Case Of Mucormycosis Research Articles

An Observational Study of Fungal Infections in COVID-19: Highlighting the Role of Mucormycosis in Tertiary Healthcare Settings.

Background Fungal infections, especially mucormycosis, have remarkably surged during the coronavirus disease 2019 (COVID-19) era, especially during the second wave peak of the pandemic raising the concern of the clinicians for the admitted patients. Steroid therapy, diabetes, and other immunocompromised states are more commonly associated with COVID-19-associated mucormycosis (CAM). Aim and objective The aim of this study is to ascertain the prevalence of fungal infections amidst the second wave of the COVID-19 pandemic and discern the associated risk factors. Materials and methods During the second peak of COVID-19, samples were received in the microbiology laboratory from all clinically suspected mucormycosis patients. These samples underwent processing for potassium hydroxide (KOH) wet mount, fungal cultureonSabouraud's dextrose agar (SDA) medium, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) testing.All relevant clinical and associated risk factors were tabulated and analyzed. Results Among the 107 suspected cases of mucormycosis, 39 (36.4%) were confirmed positive for COVID-19 via RT-PCR, while 68 (63.6%) tested negative. Males exhibited a predominant infection rate, with the rhinocerebral system being the most commonly affected site. Significantly higher mortality rates were observed in COVID-19-associated mucormycosis (CAM) patients (33.4%) compared to those without COVID-19 (5.9%), with a notable p-value of 0.0005. CAM patients also demonstrated a higher frequency of ICU admissions (77%) compared to non-COVID-19-associated mucormycosis patients (21.4%), a statistically significant finding (p-value of 0.007). Additionally, immunocompromised states, diabetes, and the administration of oxygen therapy were identified as significant risk factors in CAM (p < 0.05). Notably, mucormycosis accounted for the majority of fungal isolates (48.27%) among COVID-19 patients. Conclusion Mucormycosis infection is more commonly seen in COVID-19-infected patients as compared to non-COVID-19 patients, especially with comorbidities such as diabetes mellitus, steroid usage, and other immunocompromised states.

Comprehensive Review on COVID-19 associated Mucormycosis: Diagnosis, Types and Treatment

ABSTRACT: In the past couple of years, the world has been dealing with a dreadful pandemic known as Covid-19 along with one of the life-threatening infection i.e. mucormycosis. Mucormycosis (Zygomycosis) is a fungal infection caused by a group of molds called mucormycosis. Several clinical cases of mucormycosis have been reported globally during the Covid-19 pandemic. Patients with compromised immunity or uncontrolled diabetics or patients that were given steroid therapy to combat infection due to corona virus were at high risk of acquiring mucormycosis as co-morbidity associated with Covid-19. In the present review, various types of mucormycosis, diagnosis, and treatment strategies are explained as it is associated with high morbidity and mortality. Amphotericin B liposomal formulation was found to be the most widely used to treat mucormycosis. Other antifungal agents and adjuvant therapies were also tried to treat this infection.

Use of the Mucorales qPCR on blood to screen high-risk hematology patients is associated with better survival.

Our objective was to determine whether the twice-weekly screening of high-risk hematology patients by Mucorales qPCR on serum affects the prognosis of mucormycosis. Results from all serum Mucorales qPCR tests performed on patients from the hematology unit from January 2017 to December 2022 were analyzed. Patients with positive results were classified as having proven, probable or 'PCR-only' mucormycosis. One-month mortality for the local cohort was compared with that of a national cohort of cases of mucormycosis collected by the French surveillance network for invasive fungal disease ('Réseau de surveillances des infections fongiques invasives en France' (RESSIF)) from 2012 to 2018. From 2017 to 2022, 7825 serum Mucorales qPCR tests were performed for patients from the hematology unit; 107 patients with at least one positive Mucorales qPCR (164 positive samples) were identified. Sixty patients (70 positive samples, median Cq=40) had no radiological criteria for mucormycosis and were considered not to have invasive fungal disease (70/7825, 0.9% false positives). It was not possible to classify disease status for six patients (12 positive samples, median Cq=38). Forty-one patients (82 positive samples, median Cq=35) had a final diagnosis of mucormycosis. In comparison with the RESSIF cohort, the local cohort was independently associated with a 48% lower one-month all-cause mortality rate (age-, sex-, and primary disease-adjusted hazard ratio=0.52; 95% confidence interval: 0.29-0.94; P 0.03). Proactive screening for invasive mold diseases in high-risk hematology patients, including twice-weekly Mucorales qPCR on serum, was associated with mucormycosis higher survival.

