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1.
Int J Infect Dis ; 121: 203-210, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1873078

ABSTRACT

BACKGROUND: A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. METHODS: We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. RESULTS: The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). CONCLUSION: Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.


Subject(s)
COVID-19 , Mucormycosis , Opportunistic Infections , COVID-19/complications , COVID-19 Testing , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Opportunistic Infections/complications , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , SARS-CoV-2
2.
Front Public Health ; 10: 833783, 2022.
Article in English | MEDLINE | ID: covidwho-1847235

ABSTRACT

Background: In the era of the COVID-19 pandemic, people living with HIV (PLWH) face more challenges. However, it is unclear if PLWH is more susceptible to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than HIV-negative individuals. This study aimed to explore the prevalence of the SARS-CoV-2 infection and the associated risk factors among PLWH. Methods: From 1 to 30 May 2020, we conducted a cross-sectional survey that enrolled 857 PLWH and 1,048 HIV-negative individuals from the Wuchang district in Wuhan, China. Our data analysis compared the rate of the SARS-CoV-2 infection among PLWH and HIV-negative participants, and the proportions of symptomatic patients and asymptomatic infectors between the two groups. We also assessed the risk factors associated with the SARS-CoV-2 infection among PLWH. Results: Overall, 14/857 (1.6%) PLWH and 68/1,048 (6.5%) HIV-negative participants were infected with SARS-CoV-2. Among the SARS-CoV-2-infected PLWH participants, 6/14 (42.8%) were symptomatic patients, 4/14 (28.6%) were SARS-CoV-2 nucleic acid-positive asymptomatic infectors, and 4/14 (28.6%) were serology-positive asymptomatic infectors. Among the infected HIV-negative participants, 5/68 (7.4%) patients were symptomatic and 63/68 (92.6%) were serology-positive asymptomatic infectors. The rate of the SARS-CoV-2 infection was lower among the PLWH than in the HIV-negative group (1.96% vs. 5.74%, p = 0.001) and the rate of morbidity among the symptomatic patients was similar between the two groups (p = 0.107). However, there were more serology-positive asymptomatic infectors among the infected HIV-negative participants than among the infected PLWH (0.54% vs. 5.46%, p = 0.001). Furthermore, being 50 years or older (aOR = 4.50, 95% CI: 1.34-15.13, p = 0.015) and having opportunistic infections (aOR = 9.59, 95% CI: 1.54-59.92, p = 0.016) were associated with an increased risk of SARS-CoV-2 infection among PLWH. Conclusions: PLWH has more varied forms of the SARS-CoV-2 infection than the HIV-negative population and should, therefore, undertake routine screening to avoid late diagnosis. Also, older age (≥50 years) and having opportunistic infections increase the risks of SARS-CoV-2 infection among PLWH.


Subject(s)
COVID-19 , HIV Infections , Opportunistic Infections , COVID-19/epidemiology , Cross-Sectional Studies , HIV Infections/complications , HIV Infections/epidemiology , Humans , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Pandemics , SARS-CoV-2
3.
J Infect Public Health ; 15(4): 466-479, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693246

ABSTRACT

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is yet to be controlled worldwide, especially in India. The second wave of coronavirus disease 2019 (COVID-19) led to panic and confusion in India, owing to the overwhelming number of the population that fell prey to this highly infectious virus of recent times. In the second wave of COVID-19, the patients had to fight both the virus and opportunistic infections triggered by fungi and bacteria. Repeated use of steroids, antibiotics, and oxygen masks during the management of severely and critically ill COVID-19 patients nurtured opportunistic infections such as mucormycosis. Despite mucormycosis being a decades-old disease, it has gained notice of its widespread occurrence in COVID-19 patients throughout India. Instances of mucormycosis are usually unearthed in immunocompromised individuals and are caused by the inhalation of filamentous fungi, either from the natural environment or through supportive care units. In the recent outbreak during the second wave of COVID-19 in India, it has been seen to cause secondary infection as it grows along with the treatment of COVID-19. Furthermore, COVID-19 patients with comorbidities such as diabetes were more likely to have the mucormycosis co-infection because of their challenged immune systems' inability to fight it. Despite the hype, mucormycosis still remains neglected and least studied, which is predominantly due to all focus on diagnostics, vaccine, and therapeutic research. In this review, we emphasize mainly on the association of mucormycosis in COVID-19 patients. We also present the molecular mechanism of mucormycosis for a better understanding of the fungal infections in patients who have recently been infected with SARS-CoV-2. Better understanding of fungal pathogens, immediate diagnosis, and management of the infections are crucial in COVID-19 patients, as high mortalities have been recorded in co-infected patients despite recovery from COVID-19.


