Mucormycosis In Diabetic Patient Research Articles

Impact of coronavirus disease 2019 on the prognosis of mucor mycosis in diabetic patients in Egypt: a comparative multicenter study

Aim The current study was designed to figure out the influence of Corona virus infection (COVID-19) on the course and outcome of mucor mycosis in controlled diabetic Egyptian patients. Patients and methods The presented multicenter study compared retrospectively two groups of diabetic patients with clinically and radiologically documented rhino-orbital-cerebral mucor mycosis. The first group included 20 patients who had COVID-19 infection documented clinically, radiologically, and laboratory at the time of admission to the hospital, while the 22 patients in the second group did not. Full ophthalmological evaluation and necessary medications were offered to all patients, and the decision to exenteration was made and performed when appropriate. Medical conditions like diabetes mellitus and other aspects of mucor mycosis were controlled carefully by specialized consultants, and detailed medical reports for morbidity and mortality were provided. Comparisons of the clinical picture, final visual acuity, exenteration, and mortality/survival rates were done between the two groups. Recovered patients were followed up for 4 months after discharge from the hospital. Results COVID-19 infection in the first group aggravated the clinical picture significantly, especially the soft tissue affection like face swelling (P=0.0047) and worsened the final visual outcome (P=0.047). It also increased the rates of ICU admission, exenteration, and death as compared to the non-COVID group by 6, 15, and 11%, respectively (P>0.05). Conclusion Infection by COVID-19 worsened the course and prognosis of rhino-orbital-cerebral mucor mycosis in controlled diabetic patients in the form of a more aggressive clinical picture, exenteration, and death (although statistically insignificant). It also resulted in poorer visual outcome (in acuities CF to 3/60, P=0.047). Early hospitalization, anti-fungal, and surgical exenteration, if needed, increase the survival rate and decrease morbidity.

Fulminant mucormycosis in diabetic patient

Fulminant mucormycosis in diabetic patient

ENT mucormycosis in diabetic patients: report of 5 cases

ENT mucormycosis in diabetic patients: report of 5 cases

A Case Report of Mucormycosis in a Diabetic Patient and an Approach to its Management in a Tertiary Care Centre of Central India

Background: Mucormycosis is one of the most rapidly progressing and fulminant forms of fungal infection which usually begins in the nose and paranasal sinuses following inhalation of fungal spores.
 Case details:This is a case report of a 65 year old male ,admitted in our hospital with long history of Type 2 diabetes with pain and swelling on right side of nose and signs and symptoms indicating Rhino-Orbital-Cerebral-mucormycosis. 
 Methodology:The level of involvement like nasal cavity, septum, turbinates, sinuses, palate, orbit involvement was noted and the protocol of medical and surgical management was decided in accordance to that. Post surgery KOH mount and HPE report after every debridement,CT and MRI findings were the mainstay.
 Conclusion : We here report a case of mucormycosis in diabetic patient shows aggressive and alarming mortality,which can be reduced by rapid diagnosis, surgical debridment and administration of drugs like amphotericin B.

Isolated Pulmonary Mucormycosis in Diabetic Patients

Mucormycosis refers to the infection caused by a growing number of members of the Mucorales. Mucormycosis has emerged as an important opportunistic infection in severely immunocompromised patients with hematological malignancies and recipients of stem cell or organ transplantation and in poorly controlled diabetics. The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Here, we present two cases of mucormycosis in diabetic patients diagnosed with tissue biopsy.

Susceptible mechanisms of pulmonary mucormycosis in diabetic patients

Pulmonary mucormycosis is a rare pulmonary fungal infectious disease. Domestic and international studies have shown that diabetes is the most common underlying condition of this disease, especially with poor glycemic control and diabetic ketoacidosis. The susceptible mechanisms of pulmonary mucormycosis in diabetic patients are closely related to hyperglycemia and diabetic ketoacidosis-induced internal environment alterations. The detailed pathogenesis includes respiratory epithelial cell damage, vascular endothelial injury, immune cell dysfunction, coagulation abnormalities, iron-rich, and high keto-acid environment in diabetic patients. Pulmonary mucormycosis always presents atypical manifestations with rapid progress and poor prognosis in patients with diabetes. This article reviews the recent research progress in the susceptible mechanisms of pulmonary mucormycosis in patients with diabetes.

Isolated Lower Motor Neuron Facial Nerve Palsy as a Presenting Sign in COVID-19 Associated Orbital Mucormycosis Patients: A Retrospective Observational Study

Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.

