Class Zygomycetes Research Articles

DIAGNOSIS AND TREATMENT OF MUCORMYCOSIS: AN INTRUDER POST-COVID-19

Mucormycosis can be elaborated as mycosis due to Mucorales. Mucormycosis is an angioinvasive infection. Fungi of Mucorales order is the causative organism of mucormycosis and pertains to the class of zygomycetes. It is ordered on number third after candidiasis and aspergillosis in the category of invasive mycosis. Rhizopus arrhizus (oryzae) is the most important species which cause this disease. It is categorized as a disease with high mortality. There is a 46% chance of mucormycosis with person having sinus infection, 76% of chances with pulmonary infection, and 96% for disseminated Mucormycosis. The COVID-19 pandemic precipitated this disease in a common way. Around 90% of the population was exposed to coronavirus disease 2019 (COVID-19) infection during the pandemic which ultimately affected the immunity of individual, leading to increased chance of exposure to other infectious disease. Mucormycosis is one of such disease which can highly affect the individual with COVID-19 infection in patient’s history. This review presents a brief about the disease origin, occurrences, types, signs and symptoms, risk factors, diagnosis, and treatments available, along with recent patents. This review also elaborated the treatment of COVID-19-associated mucormycosis and other risk factors. It was found that the diagnosis is not simple and easy sometimes it was observed postmortem also. This review also focuses on various methods with which easy diagnosis of this dreadful disease can be done.

A Case of Lung Abscesses Secondary to Mucormycosis in a Diabetic Female Patient

Mucormycosis is a rapidly advancing and hazardous form of opportunistic infection usually starts in nose and/or paranasal sinuses after inhaling fungal spores. This infection is caused by Mucorales fungi which belong to the Zygomycetes class. The incidence of Mucormycosis is approximately 1.7 cases in 1 million. They more frequently exist in rhinomaxillary area and is a rare pulmonary disease of an opportunistic fungi, which is difficult to diagnose with an unpredictable response to treatment. They usually appear in individuals with immunocompromised states such as diabetes, long term use of corticosteroids, immunosuppressive therapy for solid organ and hematopoietic cell transplantation, and disorders like neutropenia are notably common risk factors. As a potential for relatively life-threatening condition, the disorders warrant an anticipatory approach. We report here a case of pulmonary mucormycosis in uncontrolled diabetes presented with bilateral cavitary lesions in lungs that was first misdiagnosed as case of Pulmonary TB, later diagnosis was made on the basis of results of bronchoscopic biopsy, and was started on amphotericin and followed up with improvement of her symptoms.

POST-COVID ROCM (RHINO ORBITAL CEREBRAL MUCORMYCOSIS) INVOLVING SKULL BASE – A RARE CASE REPORT

INTRODUCTION Mucormycosis in the setting of COVID-19 has given rise to the concept of 'epidemic within a pandemic'. It is a life-threatening fungal infection caused by fungi belonging to class Zygomycetes. It has got special affinity for the immunocompromised which is one of the main reasons for the flare up of the disease during COVID. Rhino-orbito-cerebral Mucormycosis (ROCM) is by far known to be the most common form of this disease. This usually presents with nasal dryness and blockage, swelling and numbness of cheek, blackish discoloration of nose, cheek and palate. It has been seen that in late stages of mu c o rmy c o s i s , p a t i e n t s p r e s e n t e d w i t h ophthalmoplegia, diminuition of vision, loss of vision, altered sensorium or even facial palsy. MATERIAL AND METHOD We here-in report a rare case of a 67-year-old diabetic male who was diagnosed with post- COVID Mucormycosis involving skull base with right abducens nerve and right hypoglossal nerve palsies. Management comprised of endoscopic debridement of the disease followed by administration of liposomal amphotericin. Patient was followed for 6 months with repeated nasal endoscopies and follow-up MRI. CONCLUSION There was visible recovery of the sixth and twelfth nerves. No recurrence has been observed. K e y w o r d s – R h i n o - o r b i t o - c e r e b r a l m u c o r m y c o s i s , a b d u c e n s n e r v e p a l s y, h y p o g l o s s a l n e r v e p a l s y, e n d o s c o p i c debridement, dolleros canal

Rise of mucormycosis during the COVID-19 pandemic and the challenges faced.

Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared toother developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following generafrom the Order Mucorales Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk factors for the development of mucormycosis are diabetic ketoacidosis, deferoxamine treatment, cancer, solid organ or bone marrow transplantations, prolonged steroid use, extreme malnutrition, and neutropenia. The common clinical forms of mucormycosis are rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal. During the second wave of COVID-19, there was a rapid increase in mucormycosis with more severity than before. Amphotericin B is currently found to be an effective drug as it is found to have a broad-spectrum activity and posaconazole is used as a salvage therapy. Newer triazole isavuconazole is also found effective against mucormycosis. This study aimed to review various studies on the laboratory diagnosis and treatment of mucormycosis.

Mucormycosis in India: Pathophysiology and Perspectives on Treatment and Management.

Mucormycosis, also known as "black fungus," is a potentially fatal disorder that causes blurred or double vision, chest pain, and breathing problems. The introduction of novel risk factors and causative agents, as well as the problems with controlling the disease, are all significant problems with mucormycosis in India. It is most common among COVID-19 patients. Mucormycosis is an invasive fungal disease that primarily affects immunosuppressant patients, mainly caused by mold fungi of the genus mucor, rhizopus, rhizomucor, and absidia, which are in the zygomycetes class and the Mucorales order. The most common risk factor is diabetes mellitus, followed by haematological malignancy and solid-organ transplantation. Reversal of underlying predisposing factors, surgical debridement of infected tissues, and proper antifungal therapy are all required for the treatment of mucormycosis. In this review, the epidemiology, pathogenesis, and symptoms of black fungus and its association with covid-19, treatment, and diagnosis are discussed.

Colonic basidiobolomycosis in a patient with systemic lupus erythematosus (SLE)

BackgroundBasidiobolus ranarum belongs to the Entomophthorales order and the Zygomycetes class. This fungus is an environmental saprophyte that can be found in soil and rotting vegetables.Primarily restricted to tropical regions including Asia, Africa, and South America. It might cause chronic inflammatory diseases, mostly affect subcutaneous tissue. Systemic infections involving the gastrointestinal tract are extremely rare.Case presentationHerein, we present a 44-year-old Persian man with the past medical history of lupus erythematosus with colicky abdominal pain started from three months before admission with many vomiting episodes, and a mass on the right lower quadrant, who had been thought initially to have an abdominal malignancy. The patient had vital signs were within normal ranges. His physical examination revealed tenderness and rebound tenderness on the right lower quadrant of the abdomen. A fixed mass 10 × 10 centimeter in diameter was palpated in the same quadrant. Laboratory, radiologic, colonoscopic examination was requested. The patient underwent laparotomy which revealed a mass in the terminal ileum and ascending colon with retroperitoneal adhesion and invasion to the right ureter behind it. Pathologic examination showed basidiobolomycosis infection in the specimen.ConclusionFungal infection should be among the differential diagnoses for adults present with abdominal mass in endemic regions of the world.

Post-COVID-19 Mucormycosis

In India, thousands of COVID-19 patients are suffering from mucormycosis, a deadly fungal infection. Mucormycosis is an infection caused by a group of filamentous molds belonging to the order Mucorales and class Zygomycetes. Typically, mucormycosis is called black fungus disease. The infection primarily affects diabetics and immunocompromised patients. Infections caused by this fungal infection can be divided into four types: rhino-orbito-cerebral, cutaneous, disseminated, pulmonary, and gastrointestinal types. The mortality rate is higher even when aggressive treatment has been administered once it is detected or diagnosed. A multimodal approach to mucormycosis management involves reversing or discontinuing the predisposing factors, administering active antifungal agents at optimal doses, removing all infected tissues, and employing adjuvant therapy. The purpose of this review is to provide brief details related to the etiopathogenesis, fatality, diagnosis, and treatment of mucormycosis.

Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience.

Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.

Review on Mucormycosis the uprising infection and post COVID effect

Mucormycosis commonly called as Black Fungus is a fulminant angio-invasive infection that is caused by a distinctive group of fungi belonging to the genera of Class Zygomycetes and Taxonomic Order Mucorales, and is principally seen in immunosuppressed patients. It is an air-borne infection and primarily associated with upper and lower airways. It is a rare, infrequently and critically life-threatening fungal infection characterized by vascular invasion by hyphae and caused by the inhalation of its filamentous fungi, resulting in thrombosis, necrosis and infarction of tissue. The major risk factors that develop the infection include diabetic ketoacidosis, neutropenia, and protein-calorie malnutrition iron overload. Patients suffering from COVID-19 are more prone to have an infection due to low immunity power. Coronavirus disease causes an immunological disorder state and increases the risk of secondary infections like Mucormycosis. The mortality and morbidity rate caused by Mucormycosis has rapidly increased within the last decades, majorly in developing countries. Patients with Mucormycosis that endure surgical operation and who receive medical aid with IV Amphotericin B might have higher rates of survival. The work of the latest derivatives of azole within the treatment of Mucormycosis is unknown.

