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1.
Indian J Ophthalmol ; 70(4): 1365-1370, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760976

ABSTRACT

Purpose: To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization. Methods: A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher's test. Results: A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial muscles. Conclusion: FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.


Subject(s)
COVID-19 , Facial Paralysis , Mucormycosis , COVID-19/complications , COVID-19/diagnosis , Facial Paralysis/diagnosis , Facial Paralysis/etiology , Humans , Magnetic Resonance Imaging , Mucormycosis/complications , Mucormycosis/diagnosis , Prospective Studies
2.
Indian J Ophthalmol ; 70(4): 1425-1427, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760973

ABSTRACT

"Guitar pick sign," also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19-associated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.


Subject(s)
COVID-19 , Mucormycosis , Orbital Cellulitis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/microbiology , Orbit , Tomography, X-Ray Computed
3.
Acta Medica (Hradec Kralove) ; 64(4): 227-231, 2021.
Article in English | MEDLINE | ID: covidwho-1743012

ABSTRACT

Coronavirus infectious disease-19 caused by Severe acute respiratory distress syndrome-coronavirus-2 has emerged to be an emergency global health crisis for more than a year. And, as the disease has spread, a number of new clinical features have been observed in these patients. Immunosuppression caused by this disease results in an exacerbation of pre-existing infections. While corticosteroids are considered a life-saving therapeutic intervention for this pandemic, they have proved to be a double-edged sword and their indiscriminate use has produced some deleterious results. Recently, in the backdrop of this expression, a notable rise in invasive fungal infections has been identified even in the post-remission phase. Mucormycosis, Aspergillosis, and Candidiasis are the three most common opportunistic fungal infections among those observed. COVID-19 patients with diabetes mellitus are already at a higher risk of developing such secondary infections due to impaired immunity. Here we present a rare case report of a 50-year old male diabetic mellitus patient diagnosed with dual fungal infections (Aspergillosis along with Mucormycosis) leading to maxillary sinusitis as a post-COVID manifestation. To our knowledge, this is the first such case reported till date.


Subject(s)
Aspergillosis , COVID-19 , Diabetes Mellitus , Maxillary Sinusitis , Mucormycosis , Mycoses , Aspergillosis/complications , Aspergillosis/diagnosis , Aspergillosis/therapy , COVID-19/complications , Humans , Male , Maxillary Sinusitis/complications , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/therapy , Mycoses/complications , SARS-CoV-2
4.
Acta Medica (Hradec Kralove) ; 64(4): 218-223, 2021.
Article in English | MEDLINE | ID: covidwho-1743011

ABSTRACT

BACKGROUND: The second wave of COVID-19 has emerged with the addition of vivid types of oral manifestations. Immunosuppression caused by COVID-19 results in an exacerbation of pre-existing infections. Recently, in the backdrop of COVID-19 expression, a notable rise in the incidence of secondary infections, both fungal and bacterial, have been reported either during the disease or as a post-COVID manifestation. CASE PRESENTATION: A 70-year-old male diabetic COVID-19 patient reported with a chief complaint of pain in the right side maxillary region for 3 months and the passage of content from the oral cavity into the nose. Intraoral examination revealed missing teeth i.r.t. 12 to 17, denuded mucosa with exposed necrotic bone and an oroantral opening. Sequestrectomy was done and the tissue was sent for histopathological examination which revealed necrotic bone interspersed with broad aseptate fungal hyphae branched at right angles along with actinomycotic colonies and Candidal hyphae in few areas. Based on histopathological findings, a final diagnosis of mixed infections leading to Maxillary Osteomyelitis was given. No recurrence was noticed after 3 months of follow up. CONCLUSIONS: The occurrence of oral infections even after the remission period of COVID-19 signifies an alarming sign both for the patient and clinicians monitoring the oral health status during the follow-up period. To our knowledge, this is the first such case (three oral infections as a post covid manifestation in a single diabetic patient) reported in the literature till date.


Subject(s)
Actinomycosis , COVID-19 , Candidiasis , Coinfection , Diabetes Mellitus , Mucormycosis , Osteomyelitis , Aged , COVID-19/complications , Candidiasis/complications , Coinfection/complications , Humans , Male , Mucormycosis/complications , Osteomyelitis/microbiology , SARS-CoV-2
5.
Ophthalmic Surg Lasers Imaging Retina ; 53(3): 173-174, 2022 03.
Article in English | MEDLINE | ID: covidwho-1737123

ABSTRACT

[Ophthalmic Surg Lasers Imaging Retina. 2022;53:173-174.].


