Case Of Mucormycosis Research Articles

Isolate profiling and geographical distribution of COVID-19 associated mucormycosis cases presenting to a tertiary care hospital in Jodhpur, India

Background and PurposeCOVID-associated mucormycosis (CAM) was as a dreadful complication in India. The state of Rajasthan, reported remarkably more patients than others but the cause for such geographical variation was unclear. The demography, clinical presentation and pathogens of CAM were studied. MethodologyThis was a prospective observational study where tissue specimens from CAM patients were subjected to microscopy and culture. Results and conclusionOut of 324 suspected CAM patients, the diagnosis was proven in 215 cases (66.36%). Culture was positive in 51.63% patients. Rhizopus arrhizus was the most common mucorale (82.88%) and rhino-orbital-cerebral (95.37%) was most common clinical presentation.

Turbinates involvment in rhino orbital cerebral mucormycosis in covid positive cases - A study on 100 cases

Mucormycosis also called as zygomycosis previously refers to several different diseases caused by infection with fungi belonging to the order Mucorales. Rizopus species are the most common causative organism. The infections are life threatening. Risk factors such as Diabetic Ketoacidosis and Neutropenia are present in most cases. During the pandemic period of COVID-19 2 wave rhino orbital mucormycosis was commonly effected with probable reasons are due to over dosage of steroid usage and o2 therapy, Uncontroled diabetes etc. To know the percentage of involvement of turbinates (MT,IT)in Rhino orbito cerebral mucormycosis cases in covid positive patients by doing endoscopic sinus surgery. A total of 100 covid positive patients with ROMM were selected and taken for radiological evaluation and selected for ESS during intraoperatively turbinates involvement with mucor (eschar/pus/crusting) was noted diagnosis of ROMM was based on CECT findings and symptoms in covid positive cases. Patients who are attending to Gandhi hospital during the pandemic of 2 wave of covid 19 were selected in study. Common age group with ROMM are 36to 55 years, with male predominance, commonest symptoms are unilateral facial pain & swelling, nasal crusting and dental complaints, commonest sinus to be involved is maxillary sinus, comorbid condition is Diabetes mellitus and moderate percentage of involvement of turbinates(common is middle turbinate) were noted. On microbiological and pathological examination of specimen showed positive KOH mount and mucorales order fungi are common followed by rizopus species. Main conclusions in this study are turbinates involvement with mucor in covid positive cases (eschar/necrosis/pus discharge) is more common in 43 patients (43%), most common mucor pathology seen in maxillary sinus in 58 patients(58%),followed by ethmoid sinus and sphenoid and orbit, teeth.

Clinical analysis of six cases of mucormycosis in children with acute leukemia

Clinical analysis of six cases of mucormycosis in children with acute leukemia

Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus.

We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02-0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03-16], itraconazole [0.03-16], posaconazole [0.03-8], and isavuconazole [0.03-16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus.

Mucormycosis - An Adamant Parasitic Fungal Infection Requiring Multiple Surgeries

Introduction - Mucormycosis is a life threatening invasive fungal infection that mostly occurs in immunocompromised patients. Aim of our study is to analyze the management of mucormycosis in rhinoorbital mucormycosis cases and dire requirement for more than one surgical intervention for their management. The limitations of first surgery, progressive nature of disease, and difficult anatomical regions were the areas to address in most of our patients in this series. Methodology - Our case series consists of 34 confirmed cases of mucormycosis using standard staining and histopathological confirmation on biopsy. The study group being subjected to complete modern diagnostic, CT, MRI scrutinization. Detailed follow up with serial endoscopies, post-surgery. Re confirmation of residual on progressive mucormycosis disease condition being subjected to repeat of these investigative tools and confirmation with PET scan. Results – Total of 34 patients were included in our study majority of them were diabetic. Only 3 patients underwent single stage debridement however 34 patients underwent debridement in two successive stage and two patients required third surgery for disease clearance. Conclusion – Repeated surgical debridement is must for complete disease eradication in case of rhinoorbitocerebral mucormycosis. Also, medical management can prolong the survival of patients with disease in areas which are inaccessible by surgical clearance. Serial radiography with CT, MRI and PET scan are not only contributary but mandatory.

A Novel Classification System for Oral Cavity Mucormycosis: a Hospital Based Cross-Sectional Study.