Mucormycosis in patients admitted to a university hospital: a case series

Mucormycosis is an aggressive disease with high morbidity and mortality caused by fungi from the Mucorales order. They are fungi widely present in nature but may also be related to nosocomial infections. We present four cases of mucormycosis identified through histopathological analysis and involving the rhino-sinus region. All the cases were related to decompensated diabetes mellitus. Among these patients, two of them had lesions that affected their eyes and central nervous system (CNS). Although there were no fatalities, the two patients with ocular and CNS lesions experienced severe complications, including loss of vision and definitive chronic renal failure. &#x0D; KEY WORDS: Mucormycosis; Covid-19; Sars-cov-2; diabetes mellitus; rhino-orbital.

Mucorales-associated osteomyelitis in an immunocompetent child

Mucormycosis is an opportunistic, aggressive, luckily rare fungal infection that most commonly causes pulmonary, sinoorbital, gastrointestinal, and skin disease [1]. Its incidence is 1.5% among invasive fungal infections [2]. But, the mortality from mucormycosis is significantly high (&gt;30-50%), with disseminated disease accounting for 90% of deaths. Patients with localized cutaneous disease have a much lower mortality rate while it is still significant (10-30%) [3]. Although diabetic ketoacidosis and immunodeficiency are wellknown risk factors for the infection, cases of Cutaneous Mucormycosis (CM) in previously healthy subjects secondary to trauma have been reported [4]. Following inoculation of the fungus into the skin, the infection can progress to the subcutaneous tissue, muscle, and bone. Osteoarticular Mucormycosis (OAM) is extremely rare. Even so, if not diagnosed and treated promptly, it can have serious consequences, including amputation of extremities and death. Herein, we describe a rare instance of mucorales-associated osteomyelitis in an immunocompetent child who survived amputation with the combination of antifungal therapy and surgery.

Preservation of Palatal Mucosa in Rhinomaxillary Mucormycosis Cases

Preservation of Palatal Mucosa in Rhinomaxillary Mucormycosis Cases

Prosthetic Rehabilitation of Post Covid Mucormycosis of Maxilla with Definitive Obturator Prosthesis- A 24 Month Follow Up Case Report

The second wave of COVID-19 in April 2021 witnessed a new mutated variant of SARS-CoV2 known as B.1.617 resulting in Mucormycosis. Inhalation, ingestion, or contamination of ulcerated mucosa by fungal spores results in infection and cause Mucormycosis. Objective: To highlight how a complex case of oral mucormycosis can be misdiagnosed due to its similar clinical presentations with other periodontal diseases and benefits of prosthetic rehabilitation of surgical defects with definitive obturator which improves the quality of life by restoring oral function and aesthetics. Case report: A 35-year-old female reported with chief complaint of pain, pus and mobility in upper front teeth region of 2 months and swelling of mid-face. Darkening of skin, swelling with tenderness over bilateral malar- infraorbital regions with epiphora and blurred vision in right eye and discharge from right nostril. She had multiple abscess in attached gingiva in incisor and premolar region of maxilla having probing depths ≤ 4mm with mobility. Conclusion: A precise diagnosis is prerequisite to specific treatment of any disease. Treatment often requires an extensive surgical resection causing facial deformation, masticatory, swallowing and speech problems. It is important to rehabilitate these patients by correcting the defects with the help of obturators and improve their lifestyle.

Evolution of mucormycosis – Systematic review and meta-analysis

The outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2, has been linked to a notable rise in mucormycosis cases, particularly evident during the second wave in the summer of 2021. Mucormycosis, characterized by its aggressive nature and high mortality rates, requires rapid identification and intervention. Factors such as poorly controlled blood sugar levels, corticosteroid usage, and COVID-19-related immune compromise are significant contributors to its development. The objective of this review is to analyze the incidence, progression, clinical manifestations, and treatment approaches of mucormycosis, drawing from a selection of 16 pertinent articles published between 2009 and 2022, and accessed through databases like PubMed and Google Scholar.

