Mucormycosis Research Articles

Coexisting Chronic Rhino-Cerebral Mucormycosis and Actinomyces Infection: A Case Report and Review of the Literature

Coexisting Chronic Rhino-Cerebral Mucormycosis and Actinomyces Infection: A Case Report and Review of the Literature

Cutaneous Mucormycosis in Buffalos in the Brazilian Amazon Biome

This is the first description of cutaneous mucormycosis in buffalo in the Brazilian Amazon biome. All buffalo showed apathy, inappetence, weight loss, reluctance to move, and prolonged sternal decubitus. Of the four affected animals, two died 15 and 30 days after the appearance of clinical signs. In the initial phase, the skin lesions were rounded areas with dry central regions, sensitive to palpation, with protruding edges and diameters ranging from 8 cm to 15 cm. These areas of necrosis were isolated or coalescing and present mainly on the limbs and sides. In an advanced stage of the disease, there was detachment of the skin from the necrotic areas with extensive wound formation, which sometimes exposed the subcutaneous tissue. The histopathology of the skin showed a multifocal inflammatory infiltrate composed of intact and degenerated eosinophils surrounded by epithelioid macrophages. At the center of these areas was a focally extensive area of epidermal ulceration characterized by intact and degenerated neutrophils, the necrosis of epithelial cells, and the accumulation of fibrin and erythrocytes. The mycological culture was positive for Rhizopus sp. The diagnosis of cutaneous dermatitis caused by Rhizopus sp. was based on clinical signs, macroscopic and histopathological findings, and the identification of the fungus by mycological and molecular techniques.

Mucormycosis Associated with COVID-19

AbstractMucormycosis is an angioinvasive disease caused by fungi of the order Mucorales. In this article, three case reports of rhinocerebral mucormycosis developing after COVID-19 infection in a diabetic patient are presented. Early diagnosis and treatment of those high morbidity conditions are vital to better outcomes.

Novel Staging Protocol for Management of Post Covid Mucor Mycosis

Introduction: There is an upsurge of Mucor Mycosis infection following Covid -19 pandemic. Disordered immune system due to covid19 infection coupled with indiscriminate use of steroids is believed to be responsible for this upsurge.Objectives: This study is aimed at analysing the preliminary epidemiological data of Mucormycosis patientsadmitted in a single tertiary care centre, stage them at presentation and to devise a treatment protocol according to their stage . To study the various surgical interventions, postoperative follow-up and treatment outcomes in terms of recovery rate and recurrence.Patients and Methods: This is a prospective longitudinal study, one of the largest of its kind involving around1841 patients diagnosed as Mucormycosis and admitted in a tertiary care hospital in India. A detailed case history, Diagnostic nasal endoscopy, CECT scan and MRI Scan were done. A novel staging was devised and patients were managed medically and surgically as per the stage. Debrided tissue was sent for microbiological and histopathological confirmation. Patients were followed-up and their recovery rates were analysed.Results: Among 1841 patients of mucor mycosis studied, 1288 were Rhino orbital and 78 were Rhino cerebraltype. 1229 patients under went surgical debridement according to the stage of disease, and rest were managed conservatively. Recovery rates fell from 90% to 26% from stage I to stage IV due to in volvement of CNS and Orbits. The mortality was as low as 17%. Re -do surgeries were done in only 12% of cases.Conclusion: Staging of mucor at presentation helps in planning, assessing response of treatment and prognosis.

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: a rare forgotten but fatal disease—a case report and literature review

Mucormycosis is a perilous fungal infection that primarily affects individuals with compromised immune systems. The escalating incidence of conditions such as diabetes, cancer and the use of immunosuppressive drugs renders more individuals susceptible to contracting this disease. This report delves into the case of a 45-year-old woman from Tanzania with diabetes who succumbed to rhino-cerebral mucormycosis. Despite aggressive treatment, which often involves disfiguring surgical debridement and administration of antifungal drugs, the mortality rate remains high. Additionally, we present a comprehensive literature review of the various clinical aspects of Mucormycosis, an uncommon yet fatal condition.

