reviewed up to September 2021. The keywords including SARS-CoV-2, type 2 diabetes mellitus in COVID-19, hyperglycemia in COVID-19, opportunistic infections in type 2 diabetes mellitus and COVID-19 were used in different combinations. Hyperglycemic individuals over-express ACE-2 receptors in the lungs thus increasing the SARS-CoV-2 susceptibility and replication. Although dipeptidyl peptidase-4 plays an important role in glucose homeostasis, additionally it also stimulates the production of proinflammatory cytokines such as IL-6 and TNF-α creating a cytokine storm. Cytokine storm might be responsible for respiratory insufficiency in severe COVID-19 patients. Type 2 diabetes mellitus is associated with immunosuppression and the patients are prone to get many opportunistic infections. Type 2 diabetes mellitus patients with severe COVID-19 have lymphopenia. Moreover, in type 2 diabetes mellitus patients the neutrophils exhibit decreased chemotaxis, hydrogen peroxide production, and phagocytosis. Reduction in lymphocyte count and defective neutrophil capacity renders them with COVID-19 susceptible to opportunistic bacterial and fungal infections increasing the mortality rate. The opportunistic bacterial infections in COVID-19 patients were due to Staphylococcus aureus, Streptococcus pneumonia, and coagulase-negative Staphylococci, E. coli, Pseudomonas aeruginosa, and Klebsiella sp. In COVID-19 patients with type 2 diabetes mellitus, mucormycosis was found to be the most common fungal infection with a higher predilection to males. Hyperglycemia in COVID-19 patients with type 2 diabetes mellitus enhances the SARS-CoV-2 replication with an adverse outcome. A strong correlation exists between the poor prognosis of COVID-19 and type 2 diabetes mellitus. Proper glycemic control in COVID-19 patients with diabetes mellitus might lessen the severity of the disease.

18.
Critical Care Medicine ; 50:353-353, 2022.
Article in English | Academic Search Complete | ID: covidwho-1596330

ABSTRACT

B Introduction: b Mucormycosis is a rare and aggressive form of an opportunistic fungal infection known to mainly affect patients with underlying comorbidities that cause dysfunctional immune systems. We report a case of tracheal mucormycosis in a pediatric patient with newly diagnosed diabetes mellitus and severe case COVID-19. Pathology tissue exam revealed rare fungal organisms and abundant mixed bacteria later identified as mucormycosis. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

19.
Journal of Clinical and Diagnostic Research ; 15(11):EC11-EC14, 2021.
Article in English | Web of Science | ID: covidwho-1572931

ABSTRACT

Introduction: The pandemic Coronavirus Disease 2019 (COVID-19) continues to be a significant problem worldwide. The disease pattern ranges from mild to life threatening pneumonia. Association of COVID-19 with mucormycosis is rare but an increase in this association has been observed recently, particularly in a background of immunocompromised state with rhino-orbital-cerebral region being the most common site of involvement. Aim: To study the site and presentation of mucormycosis in COVID-19 patients with histopathological association. Materials and Methods: A descriptive study was conducted at American International Institute of Medical Sciences, Udaipur, Rajasthan, India, in which 1st 20 patients of COVID-19 with mucormycosis of rhino-orbital region were included in the study. The study was conducted for a period of two months (April-May 2021). Detailed clinical history and associated co-morbidities were noted for each patient. Histopathological examination of all the specimens resected for fungal infection was done along with special stain. Statistical analysis was done using Chi-square test. Results: COVID-19 association with mucormycosis was observed in all 20 cases. Maximum number of cases (11) was present in the age group of 20-40 years. Diabetes Mellitus (DM) had a strong association with mucormycosis. Maxillary sinus was most commonly associated site. Preoperative Potassium Hydroxide (KOH) was positive in all 20 cases, detailed histopathology study along with Periodic Acid Schiff (PAS) stain was performed in all cases. Additional microscopic findings like angioinvasion (03), granuloma (01) and giant cell reaction (13) were also recorded. Conclusion: COVID-19 has emerged as a global threat to mankind. In the present scenario the entire medical fraternity should have a prompt and team approach towards the management of this pandemic, in terms of, early detection of the infection, meticulous use of corticosteroids and screening of comorbidities to safeguard patients from such life threatening fungal infections.

20.
IDCases ; 26: e01346, 2021.
Article in English | MEDLINE | ID: covidwho-1531342

ABSTRACT

The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. Cytomegalovirus (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.

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