Mucormycosis of left maxilla: A case report and review

Mucormycosis is an angioinvasive infection caused by fungi of the Zygomycetes order. Rhizopus is the main pathogen responsible for 90% of cases of cerebral mucormycosis. The term rhinocerebral mucormycosis should be used only in the face, palatal, orbital, paranasal sinus, or brain area. Here, we present the case of a 42-year-old man who presented with complaints of pain and swelling in relation to the left upper back tooth region for the past 20 days. In this case, the patient was immunocompromised due to type II diabetes, as well as COVID hospitalization. This case enlightens the investigation, as well as the management protocol followed by post-operative rehabilitation. Early diagnosis and prompt treatment can significantly reduce the morbidity and mortality of these deadly fungal infections.

Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report

Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.

Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India.

A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens. This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge. Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%). Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..

The mutual value of histopathology and ITS sequencing in the diagnosis of mucormycosis.

Mucormycosis is a fast-progressing disease with a high mortality rate. The most important factor determining survival of patients is early and accurate diagnosis. Although histopathology often recognises invasive mould infections at first, histomorphology alone is insufficient in providing an accurate diagnosis. Unbiased molecular methods to detect and identify fungi are promising, yet their role in complementing routine histopathological workflows has not been studied sufficiently. We performed a retrospective single-centre study examining the clinical value of complementing histopathology with internal transcribed spacer (ITS) sequencing of fungal DNA in the routine diagnosis of mucormycosis. At our academic centre, we identified 14 consecutive mucormycosis cases diagnosed by histopathology and subsequent ITS sequencing. Using histomorphological examination, fungal hyphae could be detected in all cases; however, morphological features were unreliable regarding specifying the taxa. Subsequent ITS sequencing identified a remarkable phylogenetic diversity among Mucorales: the most common species was Rhizopus microsporus (six of 14; 42.9%), followed by Lichtheimia corymbifera (three of 14, 21.4%) and single detections of Rhizopus oryzae, Actinomucor elegans, Mucor circinelloides, Rhizomucor pusillus and Rhizomucor miehei (one of 14; 7.1%, respectively). In one case, we additionally detected Pneumocystis jirovecii in the same lung tissue specimen, suggesting a clinically relevant co-infection. Fungal culture was performed in 10 cases but yielded positive results in only two of 10 (20%), revealing its limited value in the diagnosis of mucormycosis. Our study demonstrates that a combination of histopathology and ITS sequencing is a practically feasible approach that outperforms fungal culture in detecting Mucorales in tissue-associated infections. Therefore, pathologists might adapt diagnostic workflows accordingly when mucormycosis is suspected.

Fractional commensurate model on COVID‐19 with microbial co‐infection: An optimal control analysis

AbstractCrossover behaviors have always existed in the history of infectious pandemics due to a few distinct, erratic spread outlines. This research aims to investigate the crossover behavior of the proposed SVICR commensurate fractional model for the COVID‐19 delta variant, considering microbial coinfections. A mathematical model in terms of Atangana–Baleanu Caputo (ABC) category fractional integrals takes into account the co‐infection of mucormycosis in immunocompromised COVID‐19 patients caused by microbial infections. ABC operators preserve the intact history of the happenings under contemplation through its nonsingular kernel. It is observed that the framed five‐compartmental SVICR model is positively bounded on R5, the solution space. Two equilibrium points representing the survival and annihilation of sickness respectively are contributed by the single population N(t), which is counted in five dependent compartments: The bilinear growth rate of new additional infections from the contagious infectives over time ‘t’ is viewed through the threshold metric Lyapunov's stability function examines the parametric influences over the virulent spread globally. The significant focus is to investigate the Mucormycosis cases in COVID‐19 patients with underlying diabetic complications. Diabetes mellitus is the major concern for several coinfections among COVID‐19 recoveries. Aiming to minimalize the critical states, an Lagrangian–Hamiltonian optimum control structure is also performed for the SVICR model by introducing control variables in effect to tri‐control probes of minimized contact rates, persuasive vaccinations, and glycemic control of post recovered diabetic patients. The hike in the Severity of the ailment due to fungal pathogens is studied through numerical convergence of predictor–corrector scheme and simulations. Using estimated parametric values from the statistical data of mucormycosis and infections of COVID‐19 reported cases in India, the prominence of control effects are visualized graphically. To conclude, a complete qualitative analysis of the minimization problem is executed for different levels of control values. We avow that effective control intrusions would almost certainly decline the complexities associated with the viral pathogens.

