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1.
J Stomatol Oral Maxillofac Surg ; 123(6): e757-e759, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1885944

ABSTRACT

This paper aims to discuss clinical aspects of mucormycosis. This case series was conducted in two services, comprising six mucormycosis cases during COVID-19 pandemic. About gender, there are 4 (66.7%) males and 2 (33.3%) females with mean age (48.7 ± 9.4) years. All cases presented complaints of pain and swelling in oral cavity and had an aggressive clinical presentation. Five patients had diabetes and one had a nasal non-Hodgkin lymphoma. Histologically, large, branched, hyphae associated with necrotic areas were observed, confirming microscopically such as mucormycosis through PAS and GMS stains. In four cases, treatment consisted in surgical debridement associated with antifungal therapy. All patients were submitted to debridement and received antifungal treatment (amphotericin B). Five patients were followed up without clinical recurrence, but unfortunately one patient died. Diagnosis of mucormycosis should be early because it is related to high mortality. The treatment consists of surgical debridement associated with antifungal therapy.


Subject(s)
COVID-19 , Mucormycosis , Male , Female , Humans , Adult , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/etiology , Mucormycosis/therapy , Antifungal Agents/therapeutic use , Pandemics , Debridement , COVID-19/complications , COVID-19/therapy , Hospitals
2.
Mar Drugs ; 20(3)2022 Mar 20.
Article in English | MEDLINE | ID: covidwho-1760762

ABSTRACT

The world is already facing the devastating effects of the SARS-CoV-2 pandemic. A disseminated mucormycosis epidemic emerged to worsen this situation, causing havoc, especially in India. This research aimed to perform a multitargeted docking study of marine-sponge-origin bioactive compounds against mucormycosis. Information on proven drug targets and marine sponge compounds was obtained via a literature search. A total of seven different targets were selected. Thirty-five compounds were chosen using the PASS online program. For homology modeling and molecular docking, FASTA sequences and 3D structures for protein targets were retrieved from NCBI and PDB databases. Autodock Vina in PyRx 0.8 was used for docking studies. Further, molecular dynamics simulations were performed using the IMODS server for top-ranked docked complexes. Moreover, the drug-like properties and toxicity analyses were performed using Lipinski parameters in Swiss-ADME, OSIRIS, ProTox-II, pkCSM, and StopTox servers. The results indicated that naamine D, latrunculin A and S, (+)-curcudiol, (+)-curcuphenol, aurantoside I, and hyrtimomine A had the highest binding affinity values of -8.8, -8.6, -9.8, -11.4, -8.0, -11.4, and -9.0 kcal/mol, respectively. In sum, all MNPs included in this study are good candidates against mucormycosis. (+)-curcudiol and (+)-curcuphenol are promising compounds due to their broad-spectrum target inhibition potential.


Subject(s)
Antifungal Agents , Biological Products , COVID-19/drug therapy , Mucormycosis/drug therapy , Porifera/chemistry , SARS-CoV-2 , Animals , Antifungal Agents/chemistry , Antifungal Agents/isolation & purification , Antifungal Agents/pharmacokinetics , Antifungal Agents/toxicity , Biological Products/chemistry , Biological Products/isolation & purification , Biological Products/pharmacokinetics , Biological Products/toxicity , COVID-19/complications , Coinfection , Fungal Proteins/chemistry , Molecular Docking Simulation , Molecular Dynamics Simulation , Mucormycosis/etiology , Toxicity Tests, Acute
3.
Mol Biol Rep ; 49(4): 3349-3356, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1640943

ABSTRACT

The COVID-19 patients, both infected and recovered are rapidly contracting mucormycetes infections due to the 'Mucorales' order, under Zygomycetes class of fungi. The mucorales fungi commonly known to exist in our natural surroundings including soil, but the frequency of incidences was never rampant. This sudden spike in infections, is locally known as 'black fungus,' and is affecting various organs, including- eyes, sinuses, nose, brain, skin, intestine, lungs, etc. The severity of situation is ascertainable from the fact that, in certain cases surgical eye/jaws removal persists as the only viable option to avert mortality, as therapeutic interventions are limited. This epidemic situation intrigued experts to investigate the probable reason behind this unpredicted escalation in reported cases, including in recuperated COVID-19 patients, as person-to-person spread of infection is not common. The comparison of physiological parameters in healthy and COVID-19 afflicted patients highlights that the underlying conditions including diabetes mellitus, steroidal therapy, lymphopenia (decreased CD4+ and CD8+ lymphocytes), deregulated cytokine release storm, elevated free iron levels (hemosiderosis) in blood and insulin insensitivity are playing major roles in deteriorating conditions in rarely pathogenic fungal infections. This review is an attempt to explain the rationalities that makes people vulnerable to mucormycetes infection.


