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COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending?Funding None.
Mucormycosis (also known as black fungus) is caused by fungi of the Zygomycetes class and is the third most common invasive mycosis after candidiasis and aspergillosis. They colonize a large number of patients without invading them. Systemic glucocorticoids are currently used to treat severe Coronavirus disease 19 (COVID-19). In such patients, opportunistic fungal infections are a problem. Although COVID-19-related pulmonary aspergillosis is becoming more common, mucormycosis is still uncommon. Mucormycosis normally appears 10 to 14 days after being admitted to the hospital. Mucormycosis is a rare but dangerous infection that can make extreme COVID-19 worse.
Mucormycosis is more likely to occur in people who have diabetes mellitus and other risk factors. Mucormycosis is most likely exacerbated by concurrent glucocorticoid treatment. To improve outcomes, a high index of suspicion and aggressive management is required. Excessive usage of steroids, monoclonal antibodies, and broad-spectrum antibiotics might cause the formation or worsen of a fungal infection.
A high index of suspicion and aggressive management are needed. In patients with COVID-19 infection, physicians should be vigilant of the likelihood of subsequent invasive fungal infections. To enhance results in pulmonary mucormycosis, early diagnosis and treatment are critical. Confirmation of the clinical form necessitates a combination of symptoms that are consistent with tissue invasion histologically. Combining various clinical data and the isolation of the fungus from clinical samples in culture is needed for the probable diagnosis of mucormycosis. The organism that causes mucormycosis is identified using macroscopic and microscopic morphological criteria, carbohydrate assimilation, and the maximum temperature at which they can expand. Mucormycosis must be treated with antifungal medication prescribed by a doctor. It may necessitate surgery in some circumstances, and it can result in the loss of the upper jaw and, in some situations, an eye.
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02 December 2021 (online)
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- 1 Steinbrink JM, Miceli MH. Mucormycosis. Infect Dis Clin North Am 2021; 35 (02) 435-452
- 2 Ackermann M, Verleden SE, Kuehnel M. et al Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 2020; 383 (02) 120-128
- 3 Karimi-Galougahi M, Arastou S, Haseli S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol 2021; 11 (06) 1029-1030
- 4 Bermejo-Martin JF, Almansa R, Menéndez R, Mendez R, Kelvin DJ, Torres A. Lymphopenic community acquired pneumonia as signature of severe COVID-19 infection. J Infect 2020; 80 (05) e23-e24
- 5 Seo H, Kim JY, Son HJ. et al Diagnostic performance of real-time polymerase chain reaction assay on blood for invasive aspergillosis and mucormycosis. Mycoses 2021; DOI: 10.1111/myc.13319.
- 6 jrnbok . Arastehfar A, Carvalho A, van de Veerdonk FL, et al. COVID-19 associated pulmonary aspergillosis (CAPA)-from immunology to treatment. J Fungi (Basel 2020;6(2):91/jrn
- 7 Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000; 13 (02) 236-301
- 8 Bouza E, Muñoz P, Guinea J. Mucormycosis: an emerging disease?. Clin Microbiol Infect 2006; 12 (Suppl. 07) 7-23
- 9 Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J Med Cases 2021; 12 (03) 85-89
- 10 Mejia Buritica L, Karduss Urueta AJ. Pulmonary Mucormycosis. N Engl J Med 2021; 384 (18) e69
- 11 Fujisaki T, Inagaki J, Kouroki M. et al Pulmonary actinomycosis and mucormycosis coinfection in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia undergoing chemotherapy. J Pediatr Hematol Oncol 2021; DOI: 10.1097/MPH.0000000000002181.