Estimation of Serum Ferritin in Mucormycosis Patients and Prognostication Based on the Ferritin Value.

Introduction: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in a variety of vulnerable bacterial and fungal diseases. Mucormycosis is a life-threatening infection caused by fungi belonging to the class Zygomycetes and the order Mucorales. The aim of the present study is to evaluate the level of serum ferritin level in mucormycosis patients and to prognosticate them based on those values.Materials and methods: This prospective observational study was conducted in the Department of General Medicine, Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli, in 50 diagnosed mucormycosis patients.Results: During the study period, 44 had prior COVID-19 illness (post-COVID). Six patients had mucormycosis with no prior COVID-19 illness. Rhino-orbital involvement was found in 44 of the 50 cases, with three of them having cerebral extension. Forty-one cases recovered and were discharged, six cases remained sick and were hospitalized, and three died. The post-COVID patients (554.13 ± 371.60) have greater serum ferritin levels than non-COVID patients (259.95 ± 110.15), which are statistically significant. Conclusion: Mucormycosis patients tend to have higher serum ferritin values, especially among non-survivors and sick patients than survivors. For a better chance of recovery and survival, early identification, surgical debridement, and antifungal medications are essential.

Cutaneous Mucormycosis in an Immunocompetent Child following a Minor Skin Trauma

Cutaneous mucormycosis is a rare infection by the Zygomycetes class of fungi, which carries significant morbidity and mortality. While typically associated in patients with underlying immunocompromise (especially in the current era of COVID-19), it may also be seen in immunocompetent patients. We report a case of a healthy 4-year-old girl with acute right leg cellulitis and abscess formation, who required surgical debridement following poor response to antibiotic therapy and initial incision and drainage. Tissue histopathology returned cutaneous zygomycosis despite negative tissue cultures. At four-week follow-up, her wound was healed well. Clinicians should maintain a high degree of clinical suspicion for cutaneous mucormycosis given its potential for rapidly progressive and disseminated disease. Currently, the mainstay of diagnostic investigations is tissue histopathology, with a growing role for tissue fungal PCR. Treatment involves multidisciplinary management between surgeons and Infectious Diseases team to guide the role for surgical debridement and antifungal therapy.

Let's talk about mucormycosis emergency with COVID-19: Invest in future.

Despite recent breakthroughs in the detection and treatment during the COVID-19 pandemic, mucormycosis is a serious infection with a high death rate. It is a filamentous fungal infection from the zygomycetes class of order mucorales. It is a fatal fungal infection with a 50% or higher overall fatality rate. Mucormycosis is a fungal infection caused by mucor, which is a mold that can be found in soil, rotting fruits, and vegetables. It can primarily affect the brain, lungs, and sinuses. It is very much fatal in patients with diabetes or who are highly immunocompromised such as patients with cancer. In addition to more than 50% mortality rate, surgical intervention may require necrotic tissue removal, which leads to severely disfiguring surgery.

Mucormycosis—Emerging Fungal Threats

Mucormycosis is an opportunistic fungal infection due to organisms of the Zygomycetes class and the order of Mucorales that can cause various types of infections. In recent years, an increasing phenomenon has been observed—invasive fungal infections especially in the healthcare setting. Among immucompromised patients, an important clinical emergency could be represented by mucormycosis. The epidemiology of mucormycosis has shown an alarming trend and its incidence is rising globally. Four elements are fundamental for a successful treatment: rapid diagnosis, reduction of predisposing factors (if possible), surgical debridement of infected tissues, and appropriate antifungal therapy.

Resolving the equation between mucormycosis and COVID-19 disease.

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.