A clinicoepidemiological study of pattern of skin disorders among diabetes mellitus in a tertiary care centre

Diabetes Mellitus (DM), a most common metabolic disorder affects every organ of the body including skin causing increased morbidity and serious impact on quality of life. Aim of this study is to analyse the prevalence and pattern of cutaneous manifestations among type 1 and type 2 DM correlating it with the mean duration of diabetes. This was an observational study conducted on 200 consecutive patients with DM attending dermatology department. Apart from detailed history, thorough clinical examination and relevant investigations were done. Skin biopsy were done in cases with diagnostic ambiguity. Cutaneous infections occurred in majority (70.5%). Among fungal infections (59.5%) candidiasis was the most common (28%). Pruritus and neuropathy were observed in 37% and 33% respectively and was more common in type 1 DM. Leg ulcer was observed in 8.5%. Vitiligo, oral lichen planus, granuloma annulare were seen common among type 1 DM. Psoriasis, acrochordon, acanthosis nigricans, cutaneous amyloidosis, bullous pemphigoid and diabetic bulla were common in Type 2 DM. Mucor mycosis, scleredema diabeticorum, cheiroarthropathy and perforating dermatoses were uniquely observed among prolonged uncontrolled diabetics. Candidiasis was found to be an early manifestation of diabetes. Poor glycemic control and longer duration of diabetes were associated with an increased frequency and number of skin disorders. Skin manifestations are more common among undiagnosed and uncontrolled diabetics..

Aggressive debridement and early antifungal therapy in the management of cutaneous mucormycosis: A case report with review of literature

Mucormycosis is an infectious disease caused by fungi. The worldwide spread of coronavirus disease-19 did create a public health crisis, infecting millions of people and causing huge numbers of deaths worldwide. Cutaneous manifestations of mucormycosis can either be primary or secondary diseases. Clinical manifestations can vary from cellulitis, abscess, or ulcer. Standard management includes early diagnosis, surgical debridement, and antifungal therapy. Early initiation of antifungal therapy can lower mortality rates and improve the prognosis of patients. The estimated mortality ranges from 25% to 87%, depending on the site of infection.

Assessment of awareness regarding rhinocerebral mucormycosis among undergraduate and postgraduate dental students: A cross-sectional survey

Objectives: The incidence of rhinocerebral mucormycosis (RCM), a fungal disease seen in immunocompromised individuals, have drastically increased after the COVID-19 outbreak. The aim of the study was to assess the awareness of dental students regarding RCM. Material and Methods: An online cross-sectional survey was conducted among students pursuing BDS/MDS from various dental colleges in Tamil Nadu from August 2021 to October 2021. The questionnaire of 13 questions assessing awareness regarding RCM was administered using Google Forms. List-based random sampling method was used to sample the participants through e-mail and phone numbers of the students from college registries. Reminder calls were made every week to increase the response rate of the study. At the end of 2 months, the final data collected was organized using Google spreadsheets and subjected to statistical analysis through SPSS 22.0. Results: There were 597 respondents from 10 dental colleges, of which 172 were males, and 417 were females. Overall knowledge score for the disease ranged from 0.39 to 12.77 with a mean of 6.37. Postgraduates had greater knowledge in all categories of questions, except for causative micro-organisms, other forms of mucormycosis, its sources in the environment, and symptoms of RCM where there were no significant differences (P > 0.05) between preclinical, clinical undergraduates, and postgraduates. Conclusion: Awareness of dental students regarding RCM was found to be poor to average. Among the three study groups, postgraduates were most aware of the disease. Education and training programs on RCM are necessary for dental students to help them keep an eye out for features of rhinocerebral mucormycosis among the immunocompromised.

Mucormycosis of left maxilla: A case report and review

Mucormycosis is an angioinvasive infection caused by fungi of the Zygomycetes order. Rhizopus is the main pathogen responsible for 90% of cases of cerebral mucormycosis. The term rhinocerebral mucormycosis should be used only in the face, palatal, orbital, paranasal sinus, or brain area. Here, we present the case of a 42-year-old man who presented with complaints of pain and swelling in relation to the left upper back tooth region for the past 20 days. In this case, the patient was immunocompromised due to type II diabetes, as well as COVID hospitalization. This case enlightens the investigation, as well as the management protocol followed by post-operative rehabilitation. Early diagnosis and prompt treatment can significantly reduce the morbidity and mortality of these deadly fungal infections.

Retrieved from the jaws of death – A successfully managed case of rhino- cerebral mucormycosis despite healthcare constraints due to economic turmoil

Rhino- orbital-cerebral mucormycosis is a rapidly progressive life-threatening fungal infection which primarily affects the nose, paranasal sinuses and orbit. It is an opportunistic fungal infection caused by fungi of order Mucorales. They are a group of ubiquitous fungi which grow on decaying vegetation and a wide variety of organic compounds, and they pose a huge threat to life by direct invasion of the vital structures in the body. Early identification and treatment of this disease is therefore of paramount importance for a better outcome. We report a case of a 65-year-old man with a background history of poorly controlled type 2 diabetes mellitus, hypertension and chronic kidney disease, who presented with a diffuse headache of 5 days along with left sided facial oedema, redness of left eye and visual disturbance. Imaging studies revealed sinusitis involving multiple sinuses and the nasal mucosal biopsy showed fungal hyphae. Considering the clinical presentation and the overall findings from the investigations a diagnosis of rhino-cerebral mucormycosis was made. Medical management was done with administration of intravenous Amphotericin B and IV itraconazole along with other supportive medication. Patient had a successful recovery after a lengthy hospital stay which included surgical debridement of affected tissues and the medical treatment even with challenges faced due to unavailability of drugs due to economic constraints on health.