Subject(s)
Mucorales/immunology , Mucormycosis , SARS-CoV-2/immunology , COVID-19/complications , COVID-19/microbiology , COVID-19/mortality , COVID-19/therapy , Diabetes Mellitus/immunology , Diabetes Mellitus/mortality , Humans , Mucormycosis/etiology , Mucormycosis/immunology , Mucormycosis/mortality , Mucormycosis/therapy
4.
J Laryngol Otol ; 135(5): 442-447, 2021 May.
Article in English | MEDLINE | ID: covidwho-1637623

ABSTRACT

OBJECTIVE: To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease. METHODS: A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection. RESULTS: Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment. CONCLUSION: New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.


Subject(s)
COVID-19/microbiology , Mucorales/isolation & purification , Mucormycosis/microbiology , Paranasal Sinuses/microbiology , Administration, Intravenous , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Diabetes Mellitus/epidemiology , Female , Humans , India/epidemiology , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/epidemiology , Invasive Fungal Infections/microbiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mucorales/drug effects , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/etiology , Pandemics , Paranasal Sinuses/diagnostic imaging , Prospective Studies , SARS-CoV-2 , Sinusitis/diagnosis , Sinusitis/microbiology , Steroids/adverse effects , Steroids/therapeutic use
6.
Acta Neurol Belg ; 122(2): 273-280, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1530445

ABSTRACT

India is considered the diabetes capital of the world and has the highest burden of mucormycosis. Bacterial, viral and fungal co-infections are increasingly being reported in severe acute respiratory syndrome virus 2 (SARSCoV-2) infected patients. India is one of the worst affected countries during the second wave of the COVID-19 pandemic. This combination of diabetes mellitus, COVID-19 and mucormycosis has led to the drastic upsurge of COVID-19-associated mucormycosis (CAM) in India. Immunosuppression, iron disequilibrium, endothelial injury, ketoacidosis and hypoxia are some of the other COVID-19-related risk factors for CAM. There has been an increase in the proportion of mucormycosis affecting paranasal sinuses and central nervous system (CNS) in CAM compared to pre-COVID-19 literature due to the SARSCoV-2-related pathophysiological mechanisms, complications and treatment strategies. CAM is a medical and surgical emergency, and it can present with non-specific symptoms and signs initially resulting in diagnostic delay. High index of suspicion and regular screening for features of CAM are of paramount importance to prevent lethal consequences. Rapid action with a tripod approach consisting of withdrawal of immunomodulators, early antifungal therapy and extensive surgical debridement is considered the best possible treatment model. We review the published data to give a detailed account of the predisposing factors and their mechanisms, diagnostic work-up, treatment modalities and prevention strategies of CAM with special emphasis on CNS mucormycosis.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , COVID-19/complications , Delayed Diagnosis , Humans , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/etiology , Pandemics , Risk Factors , SARS-CoV-2
7.
Int Urol Nephrol ; 54(7): 1693-1703, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1520430

ABSTRACT

PURPOSE: Coronavirus disease (COVID-19) sequelae in the transplant population are scarcely reported. Post-COVID-19 mucormycosis is one of such sequelae, which is a dreadful and rare entity. The purpose of this report was to study the full spectrum of this dual infection in kidney transplant recipients (KTR). METHODS: We did a comprehensive analysis of 11 mucormycosis cases in KTR who recovered from COVID-19 in IKDRC, Ahmedabad, Gujarat, India during the study period from Nov 2020 to May 2021. We also looked for the risk factors for mucormycosis with a historical cohort of 157 KTR who did not develop mucormycosis. RESULTS: The median age (interquartile range, range) of the cohort was 42 (33.5-50, 26-60) years with 54.5% diabetes. COVID-19 severity ranged from mild (n = 10) to severe cases (n = 1). The duration from COVID-19 recovery to presentation was 7 (7-7, 4-14) days. Ten cases were Rhino-orbital-cerebral-mucormycosis (ROCM) and one had pulmonary mucormycosis. Functional endoscopic sinus surgery (FESS) was performed in all cases of ROCM. The duration of antifungal therapy was 28 (24-30, 21-62) days. The mortality rate reported was 27%. The risk factors for post-transplant mucormycosis were diabetes (18% vs 54.5%; p-value = 0.01), lymphopenia [12 (10-18) vs 20 (12-26) %; p-value = 0.15] and a higher neutrophil-lymphocyte ratio [7 (4.6-8.3) vs 3.85 (3.3-5.8); p-value = 0.5]. CONCLUSION: The morbidity and mortality with post-COVID-19 mucormycosis are high. Post-transplant patients with diabetes are more prone to this dual infection. Preparedness and early identification is the key to improve the outcomes.