Rhino-oculo-cerebral Mucormycosis (ROCM) is a well-known complication post-COVID-19 infection. The extension of this disease into the oral cavity is a grey area with no proper protocol for management of the same in the existing literature. Based on our experience in the management of oral extension, this study aims to propose a protocol to treat these cases. To derive a classification for the surgeon from retrospectively collected data of 53 operated cases of oral Mucormycosis. Hospital record-based cross-sectional study; evaluation of the previously treated 53 cases of oral extension of post-COVID-19 Rhino-oculo-cerebral Mucormycosis in the duration between May 2021 to August 2021. Follow-up for a period of 1year. Based on the preoperative data, 4 parameters were taken -Tooth tenderness, Tooth mobility, Palatal perforation, and Radiological findings. A clinical-radiological classification system was derived based on the intraoperative data from the OT notes and the preoperative findings corresponding to the 4 parameters. The statistical analysis was done using SPSS for windows version 20 software (SPSS Inc., Chicago, IL, USA). Totally 220 cases of ROCM were recorded in our institute. Of this, 53 patients were treated for ROCM extending into the oral cavity. In 27 patients, we were able to achieve primary closure. In 26 patients, there was oro-antral communication after removal of the palate. Based on this data, we derived a protocol that may be used by the treating surgeon to manage oral cavity cases of ROCM, so that aggressive tissue resection may be avoided unnecessarily. This protocol will help the treating surgeon to have a clearer outlook on treating this disease.

A hospital-based observational study on clinical and radiographic findings in COVID-19 associated rhinomaxillary mucormycosis

Mucormycosis is a rare, rapidly spreading, fulminant, opportunistic infection that is caused by a group of filamentous molds. During the second wave of COVID-19 India reported most of the cases of mucormycosis which is termed as COVID-19-associated mucormycosis (CAM). Aim: The purpose of this study is to describe and understand the clinical and radiographic findings related to COVID-19 associated rhinomaxillary mucormycosis. Methods: In this observational study 76 individuals with proven rhinomaxillary mucormycosis were included. The demographic profile, predisposing factors, anatomic structures involved, oral manifestations, radiographic findings management, and 90-day mortality were recorded and analyzed. Results: Among 76 individuals with COVID-19-associated rhinomaxillary mucormycosis diabetes mellitus was present in 93.42% of cases. Almost all patients received corticosteroids during COVID-19 treatment. The maxilla was most commonly involved in around 98.6% of cases. Interestingly 1 case involving the mandible was noted and the maxillary sinus was the most commonly involved. Mortality occurred in 1.31% (n=1) of cases. Conclusion: Diabetes was the most common predisposing factor. Administration of corticosteroids was evident. A considerable number of patients developed diabetes during the treatment of COVID-19. Early signs and oral manifestations of rhinomaxillary mucormycosis play a pivotal role in the early diagnosis and prompt treatment to reduce mortality and morbidity in COVID-19 associatedrhinomaxillary mucormycosis patients.

Traumatic mucormycosis caused by Apophysomyces species - A case series

BackgroundApophysomyces species are emerging as the second most common agent of mucormycosis in India. It is worrisome as it affects predominantly immunocompetent host unlike other Mucorales. Unfortunately, the most common presentation is necrotising fasciitis which can be overlooked as bacterial infection. ResultsSeven cases of mucormycosis due to Apophysomyces species were detected in our hospital between January 2019 and September 2022. Mean age was 55 years and all were males. Six patients presented with necrotising soft tissue infection following accidental or iatrogenic trauma. In four cases, multiple fractures over the body were observed. Median days between admission to laboratory diagnosis was 9 days. All isolates were phenotypically identified as Apophysomyces variabilis. Multiple wound debridements, on an average two, was performed in all the cases and amputation performed in two patients. Three patients recovered, two could not be treated due to financial constraints and lost to followup and two patients died. ConclusionThrough this series, we anticipate to upheave awareness among the orthopedician community about this emerging infection and contemplate it in appropriate case settings. All patients with necrotising soft tissue infection following trauma and significant degree of wound contamination with soil should be suspected for traumatic mucormycosis at the time of wound assessment.

An overview of opportunistic fungal infections associated with COVID-19.