Subject(s)
COVID-19 , Mucormycosis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , SARS-CoV-2 , Vision Disorders
7.
Indian J Ophthalmol ; 70(3): 1013-1018, 2022 03.
Article in English | MEDLINE | ID: covidwho-1715919

ABSTRACT

Purpose: Known predisposing factors for mucormycosis are neutropenia and diabetes. Though COVID-19 is associated with hyperinflammatory response, a high surge in rhino-orbital-cerebral mucormycosis (ROCM) cases was observed during the second wave. The histopathological features reflect the background pathogenesis. This study analyzes the histopathological features and clinical presentation of COVID-19-associated ROCM. Methods: In this retrospective observational study, the clinical details of 89 proven ROCM patients treated during May-July 2021 were collected from the case records. Histopathological features were correlated with clinical staging groups and outcomes. The mean neutrophil-to-lymphocyte ratio (NLR) of clinical and outcome groups were compared. Results: The mean age was 54.71 ± 11.03 years, with male patients constituting a majority (78.7%). Uncontrolled diabetes mellitus was noted in 70.8% of patients, and 3.4% had normal range of blood sugar. The mean blood sugar was 298.08 ± 99.51 mg/dL. The mean duration of onset of symptoms of mucormycosis from the diagnosis of COVID-19 was 17.36 ± 7.392 (3-45) days. Poor outcome with disease progression or death occurred in 21.3% of patients. Clinical group II patients (44.9%) with ROCM stages 3c and above had poor outcomes (P = 0.005). Histopathological analysis showed minimal inflammation in 25.8%, neutrophil extracellular trap (NET) in 75.3%, and angio-invasion in 28.1% of patients. Minimal inflammation was associated with clinical group II (P = 0.004) and poor outcome (P = 0.001). Angio-invasion correlated with poor outcome (P = 0.007). Patients with severe clinical group and poor outcome had higher mean NLR with P = 0.017 and P = 0.007, respectively. Conclusion: Vision loss and cerebral involvement had poor outcomes. The histopathologic features such as inflammation and angio-invasion along with NLR aid as prognostic indicators in the management of ROCM. The role of NET in the pathogenesis of COVID-19-associated ROCM needs further studies.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Adult , Aged , COVID-19/complications , COVID-19/diagnosis , Eye Infections, Fungal/diagnosis , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Orbital Diseases/drug therapy , SARS-CoV-2
8.
Saudi J Kidney Dis Transpl ; 32(4): 1152-1157, 2021.
Article in English | MEDLINE | ID: covidwho-1715894

ABSTRACT

Coronavirus disease-2019 (COVID-19) emerged as a pandemic with varied clinical presentations. Patients with an underlying comorbidity such as diabetes and chronic kidney diseases (CKDs) had an increased risk of developing secondary bacterial and fungal coinfections which was further accentuated by the use of steroids during the management and with prolonged intensive care unit stay. This case series describes the clinical course of two patients with CKD who developed acute respiratory syndrome coronavirus-2 infection and mucormycosis.


Subject(s)
COVID-19 , Mucormycosis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Pandemics , Renal Dialysis/adverse effects , SARS-CoV-2
9.
Clin Infect Dis ; 74(7): 1279-1283, 2022 Apr 09.
Article in English | MEDLINE | ID: covidwho-1703103

ABSTRACT

The severe surge of coronavirus disease 2019 (COVID-19) cases on the Indian subcontinent in early 2021 was marked by an unusually high number of COVID-19-associated mucormycosis (CAM) cases reported during this same period. This is significantly higher than predicted based on available data about prevalence and risk factors for this condition. This may be due to an unusual alignment of multiple risk factors for this condition. There is high background prevalence of mucormycosis in India likely from a high prevalence of risk factors, including undiagnosed or poorly controlled diabetes. COVID-19-induced immune dysregulation and immune suppression from steroid therapy increase the risk. The role of environmental exposure is unclear. System factors such as lack of access to healthcare during a pandemic may result in delayed diagnosis or suboptimal management with potentially poor outcomes. Here, we review currently identified risk factors and pathogenesis of CAM in a pandemic surge.