Soil nutrients dynamics and status of Mycoflora Population in a tropical Forest Soil of Uttarakhand Himalaya

Tropical forests have a great diversity of microorganisms. Fungi are the most important group of microbes. They play an essential role in tropical forest ecosystem as saprotrophs, mutualists and pathogens. In the present study, we attempted to study the soil nutrient dynamics and status of the mycoflora population, along with the effect of soil nutrient dynamics on the fungal population. Fourteen species of fungi within five genera belonging to three families were isolated and identified from the six forest sites in the Chilla forest division under Rajaji tiger reserve. They belong to the class Zygomycetes and form class Deuteromycetes. The soil of the study area was acidic without much variation among all the six study sites. Higher nutrient concentrations were recorded in the top layer of the soil, which supports the maximum number of fungi population in the study area. Further, fungal flora was also correlated with varying ecological factors, viz. pH, organic carbon and nitrogen and phosphorus.

Characteristics of fungi contaminant in tissue culture of Bromheadia finlaysoniana (Lind.) Miq

Generative propagation of orchid plants has problems because orchid seeds do not have endosperm that need to be multiplied using tissue culture. Contamination is a limiting factor in the multiplication of plants in tissue culture. This study describes the types of contaminants found in Bromheadia finlaysoniana callus. This research was carried out in two stages. The first stage is carried out culture of various explants of Bromheadia finlaysoniana using murashige and Skoog media with enrichment of hormone Benzylaminopurine 1 mg/l; (Naphthalene acetic acid) 0.5 mg/l; 100 mg mynositol; pyridoxine-HCl 0.5 mg/l; thiamine-HCl 0.1 mg/l; nicotinic-acid 0.5 mg/l; glycine 2 mg/l. The second stage is observed and the percentage of contaminant fungi. The observed contaminants character includes the colour, the direction of growth, and the hyphae colony's shape. Determination of contaminants type compared to the morphology of references. The result is the highest contamination in flower stalk explants, 81%; most colonies on leaf explants are 28. Contaminant fungi grow predominantly of fungi with white and grey colour and a rough surface shape. The macroscopic character of contaminant fungi in tissue cultures mostly comes from the class of Deuteromycetes and Zygomycetes. Keywords: Bromheadia finlaysoniana , contaminant, fungi, tissue culture

Open surgical approach to management of rhino-orbito-cerebral mucormycosis

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

Association of Mucormycosis in Covid-19 and its Epidemiologic Study

Mucormycosis, also known as Zygomycosis or Black Fungus, is an infection caused in humans via various causative agents from the Zygomycetes class. Several countries including India is afflicted by the covid-19 virus, which has infected approximately 3.7 million people across the country. Some of the corona-positive patients suffer from another fatal infection, Mucormycosis, commonly known as Black Fungus. The strategy should be to administer an effective antifungal drug as soon as possible at the optimum dose. However, India being an epicenter of Diabetes with enormous 80 million diabetics, is of particular importance in the present scenario of the COVID pandemic. COVID therapy with Steroids and immune suppressants has increased the chances of infection in various individuals within the country with weaker immune system responses. The main purpose of this paper is to enlighten the community about the involvement of mucormycosis in covid-19 affected population and basic insights of its invasion. Keywords Mucormycosis, Black Fungus, Covid-19, Diabetes Mellitus, Amphotericin B, Immunosuppression, Apophysomyces, Renal Failure, Corticosteroids

Emergence of Mucormycosis during COVID-19 Pandemic in India

The present review describes about the disease and the fungal agent in brief, and also stresses for establishment of mechanically ventilated hospital wards across the country. Second wave of COVID-19 pandemic in India has been complicated by high infection rate (R0), 600% jump in medical oxygen demand by COVID hospitals, and after all emergence of Mucormycosis since April-May 2021 leading to fatal complications. Mucormycosis is a very rare infection in humans. It is caused by exposure to mucor mould/ fungi which is commonly found in soil, plants, manure, and decaying fruits and vegetables. These Fungi belonging to the class Zygomycetes and order Mucorales often cause devastating angio-invasive infections, primarily in co-morbid and immunocompromised patients. The emergence of mucormycosis is being reported globally. In India, people with diabetes mellitus are highly susceptible to the disease. But during the second wave of Covid-19 in India, several cases of mucormycosis, also called the "black fungus" disease, have been reported among convalescing and convalescent COVID-19 patients across India with a mortality rate of 50%. More than 5000 cases of mucormycosis during the second wave of Covid-19, have been reported in about 21 states of the country, with Maharashtra and Gujarat states reporting highest number of cases (as on 21 May 2021). The infection has claimed over 120 lives so far, and has complicated recovery from Covid-19 in many more. The Indian Union health ministry has declared mucormycosis as a notified disease under the Epidemic Diseases Act, 1897.

COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending?

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.