The COVID-19 survivors and long-term steroid administered patients exhibit a variety of fungal co-infections. The lives of COVID-19 patients and survivors are hampered by fungal species of the genera Candida, Aspergillus, and Mucor. There have been cases of mucormycosis, aspergillosis, and candidiasis in COVID-19 patients. The treatments given to these opportunistic fungal infections include polyene like amphotericin B, azoles including imidazoles like ketoconazole, miconazole, and triazoles like fluconazole, voriconazole, itraconazole, Echinocandin derivatives like- caspofungin, micafungin, immunomodulatory therapy, granulocyte transfusion, etc. A successful recovery and the reduction of fatalities depend on prompt diagnosis and treatment. To reduce mortality, advanced techniques to identify such uncommon infections at a very early stage are necessary. This review's goal is to provide a summary of the systemic and superficial opportunistic fungal infections that the COVID-19 survivors were dealing with, including information on illness incidence, pathogenicity, and treatment.

COVID-19 Associated Mucormycosis.

Mucormycosis is a life-threatening opportunistic fungal infection seen in immunocompromised states. Rising incidence of mucormycosis among Coronavirus Disease-2019 infected individuals is an increasing concern in India. The disease which was endemic has blown out to become an epidemic. The purpose of this research is to study the epidemiology, management and outcome of Coronavirus Disease-2019 Associated Mucormycosis (CAM) cases. Additionally, the role of diabetes and steroids in the causation of CAM was determined. A hospital-based observational study was conducted at a tertiary care centre involving cases with rhino-orbital mucormycosis with recent history of COVID-19 infection. Out of 205,166(81%) cases had Diabetes Mellitus as a comorbid condition. Among them, 75(36.6%) cases were diagnosed with diabetes during COVID-19 treatment. 161/205(78.5%) cases received corticosteroids during COVID-19 treatment. Corticosteroids were notindicated in 43(26.7%) cases. 177/205(85.4%) cases were alive at the end of 12weeks. 8 out of 10 deaths were seen in cases having diabetes. As the incidence of mucormycosis is increasing, better awareness among general population about the disease, early diagnosis and multidisciplinary approach is required to improve prognosis.

Cutaneous Rhizopus Infection Complicating Left Submammary Intertrigo

Abstract Introduction Mucormycosis is a rare, opportunistic infection commonly associated with diabetes mellitus, acidosis, neutropenia, organ transplantation, high-dose glucocorticoid therapy, iron overload syndromes, and hematologic malignancy. Case Invasive infection usually presents with rhino-orbital-cerebral (34%), cutaneous (22%), and pulmonary (20%) manifestations. Cutaneous cases are almost always precipitated by trauma or wounds. Only 6 previous cases of cutaneous mucormycosis (Mucor, Rhizopus, Lichtheimia, and others) infection of the breast have been reported in the literature. We herein report a woman with fatal submammary mucormycosis. Report A 45-year-old diabetic woman with alcohol use disorder was admitted from her basement living quarters with septic shock and lactic acidosis. During her intensive care unit stay, she developed worsening eschar of left submammary region. Cultures revealed Rhizopus species and surgical resection revealed invasive hyphae classic for mucormycosis. Despite treatment with liposomal amphotericin and complete resection, the patient died. Discussion Rhizopus infection complicated sepsis-related lactic acidosis and preexisting submammary intertrigoseveral days after admission. This case emphasizes the importance of a continued thorough physical examination that includes visualization of intertriginous areas, including those in submammary areas in septic patients in the critical care unit.

Perioperative anesthesia challenges and outcomes of patients with Rhino-Orbito-Cerebral Mucormycosis during the second wave of COVID-19 pandemic: An observational study.

A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients. This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted. The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%). Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality.

Mucormycosis in post-COVID patients: loose cannon waiting to fire at the anaesthesiologist

BackgroundRecently, several cases of mucormycosis in people with coronavirus disease 2019 (COVID-19) have been increasingly reported worldwide, in particular from India. As an increasing number of post-COVID patients with mucormycosis are presenting for surgical management, the onus is on the anaesthesiologists to adequately evaluate and optimise such patients.Case presentationWe present three cases to highlight the anaesthetic challenges in patients undergoing functional endoscopic sinus surgery (FESS) with debridement surgery for mucormycosis through a series of three cases. In our manuscript, two cases had comorbidities as a challenge uncontrolled diabetes and hypertension. The third case had difficult intubation due to a small mouth opening which was probably due to swelling and tenderness as a result of rhino orbital mucormycosis.ConclusionsProper anticipation, optimization and timed promptness to deal with the anaesthetic challenges pertaining to the multisystemic involvement and sequelae of mucormycosis should be done.