Incidence and outcome of mucormycosis in diabetic patients with COVID-19

Aims and objectives: Diabetes Mellitus predisposes patients to invasive fungal infections. Aim of this study is to find out the incidence and outcome of Mucormycosis in diabetic patients with COVID-19. Materials and Methodology: A Retrospective study of 150 patients with COVID-19 who were admitted in VMKVMCH COVID-19 Ward, Salem from May 2021 to July 2021 was included in the study. Results: Among 150 hospitalized patients with COVID 19 infection, 32 patients had CAM with an incidence of 3.36%. In patients with CAM, 87.5% had Diabetes Mellitus as the most common co-morbidity. The majority of the patients had poor glycemic control with a mean HbA1c of 9.06%. Out of the total study population, 93% had prior exposure to high dose corticosteroids. During the study period, 12.5% patients of CAM did not survive. Conclusion: Mucormycosis is an angioinvasive fungal infection with high mortality. The disease has surged in COVID 19 pandemic due to uncontrolled diabetes and improper corticosteroid use.

Palliative oral care for COVID-19 associated oral mucormycosis in diabetic patients.

Palliative oral care for COVID-19 associated oral mucormycosis in diabetic patients.

Mucormycosis, a post-COVID infection: possible adjunctive herbal therapeutics for the realigning of impaired immune-metabolism in diabetic subjects

Summary Cytokine storm is believed as a major root cause for multi-organ failure and death in severely infected diabetic patients with COVID-19. This condition is treated with anti-inflammatory drugs, mainly steroids, to recover people from critical conditions. However, steroid therapy causes immune suppression and uncontrolled hyper-glycaemia in post-COVID. This altered immune-metabolism provides a fertile environment for the infection of a black fungus, Rhizopus arrhizus which causes mucormycosis in diabetic patients. It is a life-threatening infection causing death in different countries. It is treated either with anti-fungal drugs, surgical debridement, or adjunctive therapies. The available therapies for mucormycosis have been associated with several drawbacks. Thus, the present review has explored and suggested herbs-spices based adjunctive therapy for possible realignment of the impaired immune system in the post-COVID diabetic subjects. The consumption of herbal therapeutics after COVID-19 could realign the impaired immune-metabolism in the post-COVID and thereby exert prophylactic effects against mucormycosis. Furthermore, the suggested herbal sources could help in the discovery of novel therapeutics against the COVID-19 associated mucormycosis.

Mucormycosis: A Co-infection Associated with - COVID-19 and Diabetes

Background: Rhino-orbital mucormycosis cases in patients with coronavirus disease are on the rise, particularly in India. In severe Mucormycosis and COVID-19, Diabetes mellitus is a risk factor on its own. The use of steroids and different immunosuppressive drugs to handle significantly ill sufferers has broadly spread because the COVID-19 pandemic has advanced, which has probably contributed to a boom in subordinate infections and uncontrolled blood glucose levels. Initial symptoms include fever, headache, nausea, and widespread weakness. With the start of sinusitis, purulent discharge with or without epistaxis and congestion and reduced feeling within the nose may be present. Mucormycosis is an uncommon, difficult to identify condition with high morbidity and mortality rates. Patient survival depends on early detection, rapid treatment , and consideration of the limitations of continually updating COVID-19 therapeutic recommendations.
 Objective: ‘The purpose of the study was to conduct a systemic review of the literature’ for determining the severity and co-relation of diabetes with mucormycosis.
 Methodology: Keywords were used to search the articles from the electronic databases of PubMed, Cochrane and Google Scholar upto August, 2021. All details of case reports/articles of mucormycosis in COVID-19 were utilized for this review article.
 Study Design: Systemic Review article
 Conclusions: 1. Using a literature review of all documented cases, we can comment on the correlation of diabetes with Mucormycosis in covid-19 patients.
 
 Based on the observations gained from the literature examined in this study, we are able to decide the clinical diagnostic strategy for mucormycosis in diabetic patients affected by covid-19.
 
 Study Implication: This review article ensured the clinical diagnostic strategy and management in such cases affected by covid-19.

Mucormycosis complicating diabetes mellitus and COVID-19: a diagnostic and therapeutic threat

<p class="abstract">COVID-19 infections is known to have a multitude of clinical presentations, and newer clinical complications continue to be reported from all over the world. It is now widely known that the diabetic patients with poor glycemic control are associated with a higher risk of developing severe COVID-19 infection. They are also at a high risk for developing secondary bacterial or fungal, co infections because of the complex interplay of multiple risk factors , necessitating an intensive medical care and monitoring in them. We are presenting a case of mucormycosis in a diabetic patient with moderate COVID pneumonia that presented to us as orbital cellulitis and the events that followed. There have been very few documented cases of mucormycosis in COVID infected diabetic patients so far during this pandemic and we also present a literature review of the same.</p>

Managing mucormycosis in diabetic patients: A case report with critical review of the literature

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare and potentially fatal invasive fungal infection which usually occurs in diabetic and other immunocompromised patients. This infection is associated with high morbidity and mortality rates. Prompt diagnosis and rapid aggressive surgical debridement and antimycotic therapy are essential for the patient's survival. Herein, we reviewed the localization and treatment strategies in patients with ROCM and diabetes as an underlying condition. Furthermore, we report one case of ROCM in our department. From 117 identified studies published in PubMed, 14 publications-containing data from 54 patients-were included. All patients were diagnosed clinically and by histopathological and/or bacteriological analysis for ROCM caused by the order Mucorales. Uncontrolled diabetes mellitus is one of the main risk factors for ROCM. A successful management of ROCM requires an early diagnosis, a prompt systemic antifungal therapy, and a rapid aggressive surgical debridement including exploration of the pterygopalatine fossa. An orbital exenteration may be necessary.