Subject(s)
COVID-19 , Diabetes Mellitus , Kidney Transplantation , Mucormycosis , Adult , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Diabetes Mellitus/drug therapy , Disease Progression , Humans , India/epidemiology , Kidney Transplantation/adverse effects , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Mucormycosis/etiology , RNA, Viral , SARS-CoV-2 , Transplant Recipients
9.
Mol Biol Rep ; 49(1): 747-754, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1491296

ABSTRACT

COVID-19-associated-mucormycosis, commonly referred to as the "Black Fungus," is a rare secondary fungal infection in COVID-19 patients prompted by a group of mucor molds. Association of this rare fungal infection with SARS-CoV-2 infection has been declared as an endemic in India, with minor cases in several other countries around the globe. Although the fungal infection is not contagious like the viral infection, the causative fungal agent is omnipresent. Infection displays an overall mortality rate of around 50%, with many other secondary side effects posing a potential threat in exacerbating COVID-19 mortality rates. In this review, we have accessed the role of free iron availability in COVID-19 patients that might correlate to the pathogenesis of the causative fungal agent. Besides, we have analyzed the negative consequences of using immunosuppressive drugs in encouraging this opportunistic fungal infection.


Subject(s)
COVID-19/complications , Hyperferritinemia , Immunosuppression Therapy/adverse effects , Mucormycosis , Fungi/isolation & purification , Fungi/pathogenicity , Humans , Hyperferritinemia/complications , Hyperferritinemia/microbiology , Immunosuppressive Agents/adverse effects , India/epidemiology , Iron/metabolism , Mortality , Mucormycosis/epidemiology , Mucormycosis/etiology , Mucormycosis/microbiology , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Rhizopus oryzae/isolation & purification , Rhizopus oryzae/pathogenicity
10.
Br J Radiol ; 94(1127): 20210648, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1456034

ABSTRACT

ADVANCES IN KNOWLEDGE: Radiological findings of mucormycosis in post COVID-19 patients show varied patterns of disease involvement and spectrum of imaging features. One should not solely rely on CT imaging to detect the extent of disease. MRI helps in early and accurate detection of invasion into adjacent structures and so helpful in early intervention.


Subject(s)
COVID-19/complications , Magnetic Resonance Imaging/methods , Mucormycosis/diagnostic imaging , Mucormycosis/etiology , Paranasal Sinus Diseases/diagnostic imaging , Paranasal Sinus Diseases/etiology , Humans , Paranasal Sinuses/diagnostic imaging , SARS-CoV-2
11.
Diabetes Metab Syndr ; 15(5): 102267, 2021.
Article in English | MEDLINE | ID: covidwho-1377695

ABSTRACT

AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.


Subject(s)
COVID-19/complications , Mucormycosis/epidemiology , Mucormycosis/etiology , Adult , COVID-19/epidemiology , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/etiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/etiology , Female , Humans , India/epidemiology , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Nervous System Diseases/microbiology , Orbit/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Prevalence , Rhinitis/epidemiology , Rhinitis/etiology , Rhinitis/microbiology , Risk Factors , SARS-CoV-2/physiology , Socioeconomic Factors
12.
Am J Trop Med Hyg ; 105(5): 1144-1147, 2021 08 30.
Article in English | MEDLINE | ID: covidwho-1378475

ABSTRACT

COVID-19 is a global health crisis that continues to pose new challenges all around the world. Amidst the growing pandemic, a spike in the number of mucormycosis cases in India and Pakistan has been reported in COVID-19 patients and in those who have recovered from COVID-19. This increase in cases may be related to the overuse of steroids and zinc, the use of industrial oxygen, unsterilized medical equipment, frequent intubation, a weakened immune system, and pre-existing comorbidities such as diabetes. As a result, it is critical to take steps to handle the current increase in mucormycosis cases. Therefore, this article aims to highlight the existence of mucormycosis amidst the COVID-19 pandemic in India and Pakistan, focusing on possible causes and implications, and suggests important plans of action to be taken during this pandemic.