Management of mucormycosis coexisting with aspergillosis in pediatric age group – a case report

BackgroundMucormycosis is a highly infectious deadly disease if left untreated. This disease is usually seen more in people having immunocompromised conditions like diabetes mellitus, steroid use, and neutropenia. Its presence along with Aspergillus is quite uncommon in the pediatric age group. This report will add information regarding such coexisting fungal disease in the pediatric age group and its further management.Case reportIn this study, investigators are presenting a case of mucormycosis coexisting with aspergillosis in 3-month-old male child who presented with a palatal defect. He underwent both medical management with liposomal amphotericin B and surgical debridement for necrotic foci removal.ConclusionThis case report deals with the management of coexisting mucormycosis with aspergillosis using a combination of surgical and medical management.

A Case Series on COVID-19 Associated Mucormycosis (CAM): Experience from a Tertiary Care Centre in India

Aim: During the second wave of the COVID 19 pandemic, a life threatening fungal infection, mucormycosis have been detected in patients post COVID 19 disease. Commonly known as the ‘black fungus’ can causes tissue necrosis, inflammation and necrosis of the head and neck regions, paranasal sinuses, facial bones, orbits and it can also cause intracranial spread. In the current study we describe a series of cases of COVID 19 associated mucormycosis (CAM), the clinical presentations, risk factors, diagnosis, management and follow up experience from a tertiary care centre in India.
 Methods: This is a retrospective observational study conducted over a period of one year (April 2021 to April 2022) at our tertiary care centre. The diagnosis of COVID 19 was done by RT PCR (reverse transcription-polymerase chain reaction). The diagnosis of Mucormycosis was done by Histopathology and fungal cultures. The demographic details of the patients were retrieved from the medical records.
 Results: In the present study we report four cases of Rhino-orbital-cerebral Mucormycosis, three cases of Rhino-orbital Mucormycosis, two cases of Pulmonary Mucormycosis and one case of Disseminated Mucormycosis. All the patients had undergone extensive surgical debridement and received Liposomal Amphotericin B as initial antifungal medication and Posaconazole or Isavuconazole as step down therapy. Six patients responded to treatment while four patients did not have a favorable outcome and succumbed to the illness. 
 Conclusion: Mucormycosis is a deadly disease with high mortality and morbidity if not diagnosed and treated at an early stage. Factors like poor control of blood sugars, inadvertent use of corticosteroids, immune dysfunction due to COVID 19 can result in poor outcome of the disease despite aggressive treatment interventions.

Correlation of Mucormycosis with Various Clinical Parameters Among COVID-19 Patients: A Cross-Sectional Study.

Coronavirus disease 2019 (COVID-19), during the second wave in early 2021, caused devastating chaos in India. As daily infection rates continue to rise alarmingly, the number of severe cases also increased dramatically. Mucormycosis is an infection caused by filamentous molds, and there was a rise in mucormycosis cases after COVID-19 infection. The aim of the study is to assess various parameters associated with mucormycosis patients who suffered from COVID-19. This study was a cross-sectional questionnaire study. The target population for the study were 70 mucormycosis-infected patients (51 = males, 19 = females). The questionnaire mainly focused on association of various parameters of COVID-19 with mucormycosis. Result showed that out of 70 cases of mucormycosis the association was found between history of diabetes mellitus 45 (64.2%), type of hospitalization, number of days of hospitalization, oxygen administered, type and maintenance of face mask, i.e., patient who had reused mask by washing 59 (84.3%), and method of oral hygiene practices. Mucormycosis is extremely rare in population. The study findings emphasize the need to be aware of invasive mucormycosis developing in COVID-19 patients, especially including patients with diabetes mellitus and outside the ICU, patient who had poor oral hygiene during COVID-19, patients receiving oxygen therapy should ensure that the water in the humidifier is clean and is refilled regularly, knowledge and education about the use of the facemask.

Chronic pulmonary mucormycosis caused by rhizopus microsporus mimics lung carcinoma in an immunocompetent adult: A case report

Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients. This disease usually develops acutely and progresses rapidly, often leading to a poor clinical prognosis. Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients. A 43-year-old man, who was a house improvement worker with a long history of occupational dust exposure, presented with an irritating cough that had lasted for two months. The patient was previously in good health, without dysglycemia or any known immunodeficiencies. Chest computed tomography revealed a mass in the left lower lobe, measuring approximately 6 cm in diameter, which was suspected to be primary lung carcinoma complicated with obstructive pneumonia. Thoracoscopic-assisted left lower lobectomy was performed, and metagenomic next-generation sequencing detection, along with special pathological staining of surgical specimens, suggested Rhizopus microsporus infection. Postoperatively, the patient's respiratory symptoms were relieved, and no signs of recurrence were found during the six-month follow-up. This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency. The patient's surgical outcome was excellent, reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.