- 12 Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 2004; 10 (Suppl. 01) 31-47
- 13 Ibrahim AS, Spellberg B, Avanessian V. Fu Y, Edwards JE Jr. Rhizopus oryzae adheres to, is phagocytosed by, and damages endothelial cells in vitro. Infect Immun 2005; 73 (02) 778-783
- 14 Roden MM, Zaoutis TE, Buchanan WL. et al Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41 (05) 634-653
- 15 Revannavar SM, P S S, Samaga L. v K V. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?. BMJ Case Rep 2021; 14 (04) e241663
- 16 Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32: 64-67
- 17 Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus 2020; 12 (09) e10726
- 18 Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically Ill coronavirus disease patients, India, April-July 2020. Emerg Infect Dis 2020; 26 (11) 2694-2696
- 19 Salehi M, Ahmadikia K, Badali H, Khodavaisy S. Opportunistic fungal infections in the epidemic area of COVID-19: a clinical and diagnostic perspective from Iran. Mycopathologia 2020; 185 (04) 607-611
- 20 Mekonnen ZK, Ashraf DC, Jankowski T. et al Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome. Ophthal Plast Reconstr Surg 2021; 37 (02) e40-e80
- 21 Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a viral land: a tale of two pathogens. Indian J Ophthalmol 2021; 69 (02) 244-252
- 22 Gangneux JP, Bougnoux ME, Dannaoui E, Cornet M, Zahar JR. Invasive fungal diseases during COVID-19: We should be prepared. J Mycol Med 2020; 30 (02) 100971
- 23 Dando SJ, Mackay-Sim A, Norton R. et al Pathogens penetrating the central nervous system: infection pathways and the cellular and molecular mechanisms of invasion. Clin Microbiol Rev 2014; 27 (04) 691-726
- 24 Inglesfield S, Jasiulewicz A, Hopwood M. et al Robust Phagocyte Recruitment Controls the Opportunistic Fungal Pathogen Mucor circinelloides in Innate Granulomas In Vivo. MBio 2018; 9 (02) e02010-e02017
- 25 Ghaemi N, Bagheri S, Shirdelzade S. Pulmonary and cutaneous mucormycosis in two children with diabetes mellitus type 1. J Pediatr Endocrinol Metab 2021; 34 (07) 941-945
- 26 Miller RP, Farrugia L, Leask J, Khalsa K, Khanna N, Melia L. Successful treatment of Rhizopus arrhizus rhino-orbital-cerebral mucormycosis with isavuconazole salvage therapy following extensive debridement. Med Mycol Case Rep 2021; 32: 39-42
- 27 Dallalzadeh LO, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19. Orbit 2021; 1-4 Doi: DOI: 10.1080/01676830.2021.1903044.
- 28 Fadda GL, Martino F, Andreani G. et al Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study. Acta Otorhinolaryngol Ital 2021; 41 (01) 43-50
- 29 Claustre J, Larcher R, Jouve T. et al Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy. Ann Intensive Care 2020; 10 (01) 74. Doi DOI: 10.1186/s13613-020-00673-9.
- 30 Wang J, Li Y, Luo S, Zheng H. Rhinocerebral mucormycosis secondary to severe acute pancreatitis and diabetic ketoacidosis: a case report. Diagn Pathol 2021; 16 (01) 34
- 31 Khatri A, Chang KM, Berlinrut I, Wallach F. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient - Case report and review of literature. J Mycol Med 2021; 31 (02) 101125
- 32 Vaezi A, Walther G, Kurzai O. et al Frequency of occurrence, seasonal variation and antifungal susceptibility of opportunistic Mucorales isolated from hospital soils in Iran. Mycoses 2021; 64 (07) 780-787
- 33 Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis 2012; 54 (Suppl. 01) S55-S60
- 34 Riedel S. The value of postmortem microbiology cultures. J Clin Microbiol 2014; 52 (04) 1028-1033
- 35 Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 2011; 24 (02) 247-280
- 36 Alexander BD, Lamoth F, Heussel CP. et al Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis 2021; 72 (Suppl. 02) S79-S88
- 37 Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base 2009; 19 (02) 117-125
- 38 Lackner N, Posch W, Lass-Flörl C. Microbiological and Molecular Diagnosis of Mucormycosis: From Old to New. Microorganisms 2021; 9 (07) 1518
- 39 Jiang X, Yang T, Li Q. et al Liquid-Based Cytopathology Test: A Novel Method for Diagnosing Pulmonary Mucormycosis in Bronchial Brushing Samples. Front Microbiol 2018; 9: 2923
- 40 Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel) 2020; 6 (04) 265
- 41 Hamill RJ. Amphotericin B formulations: a comparative review of efficacy and toxicity. Drugs 2013; 73 (09) 919-934
- 42 Singh Y, Ganesh V, Kumar S. et al Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series. Cureus 2021; 13 (07) e16152
- 43 Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021; 15 (04) 102146
- 44 Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol 2021; 69 (06) 1563-1568
- 45 Raut A, Huy NT. Rising incidence of mucormycosis in patients with COVID-19: another challenge for India amidst the second wave?. Lancet Respir Med 2021; 9 (08) e77
- 46 Sipsas NV, Gamaletsou MN, Anastasopoulou A, Kontoyiannis DP. Therapy of Mucormycosis. J Fungi (Basel) 2018; 4 (03) 90 DOI: 10.3390/jof4030090.
