Renal Mucormycosis Research Articles

Disseminated Mucormycosis Masquerading as Invasive Pulmonary Aspergillosis

Pulmonary mucormycosis can closely resemble invasive pulmonary aspergillosis. If the infection is not contained at its primary site, it can lead to dissemination. A middle-aged woman, initially diagnosed with acute promyelocytic leukaemia, presented with atypical non-resolving pneumonia. Despite empirical antifungal treatment targeting Candida and Aspergillus, her clinical condition continued to deteriorate, resulting in the spread of the infection. Subsequent follow-up, combined with a high index of suspicion and isolation of Mucorales from an extrapulmonary site, identified mucormycosis as the causative pathogen. Early recognition of subtle clinical and radiological cues and prompt initiation of a classical medico-surgical approach is crucial for treating invasive mucormycosis and managing the underlying immunosuppressive condition. This case underscores the importance of early suspicion of Mucorales based on clinical and radiological signs, distinguishing it from invasive aspergillosis. The atypical presentation of pulmonary, splenic, and renal mucormycosis in this patient highlights the need for vigilance and timely intervention to prevent the most severe outcomes of disseminated mucormycosis.

Post Covid-19 Invasive Renal Mucormycosis with acute renal failure; a case report and review of literature

Abstract: The worst nightmare of twenty first century has been discoverd, The Coronavirus, has been risen the incidence of mucormycosis during the( COVID-19) pandemic. There are many case reports of rhinoorbito-cerebral and pulmonary mucormycosis. Hypertension, COVID, and mucormycosis are lethal combination associated with high mortality. This is the first case of Covid-19 associated mucormycosis (CAM) in the kidneys from Pakistan. We report the case of a 68-years old woman who presented with fever, abdominal pain and renal failure. Mucormycosis was diagnosed on renal biopsy. She was managed with Amphotericin- B and hemodialysis via tunneled vascular catheter. She refused nephrectomy. The case highlighted CAM can present as localized renal mucormycosis. In this era of Covid pandemic CAM should be in the differential diagnosis

Isolated Renal Mucormycosis by Apophysomyces in an Immunocompetent Adult

ABSTRACT Isolated renal mucormycosis (IRM) in an apparently healthy immunocompetent adult is a rare entity with most cases reported from India and China. Fever not responding to antibiotics, sterile pyuria, and characteristic imaging findings are strong pointers toward renal mucormycosis. We report a rare case of IRM due to Apophysomyces elegans in an apparently healthy young adult who underwent bilateral nephrectomy and ultimately succumbed to sepsis. Clinical indicators such as fever not responding to antibiotics, severe flank tenderness, sterile pyuria, and characteristic computed tomography findings (diffuse or patchy areas of absent contrast enhancement, perinephric fat stranding, and thickened Gerota’s fascia) are strong pointers toward renal mucormycosis. Aggressive surgical debridement and timely antifungal is imperative for favorable patient outcome in this aggressive infection.

Mucormycosis: A Rare disease to Notifiable Disease.

Mucormycosis is the third most frequent invasive mycosis, following candidiasis and aspergillosis. It is frequently neglected due to its rare occurrence; but recently attend the status of notifiable disease due to its higher incidence in both developed and developing nations. India has received global notice since its estimated instances were greater than the global estimated figures. Mucormycosis has several clinical manifestations, including rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and diffuse Mucormycosis. ROCM is the most frequent clinical manifestation in India, although pulmonary mucormycosis is prevalent worldwide. This review also discusses host defenses, pre disposing risk factors and fungal virulence factors that impair host's ability to prevent fungus invasion and disease establishment. The diagnosis of the disease depends on clinical interventions,histologicalormicrobiologicalprocedures along with molecular methods to obtain timely results. But there are still unmet challenges for rapid diagnosis of the disease. Treatment of the disease is achieved by multimodal approaches such as reversal of underlying predisposing factors, rapid administration of antifungals in optimal doses and surgical procedures to remove infected tissues. Liposomal Amphotericin B, Posaconazole and Isavuconazoles are preferred as the first line of treatment procedures. clinical trials. Different studies have improved the existing drug and under clinical trials while several studies predicted the new potential targets as CotH and Ftr1 as shown in infection and in vitro models. Therefore, current scenario demands a multidisciplinary approach is needed to investigate the prevalence, pathogenesis which is highly important for the advancement of rapid diagnosis and effective treatment.

Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports.

Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.

Isolated Renal Mucormycosis Post Covid-19 Infection

Isolated Renal Mucormycosis Post Covid-19 Infection

Renal Allograft Mucormycosis: An Unusual Case Report

Mucormycosis of the renal allograft is an extremely rare and rapidly fatal infection with an incidence of 0.2−1.2%. The major predisposing risk factors are uncontrolled diabetes mellitus, immunosuppression, anti-rejection treatment, unrelated donors, and cytomegalovirus infection. We describe a case of 27-year-old young adult patient who underwent a live-related renal allograft transplant at our centre and presented 4 weeks post-transplant with high-grade fever and rapid rise in serum creatinine. Initial cultures were repeatedly sterile, and imaging studies were normal. A few days later, he developed graft tenderness, and contrast CT abdomen revealed graft pyelonephritis. He was non-responsive to broad-spectrum antibiotics, and renal function gradually declined to anuric state. Prophylactic antifungal was added and hemodialysis was initiated. A graft biopsy was done, which revealed infiltration of the graft kidney with mucor species. After a week of antifungal treatment, graft nephrectomy was done and dual antifungals were continued. The patient initially improved symptomatically but again deteriorated with new onset fever and pain abdomen. Repeat imaging revealed a moderate intra-abdominal collection managed with per-cutaneous aspiration showing sterile growth and an abdominal drain kept in situ. Four days later, there was an accidental intra-abdominal drain expulsion with oozing of pus with blood which increased acutely with a sudden drop in blood pressure and hematocrit. Emergency exploration was done, which revealed a rent in the external iliac artery. After vascular rent repair surgery, the patient initially showed gradual improvement hemodynamically, but later, he developed superadded bacterial infection at the graft nephrectomy wound site with refractory septic shock and expired. Though early diagnosis, appropriate antifungal agents, and graft nephrectomy may improve the patient outcome, the case fatality rate of renal graft mucormycosis still remains very high.

Renal mucormycosis in an immunocompetent adult female diagnosed after 5 months of coronavirus disease 2019 illness: A rare case

Renal mucormycosis in an immunocompetent adult female diagnosed after 5 months of coronavirus disease 2019 illness: A rare case

S3.2 Challenging clinical cases

S3.2 Challenging clinical cases, September 21, 2022, 4:45 PM - 6:15 PMA case of hepato-splenic-renal candidiasis will be discussed with the aim to track down the causative organism and its likely susceptibility. The role of BDG, selection of the antifungal agent, and duration of therapy will be discussed. A case of an HIV-infected patient with cryptococcal meningitis, pulmonary infection, and pulmonary IRIS will be discussed. A case of Candida auris fungemia and organ infection in a liver transplant recipient who developed serially increasing MIC will be presented. The relevance of MIC, tentative breakpoints, and selection of antifungal agents based on PK PD considerations will be discussed. Talamycosis is usually seen in HIV-infected individuals from North East India. Here we discuss a 3-year-old girl with acute lymphoblastic leukemia from Western India who developed cavitary pneumonia and multiple brain abscesses due to talaromyces. The case posed significant management challenges pertaining to both the fungal infection and cancer. Renal mucormycosis in healthy immunocompetent hosts is an entity generally reported only from India and China. We discuss the case of a previously healthy 3-month-old infant who presented with acute renal failure and renal mucormycosis. The case is unique with respect to the source of infection and management strategy. Treatment of fungal infections involving the draining system of the kidney is challenging mainly due to limited antifungal drug penetration at the site of infection. Challenges in the treatment of amphotericin-resistant Aspergillus terreus pelvicalyceal infections will be discussed. CAPA is a well-known complication of coronavirus disease 2019 (COVID-19), but usually involves the lung alone and rarely disseminates when treated. This case illustrates a rare complication of COVID-19, namely endocarditis caused by Aspergillus. Rhinosporidiosis is a well-known disease that usually involves mucosal surfaces in the head and neck. This case illustrates a rare occurrence, namely dissemination to multiple areas and mimicking the clinical presentation of other cutaneous mycoses.