Subject(s)
COVID-19 , Mucormycosis , Humans , India/epidemiology , Mucormycosis/complications , Risk Factors , SARS-CoV-2
10.
BMJ Case Rep ; 15(2)2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1685521

ABSTRACT

We describe a case of cutaneous mucormycosis in a middle-aged man with ethanol-related chronic liver disease. He presented with symptoms of fever, breathlessness for 10 days and altered mental status for 2 days. On admission, he was in septic shock and had acute respiratory distress syndrome (ARDS). He was noted to have ruptured blisters in his left axilla. Although he repeatedly had negative COVID-19 Reverse Transcription-PCR results, he had positive IgG antibodies for COVID-19. He was managed with broad-spectrum antibiotics, steroids, vasopressors and ventilation for ARDS. Over the course of his hospitalisation, the axillary lesion progressed to a necrotising ulcer with deep tissue invasion. Debridement and culture of the axillary ulcer revealed mucor species, and he was started on amphotericin and posaconazole for mucormycosis. Unfortunately, he continued to deteriorate despite aggressive management and died after a prolonged hospital stay of 40 days.


Subject(s)
COVID-19 , Mucormycosis , Ethanol , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , SARS-CoV-2
11.
Contrast Media Mol Imaging ; 2022: 4352730, 2022.
Article in English | MEDLINE | ID: covidwho-1673528

ABSTRACT

Currently, countries across the world are suffering from a prominent viral infection called COVID-19. Most countries are still facing several issues due to this disease, which has resulted in several fatalities. The first COVID-19 wave caused devastation across the world owing to its virulence and led to a massive loss in human lives, impacting the country's economy drastically. A dangerous disease called mucormycosis was discovered worldwide during the second COVID-19 wave, in 2021, which lasted from April to July. The mucormycosis disease is commonly known as "black fungus," which belongs to the fungus family Mucorales. It is usually a rare disease, but the level of destruction caused by the disease is vast and unpredictable. This disease mainly targets people already suffering from other diseases and consuming heavy medication to counter the disease they are suffering from. This is because of the reduction in antibodies in the affected people. Therefore, the patient's body does not have the ability to act against fungus-oriented infections. This black fungus is more commonly identified in patients with coronavirus disease in certain country. The condition frequently manifests on skin, but it can also harm organs such as eyes and brain. This study intends to design a modified neural network logic for an artificial intelligence (AI) strategy with learning principles, called a hybrid learning-based neural network classifier (HLNNC). The proposed method is based on well-known techniques such as convolutional neural network (CNN) and support vector machine (SVM). This article discusses a dataset containing several eye photographs of patients with and without black fungus infection. These images were collected from the real-time records of people afflicted with COVID followed by the black fungus. This proposed HLNNC scheme identifies the black fungus disease based on the following image processing procedures: image acquisition, preprocessing, feature extraction, and classification; these procedures were performed considering the dataset training and testing principles with proper performance analysis. The results of the procedure are provided in a graphical format with the precise specification, and the efficacy of the proposed method is established.


Subject(s)
COVID-19/complications , Coinfection/microbiology , Deep Learning , Mucorales/isolation & purification , Mucormycosis/epidemiology , Algorithms , COVID-19/drug therapy , Comorbidity , Humans , Image Processing, Computer-Assisted , India/epidemiology , Mucorales/classification , Mucorales/immunology , Mucormycosis/complications , Mucormycosis/microbiology , Neural Networks, Computer , Support Vector Machine
12.
Transpl Infect Dis ; 24(2): e13793, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1626700

ABSTRACT

We herein present a case of live related kidney transplant recipient who initially developed severe coronavirus (COVID-19) disease associated with E.coli related pyelonephritis and graft dysfunction, who improved over one week only to deteriorate in the second week, with fever, oligoanuria and refractory shock. A postmortem allograft biopsy revealed angioinvasive mucormycosis. With the resurgence of mucormycosis during the COVID-19 pandemic, the transplant team should add allograft mucormycosis as a rare differential for severe graft dysfunction and oligoanuria in the COVID-19-infected kidney transplant recipient.