An Epidemiological Study on Mucormycosis Patients Admitted in Tertiary Care Hospital of Central India

Introduction: The second wave of SAR Cov-2 Infection brought a new menace that was the escalation in thenumber of mucormycosis, which is a potentially life-threatening, opportunistic, invasive, fungal infectioncommonly called the “Black fungus”.Objective: To find out the factors responsible for occurrence of mucormycosis and the pattern that have emergedin the Post SARS – CoV-19 infected cases admitted in tertiary care hospital of Central India.Material and methods: This descriptive Cross-sectional study was conducted in Government Netaji SubhashChandra Bose Medical college and hospital of Central India from May 2021 to June 2021. 96 Confirmed cases ofmucormycosis were included in this study. The details about Demographical, Epidemiological, clinical data wereretrieved by us through interview with patient or his relative and by going through the case sheets of the cases.Results: The mean age for the mucormycosis was among male is 52.68 ±11.13 years and among female it is47.47±10.07years. 78% of study subjects were hospitalized for treatment while 22% received treatment at home.72.40% had steroid intake, Mean duration of steroid therapy was 10.15±5.71 days. Mean duration between steroidtherapy and appearance of mucormycosis as 14.21±9.1 while mean duration between Covid infection and mucormycosis was found to be 19.71±9.84 days.Conclusion: Immunosuppression during Covid -19 treatment had catalyst effect on the development ofmucormycosis. Early diagnosis and careful monitoring of immuno-compromised individuals is essential. Steroidand other immune- suppressive drugs should be given cautiously.

Rhino-cerebral mucormycosis in patients with COVID-19: clinical cases and treatment in a regional hospital

Mucormycosis is a serious fungal infection, which increased significantly during the COVID-19 pandemic. We retrospectively analyzed 5 histopathologically confirmed cases of rhino-cerebral mucormycosis, which were diagnosed in patients admitted to Smolensk regional clinical hospital from November 2021 to January 2022. All patients were older than 60 years of age and had a recent history of laboratoryconfirmed severe COVID-19 and were treated in infection hospitals. All patients had decompensated type 2 diabetes mellitus; 80% of patients had concomitant cardiovascular diseases (coronary heart disease, arterial hypertension), 100% of patients received previous treatment with systemic corticosteroids for COVID-19 in hospitals. All patients underwent surgical treatment. Antifungal therapy (amphotericin B) was administered, and one patient received posaconazole due to a lack of efficacy of amphotericin B. The length of hospital stay ranged from 14 to 56 days. The overall 3-month survival rate of patients with rhinocerebral mucormycosis was 80%.

Black Fungus of the Foot: An Unusual Presentation of COVID-19-Associated Mucormycosis.

Mucormycosis, also known as black fungus, is a rare but aggressive fungal disease with high morbidity and mortality rates that tends to affect patients who are severely immunocompromised. Early recognition of the infection and prompt intervention is critical for treatment success. In recent years the coronavirus disease of 2019 (COVID-19) pandemic has resulted in a surge in the number of cases of mucormycosis. This study aims to report an unfortunate event involving an immunocompromised elderly man with mucormycosis of the foot who died as a result of sepsis caused by COVID-19. It is important to have a high clinical suspicion for mucormycosis when a clinical lesion develops, and to appropriately perform biopsy the lesion in question, particularly in the context of COVID-19. Raising awareness of COVID-19-associated mucormycosis may allow for early detection of the disease, thus enabling the initiation of rapid treatment, ultimately saving lives.

Rehabilitation of Post-COVID-19 Mucormycosis Surgical Defect Using an Unconventional Obturator with Precision Attachments: A Case Report

Mucormycosis, also known as black fungus, is a rare fungal disease caused by a filamentous fungus that primarily affects the nose, paranasal sinuses, and brain. A significant number of mucormycosis cases were reported during the COVID-19 pandemic, many of which required surgical intervention. Parts of orofacial structures such as the alveolar process of the maxilla, palate, contents of the orbit, and nasal cavity were often removed to prevent a fatalities. The extent of hard tissue structures removed depended on the degree of involvement. Following surgical procedures, individuals were left with a variety of defects, ranging from lost alveolar processes and teeth to partial or total maxillectomy, and oronasal communication due to a missing palate. In such situations, Prosthodontists play a critical role in rehabilitating patients prosthetically. They analyse the defects in each case and design a prosthesis to replace the missing structures, aiding in the restoration of function and aesthetics. Hereby, the authors present a case report of 36-year-old-male with missing teeth in the upper left posterior and anterior regions and this clinical report aimed to describe an innovative aesthetic alternative to conventional cast partial obturators using OT attachments to achieve retention.