COVID-19-Associated Rhinocerebral Mucormycosis, an Incidental Finding or a Matter of Concern - Mixed-Method Systematic Review.

With the advent of COVID-19, the number of patients diagnosed with mucormycosis has increased, especially in developing countries. The reason behind this increase is that COVID-19 causes hypoxia that promotes the growth of fungus. To identify the association between mucormycosis and COVID-19, in critically ill or immunocompromised COVID-19 patients. The literature included in the review was researched from October 1, 2021, to November 1, 2022, by using the Google Scholar database as the search engine. Of the 20 articles included, there were 4 case reports, 2 case series, 10 narrative reviews, and 4 quantitative studies. Mucormycetes growth is caused by several factors, including hyperglycemia owing to previously existing diabetes or excessive use of steroids, increased ferritin levels owing to the inflammatory cascade initiated by COVID-19, and immunosuppression caused by the use of steroids or other immunosuppressive therapy. Reduced white-cell count and activity in COVID-19 leads to increased germination of fungal spores hence developing a catastrophic picture of rhinocerebral mucormycosis. Considering that the hematological patient is frequently treated with cortisone, immunosuppressed due to the underlying condition, but also through the administered therapy, the association with a possible diabetes makes this patient susceptible to developing rhinocerebral mucormycosis during COVID-19 infection. Despite being severe, the association between mucormycosis and COVID-19 is specific and treatable. Development of mucormycosis in hematological patients suffering from severe COVID-19 disease is dangerous, yet not compulsory and can be prevented. Using a common steroid-dose protocol with hyperbaric oxygen and necessary preventive measure reveals the disease as a superadded infection. Hypoxia, poor glycemic control and overuse of steroids or immunosuppressive drugs cause it.

An Unusual Presentation of Paranasal Sinus Mucormycosis

ABSTRACT Mucormycosis is an opportunistic infection caused by saprophytic fungi of the order Mucorales. This infection is seen mainly in immunocompromised people with diabetes but can be seen rarely in immunocompetent hosts. Recently, this disease is frequently seen in many patients who had suffered from COVID-19. Among the different sites of mucormycosis, rhinocerebral mucormycosis is the most prevalent form, followed by cutaneous. Surgical debridement followed by antifungal therapy with amphotericin B and the control of the immunocompromised state is the recommended treatment. This case is an unusual presentation of mucormycosis involving the maxillary sinus and the cheek, presented without any nasal symptoms.

Acute Fulminant Rhinocerebral Mucormycosis: A Case Report with Review of Management

Acute Fulminant Rhinocerebral Mucormycosis: A Case Report with Review of Management

MUCOR MYCOSIS AND OTHER FUNGAL INFECTIONS IN COVID-19 PATIENTS DURING SECOND WAVE OF PANDEMIC AT A TERTIARY CARE HOSPITAL

Objectives: In India, there has been a sudden Surge in Mucor mycosis cases during second wave of COVID-19, made the Government of India declare it as a notifiable disease. In this background, we did a study to know the fungal etiology of the suspected Mucor mycosis cases and to know the positivity rate of Mucor mycosis in COVID-19 patients during the second wave of the COVID-19 pandemic. Methods: In a retrospective study, we examined different samples from 112 Covid-19 positive, in-patients with suspected Mucor mycosis. A history of risk factors was taken. Potassium hydroxide (KOH) mount was done for all samples followed by culture on Sabouraud’s dextrose agar. Results: 81.25% of total cases were from 31 to 60 years of age group. Diabetes mellitus, steroid therapy, and Intensive care unit admissions were the risk factors observed. Fungal filaments were observed in 37 samples in KOH mount (33%) and culture was positive in 45 samples (40.17%). Mixed infection was seen in two cases (4.44%). The most common fungus isolated was Mucor in 23 samples (48.93%) followed by Aspergillus in 7 cases (14.89%; Aspergillus niger in four cases, Aspergillus fumigatus in 2 cases and Aspergillus flavus in 1 case) and Candida spp in 6 cases (12.76%). Among mixed infections, Mucor and A. niger in one case and Candida and A. niger in another case were isolated. Rhyzopus, Syncephalastrum, Penicillium, and Fusarium were the other fungi isolated. Conclusion: Mucorales were the most common species isolated (63.82%) followed by Aspergillus species. High suspicion and diagnosis of Mucor mycosis in Covid-19 patients is very important to initiate antifungal treatment, to reduce the mortality.