- 47 Moen MD, Lyseng-Williamson KA, Scott LJ. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections. Drugs 2009; 69 (03) 361-392
- 48 Ostrosky-Zeichner L, Marr KA, Rex JH, Cohen SH. Amphotericin B: time for a new “gold standard”. Clin Infect Dis 2003; 37 (03) 415-425
- 49 Miceli MH, Chandrasekar P. Safety and efficacy of liposomal amphotericin B for the empirical therapy of invasive fungal infections in immunocompromised patients. Infect Drug Resist 2012; 5: 9-16
- 50 Downes KJ, Fisher BT, Zane NR. Administration and Dosing of Systemic Antifungal Agents in Pediatric Patients. Paediatr Drugs 2020; 22 (02) 165-188
- 51 Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs 2007; 21 (04) 293-318
- 52 Park SH, Choi SM, Lee DG. et al Intravenous itraconazole vs. amphotericin B deoxycholate for empirical antifungal therapy in patients with persistent neutropenic fever. Korean J Intern Med (Korean Assoc Intern Med 2006; 21 (03) 165-172
- 53 Greer ND. Posaconazole (Noxafil): a new triazole antifungal agent. Proc Bayl Univ Med Cent 2007; 20 (02) 188-196
- 54 Page AV, Liles WC. Posaconazole: A new agent for the prevention and management of severe, refractory or invasive fungal infections. Can J Infect Dis Med Microbiol 2008; 19 (04) 297-305
- 55 Roilides E, Simitsopoulou M. Immune responses to Mucorales growth forms: Do we know everything?. Virulence 2017; 8 (08) 1489-1491
- 56 Spellberg B, Walsh TJ, Kontoyiannis DP. Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48 (12) 1743-1751
- 57 Potenza L, Vallerini D, Barozzi P. et al Mucorales-specific T cells emerge in the course of invasive mucormycosis and may be used as a surrogate diagnostic marker in high-risk patients. Blood 2011; 118 (20) 5416-5419
- 58 Montaño DE, Voigt K. Host Immune Defense upon Fungal Infections with Mucorales: Pathogen-Immune Cell Interactions as Drivers of Inflammatory Responses. J Fungi (Basel) 2020; 6 (03) 173
- 59 Ghuman H, Voelz K. Innate and Adaptive Immunity to Mucorales. J Fungi (Basel) 2017; 3 (03) 48
- 60 Hassan MIA, Voigt K. Pathogenicity patterns of mucormycosis: epidemiology, interaction with immune cells and virulence factors. Med Mycol 2019; 57 (Suppl. 02) S245-S256
- 61 Theel ES, Doern CD. β-D-glucan testing is important for diagnosis of invasive fungal infections. J Clin Microbiol 2013; 51 (11) 3478-3483
- 62 Lamoth F. Galactomannan and 1,3-β-d-Glucan Testing for the Diagnosis of Invasive Aspergillosis. J Fungi (Basel) 2016; 2 (03) 22