Subject(s)
COVID-19 , Kidney Transplantation , Mucormycosis , Pyelonephritis , Allografts , COVID-19/complications , Humans , Kidney Transplantation/adverse effects , Mucormycosis/complications , Mucormycosis/drug therapy , Mucormycosis/microbiology , Pandemics , Pyelonephritis/complications
15.
Exp Clin Transplant ; 20(2): 213-217, 2022 02.
Article in English | MEDLINE | ID: covidwho-1605056

ABSTRACT

Coronavirus disease 2019 increases transplant recipients' susceptibility to rare opportunistic infections as a consequence of the impairment that COVID-19 can cause in the immune system. Mucormycosis is a rare complication but has a high risk of fatal outcome. A 50-year-old woman who received a kidney transplant 10 years previously was admitted to the hospital with COVID-19. During follow-up by the inpatient service, the patient developed pain, edema, and proptosis in the right eye. She was diagnosed with rhino-orbitalcerebral mucormycosis. This is the first reported case of rhino-orbital-cerebral mucormycosis in a renal transplant recipient with COVID-19 infection.


Subject(s)
COVID-19 , Kidney Transplantation , Mucormycosis , Orbital Diseases , COVID-19/diagnosis , Female , Humans , Kidney Transplantation/adverse effects , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/diagnostic imaging , Orbital Diseases/etiology , Transplant Recipients , Treatment Outcome
16.
Indian J Pharmacol ; 53(6): 499-510, 2021.
Article in English | MEDLINE | ID: covidwho-1603884

ABSTRACT

BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19-associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. "R-metafor package" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041-0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212-4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205-0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.


Subject(s)
Brain Diseases/complications , COVID-19/complications , Mucormycosis/complications , Nose Diseases/complications , Orbital Diseases/complications , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Brain Diseases/drug therapy , COVID-19/virology , Humans , Mucormycosis/drug therapy , Nose Diseases/drug therapy , Orbital Diseases/drug therapy , Regression Analysis , Risk Factors , SARS-CoV-2/isolation & purification
19.
Mycopathologia ; 187(1): 31-37, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1588765

ABSTRACT

Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and rarely reported in CAPM. Herein, we report five cases of CAPM with PAP managed at our center and perform a systematic review of the literature. We diagnosed PM in those with clinico-radiological suspicion and confirmed it by microbiology or histopathology. We encountered five cases of CAPM with PAP (size ranged from 1 × 0.8 cm to ~ 4.9 × 4.8 cm). All subjects had diabetes and were aged 55-62 years (75% men). In two cases, COVID-19 and mucormycosis were diagnosed simultaneously, while in three others, COVID-19 preceded PM. One subject who underwent surgery survived, while all others died (80% mortality). From our systematic review, we identified one additional case of CAPM with PAP in a transplant recipient. CAPM with PAP is rare with high mortality. Early diagnosis and multimodality management are imperative to improve outcomes.


Subject(s)
Aneurysm, False , COVID-19 , Mucormycosis , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Female , Humans , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Pulmonary Artery/diagnostic imaging , SARS-CoV-2
20.
BMJ Case Rep ; 14(11)2021 Nov 30.
Article in English | MEDLINE | ID: covidwho-1546475

ABSTRACT

Mucormycosis represents several unusual opportunistic infection caused by saprophytic aseptate fungi. There is a recent rise in cases of mucormycosis due to an increase in diabetic and immunodeficient patients like patients on long-term steroids, immunomodulators due to organ transplantation, malignancies, mainly haematological malignancies, and autoimmunity. Anatomically, mucormycosis can be localised most commonly as rhino-orbito-cerebral followed by pulmonary, disseminated, cutaneous and gastrointestinal, rarest being small intestinal. Patients with Down syndrome are immunodeficient due to their impaired immune response. Disseminated tuberculosis is also common in immunodeficient patients. We report a rare case of small intestinal mucormycosis in a patient with Down syndrome with coexisting intestinal tuberculosis. Due to the invasiveness of mucormycosis, the patient succumbed to death despite providing aggressive surgical debridement and medical management.


Subject(s)
Coinfection , Diabetes Mellitus , Down Syndrome , Mucormycosis , Tuberculosis, Gastrointestinal , Down Syndrome/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis
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