P284 A rare case of post covid bilateral renal mucormycosis

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveThe most commonly reported sites of COVID-associated invasive mucormycosis till now have been rhino-cerebral-orbital followed by pulmonary. This is a rare instance where an apparently healthy male, who had recovered completely from COVID-19, presented with fulminant isolated bilateral renal mucormycosis.MethodA 60-year-old male was presented with low-grade fever and increased CRP. He had a known history of diabetes, hypertension, and ischemic heart disease since 2007. On examination, he was tachypneic and afebrile; blood pressure and oxygen saturation were within normal limits.He was also double vaccinated. Also had a history of moderate COVID (Omicron) in January, 2022. His CT score was 18/25. He got admitted for 10 days because of COVID and was treated with oxygen, antibiotics, remdesivir, and steroids.Later on, patient developed fatigue, anorexia, abdominal discomfort, and pain in lower back. Also vomiting and nausea for 3 months. So patient was treated with tablets Zifi CV for 5 days bd followed by; IV meropenem 1 g tds for 5 days followed/by; tablets faropenem 200 md bd for 3 weeks followed by; tablets nitrilofurantoin 100 mg bd.Ultrasonography remains the first line of investigation and can show the enlarged echogenic kidneys with hypoechoic areas of abscesses, perinephric fluid collections, hydronephrosis, and cystitis. Cortical thickness appeared normal with raised cortical echo. An unenhanced computed tomography (CT) of his abdomen and pelvis was performed and suggested of mild changes of acute bilateral pyelonephritis. CT features include diffuse patchy nephrogram, inhomogeneous enhancement with areas of low attenuation, perinephric fluid collections, and no contrast excretion.Fungal culture sensitivity report was done and Candida albicans organism was isolated and it was found to be all drug-sensitive. Later on, a biopsy of the urethra was performed and a biopsy specimen revealed a fungal ball composed of thin septate and branching thick abroad aseptate hyphae. And also, which resembled morphologically mucor. spp and Aspergillus. A bacterial culture and sensitivity report were suggestive of E.coli.The patient underwent surgical interventions, ie, cystoscopy with B/L RGP with B/L DJ stenting done under SA with a calculated risk of diabetes, hypertension, age, nature of illness, and high creatinine.Patient started treatment with sulbacin 1.5gm injection with 100 ml sodium chloride 0.9% 6 hourly. As patient's creatinine is not stable so Liposomal Amphotericin B was not given. Later on, as creatinine stabilized patient he began receiving liposomal amphotericin B at a beginning dosage of 300 mg with 25% dextrose 250 ml over 5 h. Also, posaconazole started with a loading dose of 600 mg, and then, 300 mg OD was given to patient.ResultPatient gradually recovered and a dose of liposomal amphotericin was completed for 4 weeks.ConclusionIn conclusion, this paper describes that COVID-associated mucormycosis is a known entity, however, Renal Mucormycosis is a rare disease. Especially, bilateral involvement with limited drug penetration into a urogenital system of the agents which are active in mucormycosis. Its management involves, team approach of diabetologists, infectious disease physicians, urologists, radiologists, and microbiologists. Treatment of mucormycosis is challenging as anti-fungal penetration in renal tissue is difficult. High index of suspicion should be there to make the diagnosis. Early detection and aggressive management may have a favorable outcome.

Renal Mucormycosis in a Healthy Boy for Ten Years: A Novel Case Report

: Mucormycosis is rare in urinary tract infections. Renal mucormycosis is considered in immunocompromised patients and is associated with a high mortality rate. Herein, we presented the first case of a non-invasive fungus ball caused by a Rhizopus species confined to the unilateral kidney in a healthy boy for approximately ten years. The etiology was identified using next-generation deoxyribonucleic acid (DNA) sequencing. The patient recovered completely after nephrectomy without bladder irrigation. Therefore, clinicians must have a high index of suspicion for fungal infections in refractory urinary tract infections. Next-generation DNA sequencing technology can be used for an accurate diagnosis.