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series.

Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM). We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries. Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

Rhinocerebral mucormycosis in diabetic patients. Review of a clinical case

Rhinocerebral mucormycosis in diabetic patients. Review of a clinical case

Facial Nerve Palsy: An Unusual Presentation in Patients with Rhino Cerebral Mucormycosis.

The aim of this study is to highlight involvement of facial nerve as a presenting symptom in rhino cerebral mucormycosis. A retrospective longitudinal study was carried out for a period of 1year from May 2017 to May 2018 in Department of Otorhinolaryngology of Dr. D. Y. Patil Medical College and Hospital, Kolhapur. The usual presentation include nasal stuffiness, headache, eye pain and orbital swelling, ophthalmoplegia and visual loss. However we had four patients who presented to our OPD with facial nerve palsy and rhino cerebral mucormycosis. All four patients were diabetic. The available clinical and laboratory data was retrospectively collected and analyzed. Facial nerve palsy is an unusual but significant sign in presentation of mucormycosis. It could be misdiagnosed as CVA with subsequent delay in the treatment. A high index of suspicion for mucormycosis in diabetic patients presenting with facial palsy will be helpful in achieving early and accurate diagnosis with prompt management and better outcome.

Successful Medical Treatment of Pulmonary Mucormycosis in Diabetic Patients

Pulmonary mucormycosis is a relatively uncommon infection that is mostly observed among diabetic patients. We present here three cases of pulmonary mucormycosis as the cause of non-resolving pneumonia in diabetic patients. The goals of our review are to better characterize the population at risk, presenting symptoms, radiological appearance, diagnostic methods and to demonstrate the efficacy of medical therapy.

Diet modification and metformin have a beneficial effect in a fly model of obesity and mucormycosis.

In an experimental model of obesity and hyperglycemia in Drosophila melanogaster we studied the effect of diet modification and administration of metformin on systemic infection with Rhizopus, a common cause of mucormycosis in diabetic patients. Female Wt-type Drosophila flies were fed regular (RF) or high-fat diet (HFD; 30% coconut oil) food with or without metformin for 48 h and then injected with R. oryzae. Survival rates, glucose and triglyceride levels were compared between 1) normal-weight flies (RF), 2) obese flies (HFD), 3) obese flies fed with RF, 4) flies continuously on HFD + metformin, 5) flies fed on HFD + metformin, then transferred to RF, and 6) obese flies administered metformin after infection. Glucose levels were compared across groups of non-infected flies and across groups of infected flies. Survival was significantly decreased (P = 0.003) in obese flies, while post-infection glucose levels were significantly increased (P = 0.0001), compared to normal-weight flies. Diet and administration of metformin led to weight loss, normalized glucose levels during infection, and were associated with decreased mortality and tissue fungal burden. In conclusion, diet and metformin help control infection-associated hyperglycemia and improve survival in Drosophila flies with mucormycosis. Fly models of obesity bear intriguing similarities to the pathophysiology of insulin resistance and diabetes in humans, and can provide new insights into the pathogenesis and treatment of infections in obese and diabetic patients.

A case of fatal vascular invasive rhinocerebral mucormycosis after dental extraction in a patient with type 2 diabetes mellitus

Mucormycosis is a rare life-threatening fungal infection that occurs in immunocompromised subjects, including patients with poorly controlled diabetes Mellitus (DM) There have been even rarer case reports that describe the development of rhinocerebral mucormycosis in diabetic patients after dental extraction. Here, we describe a 57-year-old female patient with type 2 DM who developed a fatal vascular invasive rhinocerebral mucormycosis after dental extraction.

La mucormycose rhinocérébrale chez le diabétique: À propos de quatre observations

Mucormycosis is caused by a zygomycetes fungus in a vascular location. This fungus is a saprophytic organism which can become pathogenic in specific conditions, particularly in patients with diabetes mellitus. A rhinocerebral localization is common, leading to often fatal devastating sinusitis. Positive diagnosis requires histological proof with characteristic hyphal tissue invasion. Frozen section is essential for diagnosis and management of rhinocerebral mucormycosis. Material and methods We report four cases of rhinocerebral mucormycosis in diabetic patients, two men and two women, mean age 51 years. Results Histological examination showed characteristic hyphae in a vascular localization. Treatment was systemic antifungal therapy with amphotericin B and debridement of necrotic tissue. Three patients recovered completely. One died. Conclusion Rhinocerebral mucormycosis is a rare fungal infection with very poor prognosis. The aim of this study was to report the clinical and pathological features of rhinocerebral mucormycosis and to evaluate the contribution of frozen section for diagnosis and management. (J Mal Vasc 2006; 31: 85-87).