Subject(s)
COVID-19/epidemiology , Coinfection/epidemiology , Mucorales/pathogenicity , Mucormycosis/epidemiology , Antifungal Agents/therapeutic use , Coinfection/microbiology , Coinfection/virology , Comorbidity , Humans , Immunocompromised Host , India/epidemiology , Mucormycosis/drug therapy , Mucormycosis/etiology , Mucormycosis/virology , Pakistan/epidemiology , Risk Factors
14.
Drug Dev Res ; 82(7): 880-882, 2021 11.
Article in English | MEDLINE | ID: covidwho-1330313

ABSTRACT

COVID-19's second wave had a significant impact on India, on May 7, 2021, the largest daily recorded case count was a little more than 4 million, and it has since fallen. Although the number of new cases reported has dropped, during the third week of May 2021, India accounted for about 45% of new cases identified globally and around 34% of deaths. As India maintains its present level of stability, a new urgent threat has emerged in the form of coronavirus-associated mucormycosis. Mucormycosis, an acute and deadly fungal infection caused by Mucorales-related fungal species, is a fungal emergency with a particularly aggressive propensity for contiguous spread, associated with a poor prognosis if not properly and immediately identified, and treated. Mucormycosis, sometimes referred to as the "black fungus," has increased more rapidly in India during the second wave of COVID-19 than during the first wave, with at least 14,872 cases as of May 28, 2021. Uncontrolled diabetic mellitus (DM) and other immunosuppressive diseases such as neutropenia and corticosteroid treatment have traditionally been identified as risk factors for mucormycosis. Therefore, the use of glucocorticoids or high doses of glucocorticoids in mild COVID-19 cases (without hypoxemia) should be avoided. In addition, drugs that target the immune pathway, such as tocilizumab, are not recommended without clear benefits.


Subject(s)
Anti-Bacterial Agents/adverse effects , COVID-19/complications , Mucormycosis/epidemiology , Mucormycosis/etiology , Prescription Drug Misuse , Anti-Bacterial Agents/therapeutic use , COVID-19/drug therapy , Emergency Medical Services , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , Humans , India , Pandemics , Prognosis , Risk Factors
17.
Eur J Ophthalmol ; 32(4): NP11-NP16, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1177699

ABSTRACT

PURPOSE: To report two cases of COVID-19 under treatment with a corticosteroid; in one case rhino-orbitocerebral mucormycosis and in another one rhino-orbital mucormycosis developed. CASE PRESENTATION: A 40-year old woman and a 54-year old man with severe COVID-19 underwent corticosteroid therapy for immune-related lung injuries. The first case presented with a bilateral visual loss and complete ophthalmoplegia of the right eye. The second case presented with vision loss, proptosis, orbital inflammation, and complete ophthalmoplegia on the left side. Histopathologic, nasal endoscopic examinations, and radiologic findings confirmed mucormycosis in both patients. The patients denied orbital exenteration and were managed with systemic amphotericin B and daily endoscopic sinus debridement and irrigation with diluted amphotericin B. Because of the intracranial space involvement, the first case died. The second case was successfully managed surgically and medically. CONCLUSION: Rhino-orbital/cerebral mucormycosis may be developed in COVID-19 patients under treatment with corticosteroid, and requires prompt diagnosis and management.


Subject(s)
COVID-19 , Eye Diseases , Eye Infections, Fungal , Mucormycosis , Ophthalmoplegia , Orbital Diseases , Adult , Amphotericin B , Antifungal Agents/therapeutic use , Eye Diseases/drug therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Female , Humans , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/etiology , Ophthalmoplegia/drug therapy , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/etiology , Steroids
18.
Mycoses ; 64(8): 798-808, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1085281

ABSTRACT

Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID-19, that requires critical care including ventilatory support, use of corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double-edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44-year-old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID-19 associated mucormycosis.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/complications , Influenza, Human/complications , Mucormycosis/drug therapy , Mucormycosis/etiology , Pneumonia, Viral/drug therapy , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Diabetes Complications , Female , Humans , Liposomes/therapeutic use , Triazoles/therapeutic use
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