Subject(s)
COVID-19 , Coinfection , Mucormycosis , Opportunistic Infections , Coinfection/epidemiology , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Pandemics , SARS-CoV-2
4.
Reumatol Clin (Engl Ed) ; 17(9): 491-493, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1510266

ABSTRACT

SARS-COV-2 infection has spread worldwide since it originated in December 2019, in Wuhan, China. The pandemic has largely demonstrated the resilience of the world's health systems and is the greatest health emergency since World War II. There is no single therapeutic approach to the treatment of COVID-19 and the associated immune disorder. The lack of randomised clinical trials (RCTs) has led different countries to tackle the disease based on case series, or from results of observational studies with off-label drugs. We as rheumatologists in general, and specifically rheumatology fellows, have been on the front line of the pandemic, modifying our activities and altering our training itinerary. We have attended patients, we have learned about the management of the disease and from our previous experience with drugs for arthritis and giant cell arteritis, we have used these drugs to treat COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Biological Factors/therapeutic use , COVID-19/drug therapy , Immunosuppressive Agents/therapeutic use , Physician's Role , Rheumatologists , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/immunology , COVID-19/complications , COVID-19/epidemiology , COVID-19/immunology , Drug Therapy, Combination , Education, Medical, Graduate , Fellowships and Scholarships , Global Health , Humans , Immunocompromised Host , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Patient Care Team/organization & administration , Practice Patterns, Physicians' , Rheumatic Diseases/complications , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Rheumatologists/education , Rheumatologists/organization & administration , Rheumatology/education , Rheumatology/methods , Rheumatology/organization & administration , Spain/epidemiology
5.
Ghana Med J ; 54(4 Suppl): 121-124, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436206

ABSTRACT

Coronavirus disease 2019 (COVID-19) is especially severe in patients with underlying chronic conditions, with increased risk of mortality. There is concern that people living with HIV (PLWH), especially those with severe immunosuppression, and COVID-19 may have severe disease and a negative clinical outcome. Most studies on COVID-19 in PLWH are from Asia, Europe and America where population dynamics, antiretroviral treatment coverage and coexisting opportunistic infections may differ from that in sub-Saharan Africa. We report on the clinical profile and outcome of three cases of PLWH co-infected with SARS-CoV-2. They all presented with fever, cough and breathlessness and also had advanced HIV infection as evidenced by opportunistic infections, high HIV viral loads and low CD4 counts. The patients responded favourably to the standard of care and were discharged home. Our findings suggest that PLWH with advanced immunosuppression may not necessarily have an unfavourable disease course and outcome. However, case-controlled studies with a larger population size are needed to better understand the impact of COVID-19 in this patient population. FUNDING: Not declared.


Subject(s)
COVID-19/virology , Coinfection/virology , HIV Infections/virology , HIV , Opportunistic Infections/virology , SARS-CoV-2 , Adult , Africa South of the Sahara , COVID-19/complications , Coinfection/complications , Female , HIV Infections/complications , Humans , Male , Middle Aged , Opportunistic Infections/complications , Viral Load
6.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1164245

ABSTRACT

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Subject(s)
COVID-19/complications , Heart Transplantation , Invasive Fungal Infections/complications , Mucormycosis/complications , Postoperative Complications/etiology , Rhizopus/isolation & purification , Aged , Anti-Infective Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , COVID-19/therapy , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Coinfection/drug therapy , Coinfection/microbiology , Combined Modality Therapy , Contraindications, Drug , Debridement , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Disease Susceptibility , Fatal Outcome , Heart Failure/surgery , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Intra-Aortic Balloon Pumping/instrumentation , Invasive Fungal Infections/drug therapy , Male , Mucormycosis/drug therapy , Mucormycosis/microbiology , Negative-Pressure Wound Therapy , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/virology , Surgical Wound Infection/complications , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Surgical Wound Infection/surgery
8.
J Mycol Med ; 31(2): 101122, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1085499

