Mortality Of Mucormycosis Research Articles

Erratum: Mortality of Mucormycosis during Coronavirus Disease Pandemic

Erratum: Mortality of Mucormycosis during Coronavirus Disease Pandemic

Mortality of Mucormycosis during Coronavirus Disease Pandemic

Abstract Background: Acute invasive fungal rhinosinusitis is an aggressive, mutilating, and in many cases life-threatening infection that results in rapid devitalization of tissues in the area of the nasal cavity and paranasal sinuses. Diabetic ketoacidosis, renal impairment, and hematological malignancies used to be the main predisposing factors for this serious infection. During the second wave of the pandemic of coronavirus disease (COVID-19), there has been an increment in these cases, in a manner that has not been witnessed before, and hence the interest in studying this topic. Objectives: Review of management outcomes and mortality in patients diagnosed with “possible invasive fungal rhinosinusitis” during the 2nd wave of COVID-19 pandemic and compare these with the outcomes observed before the pandemic in Iraq and other countries. Materials and Methods: A cross-sectional study of all patients with clinically possible invasive fungal rhinosinusitis (30 patients) presenting or referred to the ear nose and throat outpatient unit during the period from June 1st 2021 to December 31st 2021. Results: 30 patients were included, 53.3% male, 73.33% had mucormycosis following COVID-19 infection. Diabetes was the underlying condition in 57.67% of the cases. Fever, facial pain, nasal obstruction and headache were the most prevalent symptoms at presentation. The mortality rate was 16.7%. Conclusion: A reduced mortality rate was observed despite the increased number of cases, and this is mostly related to the early initiation of antifungal therapy.

Sensitivity of KOH Mount in the Early Diagnosis of Fungal Infections of Nose and Paranasal Sinuses in COVID-19 Infected Patients Suspected with Mucormycosis

Introduction: Mucormycosis represents a group of life threatening infections caused by fungi of the order Mucorales especially in Coronavirus Disease 2019 (COVID-19). It is a highly invasive and rapidly progressive disease resulting in high grades of morbidity and increased mortality. Aim: To study the sensitivity of potassium hydroxide (KOH) mount in the early diagnosis of mucormycosis in COVID-19 infected patients. Materials and Methods: A prospective, longitudinal (single group) study was done in McGANN Teaching District Hospital, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, among the patients with high index of clinical suspicion of mucormycosis from May 2021 to August 2021. Specimen from the nasal cavity or the suspected lesion on hard palate, gums, skin was sent for KOH mount and fungal culture and also biopsy of the nasal mucosa sent for histopathological examination. The sample was sent both preoperatively and intraoperatively. The positive KOH report and its role in early diagnosis and management of mucormycosis suspected cases were assessed. Results: Out of 26 patients, 6 (23.1%) were females and 20 (76.9%) were males. COVID-19 positive suspected mucormycosis were 5 (19.2%) and post COVID-19 suspected mucormycosis were 21 (80.8%). Species isolated after processing the sample were rhizopus in 10 (38.5%), candida in 1 (3.8%), aspergillus in 1 (3.8%); while in 14 (53.8%) no organisms were isolated. Out of 26 patients KOH positive sample on the day of admission confirming with positive intraoperative histopathological examination were 10 (41.7%). Admission day fungal culture positivity was seen in (n=12, 46.2% ) and negativity in 14 (53.8%) cases. Intraoperative fungal culture was positive in 24 (92.3%) cases. There was 100% specificity for both fungal culture and KOH mount and sensitivity for KOH was 41.7% and 50% for fungal culture. False negativity rate for KOH was 58.3% and for fungal culture was 50%. Conclusion: The results of KOH mount can be obtained within an hour of sending nasal scrapping samples. Hence, it helps in making the early diagnosis and early initiation of treatment for suspected cases. But in the current study, even in patients presenting with high clinical suspicion of mucormycosis, the sensitivity of KOH mount on the day of admission to the hospital was 41.7%.In view of severe morbidity and mortality of mucormycosis, this sensitivity though less is of paramount importance in these patients because treatment can be started early.

DOUBLE EDGED SWORD- MUCORMYCOIS IN COVID 19 PATIENTS

INTRODUCTION : There is an increasing risk of mucormycosis in the post Covid patients , especially in the second wave of the pandemic, there has been a tremendous rise of mucormycosis in covid 19 cases, therby increasing the mortality and morbidity. There are many risk factors contributing to mucor among which diabetes mellitus is seen as an independant and most common risk factor. AIMS AND OBJECTIVES : To study the clinical manifestations, treatment ,mortality and mortality of mucormycosis in covid 19 . MATERIALS AND METHODS : This is an observational study carried out between April 2021 to june 2021. This study observes the clinical manifestations and CT findings ,treatment and outcomes in 25 patients of mucormycosis. OBSERVATION : This study included a total 25 patients of which 21(84%) are male and 4(16%) are female. The age of the patients varied between 25 -60 years with 49 years being the mean age group. Out of 25 members ,20 have diabetes, 1 has hypertension, 3 have hypothyroidism, 6 are smokers, 2 have coronary artery disease and are alcoholics. 24 underwent FESS & debridement and were treated with Amphotericin B and posaconazole. And 23 out of 25 used steroids. 2 of the 25 members died of severe mucor out of which 1 died before surgery and 1 after surgery CONCLUSION : In this study it has been observed that the early diagnosis and treatment of mucormycosis with better control of diabetes leads to improvement of mortality and morbidity in these patients.