МРТ ВИЗУАЛИЗАЦИЯ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. Rhino-orbito-cerebral mucormycosis is an angio-invasive infection caused by filamentous fungi of the Mucoraceae family. Numerous factors were proposed determining mucormycosis against the COVID-19 background. Predisposing factors include uncontrolled diabetes, hematological malignancies, transplantation of solid organs and stem cells, corticosteroids, and weakened immunity. Aim of the study was to investigate the tomographic signs of rhino-cerebral mucormycosis. Materials and Methods. A retrospective study of CT and/or MRI images of 120 patients was conducted, who have been diagnosed with COVID-19 associated with mucormycosis, based on histopathology and/or seeding. Results and Discussion. Imaging findings of rhino-orbito-cerebral mucormycosis associated with COVID-19 using an adapted simplified (three-stage) staging system that can be easily applied to everyday practice and helps standardize and improve communication between radiologists and clinicians. The severity of the disease varies from isolated lesions of the paranasal sinuses to extensive brain damage. Clinical outcomes in patients with COVID-19 with rhino-orbito-cerebral mucormycosis gradually increase depending on the severity of imaging. Conclusions. Early diagnosis of mucormycosis is crucial because visualization is essential at staging the disease and assessing the involvement of deeper structures that may be clinically unmanifest. Although both CT and MRI are useful, contrast-enhanced MRI is the method of choice and helps determine the extent of the disease, especially with respect to the deep spread in the maxillofacial region and brain.

Cutaneous Mucormycosis Due to Rhizopus oryzae in Immunocompromised Pediatric Patient

Abstract Introduction Mucormycosis is an infection predominantly in immunocompromised patients by fungi of the Mucorales order, the most frequent being Rhizopus spp., Mucor spp. and Lichteimia spp. Characterized by vascular invasion, necrosis in the lung, CNS, paranasal sinuses, gastrointestinal system, and skin. Case Presentation 2-year-old female patient, native and resident of Valle de Chalco, State of Mexico. Recent diagnosis of B lineage acute lymphoblastic leukemia, in remission induction phase. Medical/surgical history: December 10 2021: Bone marrow aspirate -January 10 2022: Remission induction chemotherapy with vincristine and daunorubicin -January 17 2022: Central venous catheter placement -Family history: Parents are reported healthy. Positive drug addiction for smoking. They have two doses of vaccine for SARS COV2 -Epidemiologic history: Protective isolation was indicated in this patient -Allergies, rash, transfusion and traumatic: Denied -Adequate nutrition, adequate hygiene, complete vaccination schedule. Neurodevelopment according to age -Hospitalized on January 17 for fever and neutropenia, treatment with fourth-generation cephalosporin as initial management. -On January 20, 2022, she presented an erythematousviolaceous papular lesion, raised in the center, without central necrosis, without elevation, and painful on palpation on the right forearm -Treatment with fourth generation cephalosporin and glycopeptide was started, a biopsy culture of the lesion was taken and Central and peripheral blood cultures -On physical examination, an erythematous-violaceous maculopapular lesion was observed on the right forearm, without necrosis, without exudate and painful on palpation. Vital Signs in normal ranges. Relevant labs Leukopenia was found with profound neutropenia and thrombocytopenia. Positive acute phase reactants, with positive procalcitonin and C-reactive protein. Final Diagnosis For the study of the tissue, debridement of the wound, samples of the spindle center and external edges for biopsy and Lactophenol cotton blue staining were performed. Final diagnosis is Cutaneous Mucormycosis. The culture reports Rhizopus oryzae. For treatment, start Liposomal Amphotericin B 5 milligrams per kilogram per dose every 24 hours. It was increased to 10 milligrams per kilogram per dose for progression of the lesion. Teaching Points Mucormycosis is produced by opportunistic fungi of the order Mucorales. It presents an acute and fatal course that requires early diagnosis and treatment to avoid complications and death (1) A timely diagnosis is very important, since with surgical and antifungal treatment the survival rate increases to 70% (2) Isavuconazole showed activity against mucormycosis with efficacy similar to Amphotericin B. Isavuconazole can be used for the treatment of mucormycosis and is well tolerated (3,4).