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 or COVID-19 is a new infectious disease responsible for potentially severe respiratory impairment associated with initial immunosuppression. Similarly to influenza, several authors have described a higher risk of fungal infection after COVID-19, in particular for invasive pulmonary aspergillosis. The main objective here is to define the prevalence of invasive pulmonary aspergillosis (IPA) in a cohort of COVID-19 patients with moderate to severe acute respiratory disease syndrome (ARDS). MATERIAL AND METHODS: We conducted a large monocentric retrospective study investigating all the ventilated COVID-19 patients with ARDS hospitalized at Valenciennes' general hospital, France, between March 15, 2020 and April 30, 2020. In the center a systematic IPA screening strategy was carried out for all ARDS patients, with weekly tests of serum galactomannan and beta-D-glucan. Bronchoalveolar lavage with culture and chest CT scan were performed when the serum assays were positives. RESULTS: A total of 54 patients were studied. Their median age was 65 years, and 37 of the patients (71%) were male. Two patients had chronic immunosuppression and among all the patients, only 2 non-immunocompromised presented a putative IPA during their stay. CONCLUSION: The prevalence of IPA in this cohort of COVID-19 patients (3.7%) is not higher than what is described in the other ARDS populations in the literature. These results are however different from the previous publications on COVID-19 patients and must therefore be confirmed by larger and multicentric studies.


Subject(s)
COVID-19/complications , Critical Illness , Invasive Pulmonary Aspergillosis/complications , Opportunistic Infections/complications , Respiratory Distress Syndrome/etiology , Adult , Aged , Aged, 80 and over , Biomarkers , Comorbidity , Female , France/epidemiology , Galactose/analogs & derivatives , Hospitals, General/statistics & numerical data , Humans , Immunocompromised Host , Intensive Care Units/statistics & numerical data , Invasive Pulmonary Aspergillosis/diagnosis , Male , Mannans/blood , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Retrospective Studies , Risk Factors , beta-Glucans/blood
9.
PLoS Biol ; 18(12): e3000963, 2020 12.
Article in English | MEDLINE | ID: covidwho-1040033

ABSTRACT

Approximately 28% of the human population have been exposed to Mycobacterium tuberculosis (MTB), with the overwhelming majority of infected individuals not developing disease (latent TB infection (LTBI)). While it is known that uncontrolled HIV infection is a major risk factor for the development of TB, the effect of underlying LTBI on HIV disease progression is less well characterized, in part because longitudinal data are lacking. We sorted all participants of the Swiss HIV Cohort Study (SHCS) with at least 1 documented MTB test into one of the 3 groups: MTB uninfected, LTBI, or active TB. To detect differences in the HIV set point viral load (SPVL), linear regression was used; the frequency of the most common opportunistic infections (OIs) in the SHCS between MTB uninfected patients, patients with LTBI, and patients with active TB were compared using logistic regression and time-to-event analyses. In adjusted models, we corrected for baseline demographic characteristics, i.e., HIV transmission risk group and gender, geographic region, year of HIV diagnosis, and CD4 nadir. A total of 13,943 SHCS patients had at least 1 MTB test documented, of whom 840 (6.0%) had LTBI and 770 (5.5%) developed active TB. Compared to MTB uninfected patients, LTBI was associated with a 0.24 decreased log HIV SPVL in the adjusted model (p < 0.0001). Patients with LTBI had lower odds of having candida stomatitis (adjusted odds ratio (OR) = 0.68, p = 0.0035) and oral hairy leukoplakia (adjusted OR = 0.67, p = 0.033) when compared to MTB uninfected patients. The association of LTBI with a reduced HIV set point virus load and fewer unrelated infections in HIV/TB coinfected patients suggests a more complex interaction between LTBI and HIV than previously assumed.