Our 2014 approach to mucormycosis.

Mucormycosis, previously termed as zygomycosis, is caused by fungi belonging to the order Mucorales and is a very severe disease in immunocompromised patients with an often unfavourable outcome. Given the high morbidity and mortality of mucormycosis, establishing a timely diagnosis followed by immediate treatment is of major importance. As randomised clinical trials are lacking, we present our current diagnostic and treatment pathways for mucormycosis in the immunocompromised host. Due to the difficulty to distinguish mucormycosis from other filamentous fungi, mucormycosis always has to be considered as differential diagnosis in predisposed patients. Diagnostic procedures comprise imaging, microscopy, culture and histopathology and need to be rigorously used. In patients with a high suspicion of mucormycosis, e.g. reversed halo sign on computed tomography scanning, our approach combines liposomal amphotericin B (LAmB) with surgical debridement. In light of the rapid deterioration and poor prognosis of these patients, we prefer a daily dose of LAmB of at least 5 mg kg(-1) despite nephrotoxicity. In patients with stable disease we switch to posaconazole 200 mg four times per day. In case of progression antifungal combination is an option.

Emergence of Cunninghamella As a Pathogenic Invasive Mold Infection in Allogeneic Transplant Recipients

Clinical Practice Points Cunninghamella, a relatively infrequent cause of mucormycosis, is associated with aggressive and often fatal disseminated invasive fungal infection in hematopoietic stem cell transplant (HSCT) recipients, in particular those receiving high-dose immune suppression. Polyene-based antifungal agents, such as amphotericin B and its lipid derivatives, are first-line therapy for invasive mucormycosis. Despite currently available treatment approaches, the attributable mortality of mucormycosis remains very high. Our single-center experience suggests that infection with Cunninghamella species portends worse outcomes. The impact of prophylactic approaches (eg, with extended-spectrum azoles such as posaconazole) in preventing this infection in high-risk patients awaits further investigation.

Current Diagnosis and Management of Mucormycoses

Due to the rising incidence of diabetes mellitus, the increasing populations of immunocompromised individuals of varied etiologies, and the progresses that have been made in the management of the critically ill, the incidence of invasive fungal infections, in particular those caused by the Mucorales, is increasing. Currently available diagnostics frequently miss this infection. Knowledge of the factors placing individuals at risk for and the varied clinical presentations of mucormycosis should alert clinicians of the possible presence of this infection. Survival of individuals with mucormycosis is dependant on prompt diagnosis and aggressive therapy with antifungal agents; surgical debridement; and, if possible, reversal of the risk factors predisposing the individual to this infection. It is hoped that improved diagnostic testing, improvements in pharmacotherapy, and adjunctive therapies will improve the morbidity and mortality of mucormycosis.

Mucormycosis in systemic lupus erythematosus

Objective: To describe a case of mucormycosis in systemic lupus erythematosus (SLE) and to review other patients reported in the English literature. Method: A Medline search for articles about mucormycosis in SLE published between 1970 and 2002 was performed by using the key words “lupus,“ “mucormycosis,” “zygomycosis,“ “Mucorales,” “Rhizopus,” and “Mucor.” Cases were pooled for analysis, and the mycology, diagnosis, treatment, and outcome of mucormycosis in SLE was reviewed. Results: Eight cases of mucormycosis in SLE were identified (female:male = 7:1). The mean age at the time of infection was 31.8 ± 7.6 years and the mean duration of SLE was 6.3 ± 3.9 years. All except 1 patient had active lupus and all were receiving high-dose corticosteroids. Concomitant cytotoxic agents were used in 4 patients. Additional predisposing factors for opportunistic infection included hypocomplementemia, nephrotic syndrome, uremia, leukopenia, and diabetes mellitus. The disseminated form of mucormycosis was the most common presentation and the diagnosis often was made only at autopsy (63%). For cases with positive culture results, Rhizopus was the causative species. In 4 patients, manifestations of the fungal infection mimicked those of active SLE. The overall mortality of mucormycosis was very high (88%) and, in most cases, was probably a function of delayed diagnosis and treatment. The cutaneous form appeared to have the best prognosis with combined medical and surgical treatment. Conclusions: Mucormycosis is a rare but usually fatal fungal infection in SLE. Judicious use of immunosuppressive agents, a high index of suspicion, early diagnosis, and combination treatment with amphotericin B and surgical debridement may improve the prognosis of this serious infection.