Whole genome analysis of Rhizopus species causing rhino-cerebral mucormycosis during the COVID-19 pandemic.

Mucormycosis is an acute invasive fungal disease (IFD) seen mainly in immunocompromised hosts and in patients with uncontrolled diabetes. The incidence of mucormycosis increased exponentially in India during the SARS-CoV-2 (henceforth COVID-19) pandemic. Since there was a lack of data on molecular epidemiology of Mucorales causing IFD during and after the COVID-19 pandemic, whole genome analysis of the Rhizopus spp. isolated during this period was studied along with the detection of mutations that are associated with antifungal drug resistance. A total of 50 isolates of Rhizopus spp. were included in this prospective study, which included 28 from patients with active COVID-19 disease, 9 from patients during the recovery phase, and 13 isolates from COVID-19-negative patients. Whole genome sequencing (WGS) was performed for the isolates, and the de novo assembly was done with the Spades assembler. Species identification was done by extracting the ITS gene sequence from each isolate followed by searching Nucleotide BLAST. The phylogenetic trees were made with extracted ITS gene sequences and 12 eukaryotic core marker gene sequences, respectively, to assess the genetic distance between our isolates. Mutations associated with intrinsic drug resistance to fluconazole and voriconazole were analyzed. All 50 patients presented to the hospital with acute fungal rhinosinusitis. These patients had a mean HbA1c of 11.2%, and a serum ferritin of 546.8 ng/mL. Twenty-five patients had received steroids. By WGS analysis, 62% of the Rhizopus species were identified as R. delemar. Bayesian analysis of population structure (BAPS) clustering categorized these isolates into five different groups, of which 28 belong to group 3, 9 to group 5, and 8 to group 1. Mutational analysis revealed that in the CYP51A gene, 50% of our isolates had frameshift mutations along with 7 synonymous mutations and 46% had only synonymous mutations, whereas in the CYP51B gene, 68% had only synonymous mutations and 26% did not have any mutations. WGS analysis of Mucorales identified during and after the COVID-19 pandemic gives insight into the molecular epidemiology of these isolates in our community and establishes newer mechanisms for intrinsic azole resistance.

Cutaneous mucormycosis in a young immunocompetent trauma patient: a case report

Introduction: Mucormycosis, a rare and life-threatening infection, is caused by microorganisms of the Mucorales order. It affects almost exclusively immunocompromised and diabetic patients, requiring extensive surgical debridement and prolonged antifungal therapy. Discussion/Results: We report the case of a 26-year-old immunocompetent woman, presenting with cutaneous mucormycosis after suffering blunt force trauma. This rare occurrence of mucormycosis in an immunocompetent patient reinforces the importance of elevated clinical suspicion and early initiation of adequate surgical and antifungal treatment. Conclusion: Mucormycosis is a challenging condition with potentially devastating consequences. Timely diagnosis and appropriate management are vital to mitigate the morbidity and mortality associated with this condition.

Virulence traits and novel drug delivery strategies for mucormycosis post-COVID-19: a comprehensive review.

The outbreak of a fatal black fungus infection after the resurgence of the cadaverous COVID-19 has exhorted scientists worldwide to develop a nutshell by repurposing or designing new formulations to address the crisis. Patients expressing COVID-19 are more susceptible to Mucormycosis (MCR) and thus fall easy prey to decease accounting for this global threat. Their mortality rates range around 32-70% depending on the organs affected and grow even higher despite the treatment. The many contemporary recommendations strongly advise using liposomal amphotericin B and surgery as first-line therapy whenever practicable. MCR is a dangerous infection that requires an antifungal drug administration on appropriate prescription, typically one of the following: Amphotericin B, Posaconazole, or Isavuconazole since the fungi that cause MCR are resistant to other medications like fluconazole, voriconazole, and echinocandins. Amphotericin B and Posaconazole are administered through veins (intravenously), and isavuconazole by mouth (orally). From last several years so many compounds are developed against invasive fungal disease but only few of them are able to induce effective treatment against the micorals. Adjuvant medicines, more particularly, are difficult to assess without prospective randomized controlled investigations, which are challenging to conduct given the lower incidence and higher mortality from Mucormycosis. The present analysis provides insight into pathogenesis, epidemiology, clinical manifestations, underlying fungal virulence, and growth mechanisms. In addition, current therapy for MCR in Post Covid-19 individuals includes conventional and novel nano-based advanced management systems for procuring against deadly fungal infection. The study urges involving nanomedicine to prevent fungal growth at the commencement of infection, delay the progression, and mitigate fatality risk.