Subject(s)
HIV Infections/complications , Latent Tuberculosis/complications , Latent Tuberculosis/diagnosis , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/etiology , AIDS-Related Opportunistic Infections/microbiology , Adult , CD4-Positive T-Lymphocytes , Cohort Studies , Disease Progression , Female , HIV Infections/metabolism , HIV-1/pathogenicity , Humans , Interferon-gamma , Latent Tuberculosis/metabolism , Male , Middle Aged , Mycobacterium tuberculosis/pathogenicity , Opportunistic Infections/complications , Risk , Tuberculosis/complications , Tuberculosis/diagnosis , Viral Load/immunology
10.
Future Microbiol ; 15: 1405-1413, 2020 09.
Article in English | MEDLINE | ID: covidwho-883809

ABSTRACT

As the global COVID-19 pandemic spreads worldwide, new challenges arise in the clinical landscape. The need for reliable diagnostic methods, treatments and vaccines for COVID-19 is the major worldwide urgency. While these goals are especially important, the growing risk of co-infections is a major threat not only to the health systems but also to patients' lives. Although there is still not enough published statistical data, co-infections in COVID-19 patients found that a significant number of patients hospitalized with COVID-19 developed secondary systemic mycoses that led to serious complications and even death. This review will discuss some of these important findings with the major aim to warn the population about the high risk of concomitant systemic mycoses in individuals weakened by COVID-19.


Subject(s)
Coronavirus Infections/complications , Mycoses/complications , Opportunistic Infections/complications , Pneumonia, Viral/complications , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/pathology , Glucocorticoids/adverse effects , Humans , Invasive Fungal Infections/complications , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/epidemiology , Invasive Fungal Infections/microbiology , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/microbiology , Mycoses/diagnosis , Mycoses/epidemiology , Mycoses/microbiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/pathology , Risk , SARS-CoV-2
11.
Mycopathologia ; 185(4): 607-611, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-691056

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.


Subject(s)
Coronavirus Infections/complications , Mycoses/complications , Opportunistic Infections/complications , Pneumonia, Viral/complications , COVID-19 , Candidiasis, Oral/complications , Candidiasis, Oral/diagnosis , Candidiasis, Oral/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Iran/epidemiology , Mycoses/diagnosis , Mycoses/epidemiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Pandemics , Pharyngeal Diseases/complications , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/epidemiology , Pharyngeal Diseases/microbiology , Pneumocystis carinii , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/epidemiology , Pneumonia, Pneumocystis/microbiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology
12.
Transpl Infect Dis ; 22(6): e13367, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-596059

ABSTRACT

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status, and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.


Subject(s)
COVID-19/immunology , Cardiomyopathy, Dilated/surgery , Heart Transplantation , Immunocompromised Host/immunology , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/surgery , Kidney Transplantation , Malnutrition/immunology , Opportunistic Infections/immunology , Antibiotics, Antineoplastic/adverse effects , BK Virus , Bacteremia/complications , Bacteremia/immunology , COVID-19/complications , COVID-19 Nucleic Acid Testing , Cardiomyopathy, Dilated/chemically induced , Cardiomyopathy, Dilated/complications , Cardiotoxicity , Doxorubicin/adverse effects , Graft Rejection/prevention & control , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/immunology , Humans , Incidental Findings , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Malnutrition/complications , Methicillin-Resistant Staphylococcus aureus , Middle Aged , Mycophenolic Acid/therapeutic use , Opportunistic Infections/complications , Polyomavirus Infections/complications , Polyomavirus Infections/immunology , Postoperative Complications/therapy , Prednisone/therapeutic use , Renal Dialysis , SARS-CoV-2 , Staphylococcal Infections/complications , Staphylococcal Infections/immunology , Surgical Wound Infection/complications , Surgical Wound Infection/immunology , Tacrolimus/therapeutic use , Tracheostomy , Tumor Virus Infections/complications , Tumor Virus Infections/immunology , Vancomycin-Resistant Enterococci , Viremia/complications , Viremia/immunology , Water-Electrolyte Imbalance/complications , Water-Electrolyte Imbalance/therapy
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