Clinical presentations, epidemiology and management of COVID-19 associated Mucor mycosis in a tertiary care hospital in South India

To study the statistics of the epidemiology, co-morbidities, clinical presentations, management and prognosis of the study group. This is a retrospective study conducted in a tertiary care hospital in South India, among 100 subjects, between May 2021 and August 2021 when the Mucor mycosis cases were frequently being diagnosed and treated amongst COVID-19 infected patients. The results showed that 34.0% were between 51-60 years with 100% patients confirmed COVID positive through RTPCR tests. 86.0% had confirmed mucor on CT scan. 50.0% had both eyes vision of 6/60 on presentation. 67.% had periorbital swelling with 51% having prior co-morbidities.63.0% patients received tablet Posaconazole 30mg as medical treatment and 60.0% required no surgical management.10.0% required orbital exenteration and 21.0% required partial maxillectomy.2% experienced orbital apex syndrome as associated complications.97.0% were discharged post treatment with 3% mortality. There was a positive correlation of medical management with respect to anterior segment and posterior segment findings P<0.001 and P=0.79. There was a positive correlation between surgical treatment and anterior and posterior segment findings P<0.001 and P=0.43. There was a positive correlation between co-morbidities and death P<0.001, with 32.0% uncontrolled diabetics. This study shows that immune suppression is directly related to infectivity by mucor mycosis. In order to contain symptomatology and grave prognosis amongst patients, early diagnosis, affordable treatment and follow-up including patient education about the etiology and pathogenesis of the disease must be available.

BLIND-SIDED BY BLACK FUNGUS: CRAO IN CAM

Importance: There has been an outbreak of COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM) in many parts of developing world. The clinical prole, mortality rate, risk factors associated with it has been studied. A case series highlighting association of Central Retinal Artery Occlusion (CRAO) in CAM has not been reported yet. To report a case series of Central Retinal Artery Occlusion (CRAO) in 15 pati Objective: ents with history of COVID19 infection associated mucormycosis (CAM). This is a retrospective observational study of Design: 15 cases of rhino-cerebroorbital mucormycosis (ROCM) which presented to our tertiary referral centre between March 2021 and June 2021. All patients had unilateral or bilateral CRAO. Tertiary care multispecialty hospital in western India. Setting: Participants: All patients diagnosed with CAM and having unilateral or bilateral CRAO. Main outcome measure: The COVID-19 disease induced inammatory homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation in CAM. Overall prognosis appears to be poor with mortality rate of 14- 50% in various studies. Fifteen patients were studied of Results: which 13 were male and rest females. The mean age of patients was 55.6 + 12.13 years (Range: 39 –78 years). Majority had uncontrolled Type 2 Diabetes Mellitus. Tissue and radiological diagnosis of mucormycosis was made in all patients. Twelve patients had unilateral CRAO and 3 patients had bilateral CRAO. Diabetes and systemic ster Conclusions and relevance: oids have proven to be risk factors for development of CRAO in CAM. Early ophthalmic screening should be initiated in COVID-19 patients with systemic co-morbidities, to reduce the immediate and late sequelae.

An Unusual Presentation of Cryptogenic Pulmonary Mucormycosis Related to COVID-19 Infection - A Case Report

Introduction: We present a unique and rare case of post-COVID cryptogenic primary pulmonary mucormycosis manifesting with nonspecific 3-week history of low-grade fever and fatigue but without any localizing symptoms related to the chest. Material and Method: The first symptom which suggested a sinister underlying illness was limb-shaking TIAs (Transient Ischemic Attacks) related to hematogenous intracranial vascular spread of the infection. This was followed by a corpus callosal hemorrhage due to rupture of a mycotic aneurysm. Discussion: Mycotic intracranial aneurysm (MIA) from Mucor species is most often the result of extravascular spread from skull base infections though they may rarely occur due to hematogenous seeding. The case highlights the need for high index of suspicion in the appropriate clinical setting for a possible post-COVID cryptogenic pulmonary Mucor infection. We present a unique and rare case of an MIA in a patient with a cryptogenic primary pulmonary mucormycosis, without any evidence of associated sinus or skull base Mucor involvement.