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

BackgroundRenal mucormycosis (RM) is a rare presentation of invasive mucormycosis with a high mortality rate. There is no single systematic review of the literature that indicates the different clinical aspects of RM.MethodsA systematic search of PubMed/Medline was performed to collect individual case reports of RM in patients of all ages published between 2010 and April 2022.ResultsSeventy-one individual cases were detected through PubMed bibliographic database searches, with a final assessment performed on 60 patients with RM. India and Asia had the largest number of reported cases, with 30 (50%) and 42 (70%) reports, respectively. Also, 74 and 26% of the patients with a mean age of 33 years were male and female, respectively. RM showed 44% mortality rate in the analyzed cases. Immunosuppressive agent therapy followed by tissue transplantation (kidney and liver) and diabetes were the most remarkable risk factors in patients. Nevertheless, 22% of the patients were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in eight adult patients with an 87% mortality rate. The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases. In 55% of the patients, histopathologic examination alone was sufficient to diagnose RM, whereas molecular methods and culture were used in only 18 and 35% of patients, respectively. Surgery alone, surgery plus anti-infection therapy, and anti-infection therapy alone were used in 12, 60, and 13% of patients, respectively. Furthermore, 15% of the patients died before any treatment.ConclusionThe early diagnosis of RM is necessary. In this regard, the use of molecular-based diagnostic assays can help identify the fungus at the genus and species levels and use an appropriate treatment in the shortest possible amount of time. Because of the increase in antibiotic resistance in recent years, determining microbial susceptibility tests can lead to the better infection management. Additionally, withdrawal of immunosuppressant, appropriate surgical intervention, and antifungal therapy are the main factors associated with a successful outcome in RM.

Renal mucormycosis presenting during the COVID-19 pandemic: A series of 11 cases from a tertiary care center in India.

Introduction:Renal mucormycosis has been documented to occur even in apparently immunocompetent individuals. Owing to the rarity of this disease, literature on its management is small. We present our experience of diagnosing and managing 11 cases of primary renal mucormycosis who presented during the second wave of the COVID-19 pandemic in India.Methods:We reviewed the records of all patients presenting to our institute with a diagnosis of acute pyelonephritis from March 2021 to September 2021. All patients with a radiological, microbiological, or histopathological diagnosis of renal mucormycosis were included in the analysis and all demographic and clinical details, including a history of COVID-19 disease and its treatment, were noted. All patients were treated by a combination of intravenous antifungal therapy and aggressive surgical debridement including nephrectomy and multivisceral resection as required. Predictors of mortality were evaluated by statistical analysis.Results:A total of 93 patients presented to our hospital with features of acute pyelonephritis of which 11 patients were suspected to have primary renal mucormycosis based on characteristic imaging features and confirmed on microbiological and histopathological examination. Of these, four patients had a history of COVID-19 infection. Only one patient had diabetes mellitus. Ten patients underwent nephrectomy and seven needed resections of surrounding organs. The colon was the most commonly involved organ. Five patients (45.5%) died of progressive sepsis. None of the predictors of mortality that were analyzed showed statistical significance.Conclusion:A high index of suspicion, early cross-sectional imaging, prompt institution of antifungal therapy, and aggressive surgical extirpation are very important for achieving good outcomes in patients of primary renal mucormycosis.

138 Successful Treatment of Bilateral Renal Mucormycosis

138 Successful Treatment of Bilateral Renal Mucormycosis

A rare case of post-COVID mucormycosis of the kidney

Post-COVID mucormycosis of the kidney is a rare phenomenon with only very few cases reported, worldwide. Among the various opportunistic fungal infections, mucormycosis is associated with the highest mortality. Here, we report a rare case of post-COVID–recovered right renal mucormycosis with emphysematous pyelonephritis with pulmonary mucormycosis. A 34-year-old male patient status post-COVID–recovered developed pain in the right lumbar region and, on evaluation, was found to have right renal mucormycosis with left pulmonary mucormycosis with sepsis and was not improving with amphotericin B and intravenous antibiotics. Decision was taken to proceed with surgery, and the patient underwent right open subcapsular nephrectomy along with left lobectomy. Biopsy report suggested it to be mucormycosis of the kidney with angioinvasion along with interstitial inflammation and granular casts in the tubules. This case highlights the possibility of mucormycosis involving the kidney in the recovery phase and the need of urgent nephrectomy in case of sepsis, especially if associated with emphysematous pyelonephritis.