In silico studies on Epicoccum spp. Secondary metabolites as potential drugs for mucormycosis

Mucormycosis is a rare and severe form of fungal infection caused by some fungal species belonged to mucormycetes that mainly infects skin but also eyes and other organs of the human body. The COVID-19 pandemic has demonstrated the rise in mucormycosis cases due to usage of industrial grade oxygen and overuse of steroids particularly in developing nations, where the pandemic has stressed the medical system to its limit. The major aim of this study was to screen potential antifungal compounds produced by Epicoccum spp. against target enzyme lanosterol 1,4-alpha demethylase of Rhizopus arrhizus var. delemar (strain RA 99–880 / ATCC MYA-4621 / FGSC 9543 / NRRL 43880), to evaluate potential drug candidates using in silico approach, compounds that may be explored further for the treatment of mucormycosis. Sequence of enzyme was retrieved from the UniProtKB database and ligands from PubChem database. 3D structure was obtained using protein homology modelling (SWISS-MODEL server). The target enzyme was prepared along with ligands using ADT software and then subjected to molecular docking using Autodock Vina. The results and protein-target interactions were studied using the BIOVIA Discovery studio. After virtual screening of secondary metabolites produced by Epicoccum spp. and after comparing them with the results of control drugs, the compound curvularin specifically showed potential interactions with amino acid residues of target enzymes. It is also exclusively binding to the iron atom of the hemoglobin (HEME) group with binding affinity of −12.3 kcal/mol, where the hemoglobin is the main target of current existing drugs used for treating patients. The stability of molecular complexes can be measured through molecular dynamic simulation and root mean square fluctuation (RMSF) values. In this study, stable complexes were formed with curvularin and rostratin A having the highest RMSF values of 4.3 Å and 4.5 Å, respectively. Lower RMSF values indicate stability, while higher values indicate flexibility. The ADMET score gave an outlook about the absorption, distribution, metabolism, excretion and toxicity of the ligands. All the drug candidates used in this study passed the basic Lipinski rule of five except orevactaene. Curvularin and rostratin A were predicted as enzyme inhibitors by a bioactivity prediction tool (Molinspiration). In vitro and in vivo studies will be a way to go further.

Mucormycosis in COVID-19 Pandemic

Background Coronavirus disease-2019 (COVID-19) has been associated with a wide range of opportunistic fungal infections. Many countries have seen an unprecedented rise in cases of COVID-19-associated mucormycosis (CAM). The purpose of this study is to identify the correlation between the COVID-19 epidemic and mucormycosis. Our study also provides details on factors causing CAM. Methods A retrospective study from November 2020 to February 2022 includes four cases of COVID-19-associated rhino-orbital mucormycosis treated at Habib Thameur Hospital’s ENT Department. Results The mean age of patients was 67.5-years, 75% were males, and the most frequent underlying conditions were diabetes mellitus (100%). The median time interval between the diagnosis of COVID-19 and the first evidence of mucormycosis infection was 15-days; two patients required hospitalization in a COVID unit, and two patients received oxygen therapy at home. All patients received corticosteroid therapy at a dose of 1 mg/kg/d for an average of 10-days. Treatment using antifungals and surgery was described in all the patients. Amphotericin B deoxycholate was used in 75% and lipid formulation in 25%. Two patients presented renal insufficiency due to amphotericin B; the doses were adapted with good evolution. In that report, the case fatality rate was 75%. Conclusion Mucormycosis is a fatal fungal infection that usually affects patients with altered immunity. Several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide. Diabetes mellitus (DM), steroid overdose, immunosuppression, and high iron levels, combined with other factors such as prolonged hospitalization, unhygienic conditions, and the use of ventilators, combine to create an ideal environment for contracting mucormycosis. Lastly, there is a need to create awareness about fungal diseases among clinicians in order to help identify early symptoms and restrict the spread of lethal fungal diseases. A collaborative team of otolaryngologists, ophthalmologists, anesthesiologists, and resuscitators will be required in hospitals to accelerate optimal management.

A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting.

Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.