A RARE CASE OF RENAL MUCORMYCOSIS WITH MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MISC) IN PATIENT OF T- CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T -ALL) : CASE REPORT

Background: Mucormycosis is a rare Angioinvasive, opportunistic fungal infection occurring most often in immunocompromised patients with reported mortality rate of 95% in disseminated cases9. The most common clinical presentation of infection with the fungus is rhinocerebral, followed by primary pulmonary, disseminated, gastrointestinal and cutaneous manifestations, whereas Renal Mucormycosis is a manifestation of disseminated diseases(10,11). Since, isolated renal Mucormycosis is extremely rare, and there are only few case reports describing the isolated renal Mucormycosis in literature. Clinical Description: We report a case of immunocompromised child with T cell ALL, presenting as high grade fever with abdominal pain and respiratory distress, who underwent nephrectomy for renal gangrene, Histopathological examination of which revealed mucormycosis and other relevant investigations suggestive of MISC. Management: Patient was initially managed with nephrectomy and higher antibiotics, followed by IVamphotericin B, and IVIG for MISC, but later succumbed to illness. Conclusion:Ahigh index of suspicion with multidisciplinary treatment approach involving early institution of pertinent antifungal therapy, addressing underlying other comorbidities, and, where possible, surgical debridement of debilitate tissue is obligatory to achieve therapeutic success.

Post-Covid Renal Mucormycosis: A Case Report

AbstractThe Pandora's box has been opened in the twenty-first century unleashing “the Coronavirus.” There has been an increase in the incidence of mucormycosis during this coronavirus disease 2019 (COVID-19) pandemic with many case reports of rhino-orbito-cerebral and pulmonary mucormycosis. Diabetes mellitus, COVID, and Mucor fungus together are a dangerous trio associated with high mortality. We report a rare case of renal mucormycosis following COVID pneumonia in a 64-year-old patient with uncontrolled diabetes; with the imaging findings of left emphysematous pyelonephritis and cystitis, nonfunctioning left kidney, and left main renal artery and vein thrombosis. This is the first such case reported to our knowledge. A high degree of clinical suspicion with prompt recognition of imaging findings is essential to improve the chances of survival in such patients.

Bilateral Renal Mucor Mycosis Presenting as Anuria in a Covid 19 Recovered Patient: A Case Report and Review of Literature

A 62-year-old nondiabetic female presented to the emergency room with hematuria followed by anuria of 3 days duration. She had been discharged 1 week prior after a 10 day hospital admission for COVID 19 infection. On examination she was dyspneic with right renal angle tenderness. Her blood pressure was 80/50mmhg, respiratory rate 24 /minute and heart rate was 120 /minute and oxygen saturation of 85% on room air. Serum creatinine was 3.5mg/dl, total leucocyte count 35000 cells/cu mm, random blood glucose levels of 468mg/dl, serum potassium 6.1mmol/L.

A Rare Case of Renal Mucormycosis and its Management: A Case Report

A Rare Case of Renal Mucormycosis and its Management: A Case Report

Renal mucormycosis following COVID-19 treatment with immune modulators: a case report

Mucormycosis is an opportunistic fungal infection that occurs primarily in immunocompromised individuals, usually affecting the rhino-orbital areas followed by the lungs. This case report presents renal mucormycosis in a young man after COVID-19 pneumonia that escalates the need for regular follow-up of COVID-19 patients. Post-COVID-19 fungal infections are on a steep rise, and the increased use of steroids and immune modulators for COVID-19-associated immune dysregulation and cytokine syndrome increases the risk among patients treated for COVID-19.