Risk Factors For Mucormycosis Research Articles

Frequency and risk factors for Mucormycosis, A Multicenter experience

Frequency and risk factors for Mucormycosis, A Multicenter experience

Epidemiology, Risk Factors, Diagnosis and Treatment of Mucormycosis (Black Fungus): A Review.

The COVID-19 pandemic has shown an adverse effect worldwide, but in India, it has been observed during the second wave that people who recovered from COVID-19 infection developed a secondary infection because it grows in tandem with COVID-19 treatment. Meanwhile, news of a new deadly fungus has surfaced known as Mucormycosis (Black fungus). Mucormycosis is a fungal infection that invades the blood vessels and is caused by Mucormycetes, a group of fungi. Due to the post-pandemic effect of COVID-19 many fungal and bacterial diseases have affected the population. The reason behind the frequent development of opportunistic infections like mucormycosis is the use of steroids, oxygen masks, and antibiotics throughout the treatment of critically and severely ill patients with COVID-19. Inhaling filamentous fungi from the natural environment and a lack of supportive care units can be a risk factor for mucormycosis. It is usually found in people who are immunocompromised. Mucormycosis is more common in people with HIV/AIDS, COVID-19, congenital bone marrow disease, viral diseases, malignancies, severe burns, and irregularly or untreated and treated diabetes. This review emphasizes triggers that may precipitate mucormycosis related to corticosteroids, recent epidemiology, and incidence of mucormycosis. The infection was diagnosed and identified using a variety of cutting-edge medical techniques, including clinical diagnosis, histopathology, and serology. Many treatment methods, such as antifungal medications and therapies, have also been successfully used. The mortality rate, however, remains high due to an aggressive surgical excision or debridement and lack of early diagnosis.

Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India.

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1year from discharge was done. 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3years (SD 12.4years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Physicians' knowledge of invasive fungal disease in China.

Invasive fungal disease (IFD) is associated with high morbidity and mortality. Data are lacking regarding physicians' perspectives on the diagnosis and management of IFD in China. To evaluate physicians' perspectives on the diagnosis and management of IFD. Based on current guidelines, a questionnaire was designed and administered to 294 physicians working in haematology departments, intensive care units, respiratory departments and infectious diseases departments in 18 hospitals in China. The total score and subsection scores for invasive candidiasis, invasive aspergillosis (IA), cryptococcosis and invasive mucormycosis (IM) were 72.0 ± 12.2 (maximum = 100), 11.1 ± 2.7 (maximum = 19), 43.0 ± 7.8 (maximum = 57), 8.1 ± 2.0 (maximum = 11) and 9.8 ± 2.3 (maximum = 13), respectively. Although the perspectives of the Chinese physicians were in good overall agreement with guideline recommendations, some knowledge gaps were identified. Specific areas in which the physicians' perspectives and guideline recommendations differed included use of the β-D-glucan test to facilitate the diagnosis of IFD, relative utility of the serum galactomannan test and bronchoalveolar lavage fluid galactomannan test in patients with agranulocytosis, use of imaging in the diagnosis of mucormycosis, risk factors for mucormycosis, indications for initiating antifungal therapy in patients with haematological malignancies, when to start empirical therapy in mechanically ventilated patients, first-line drugs for mucormycosis and treatment courses for IA and IM. This study highlights the main areas that could be targeted by training programs to improve the knowledge of physicians treating patients with IFD in China.

Risk Factors for Mucormycosis in COVID-19 Positive Patients in a Tertiary Care Hospital of Central India: A Cross Sectional Study

Risk Factors for Mucormycosis in COVID-19 Positive Patients in a Tertiary Care Hospital of Central India: A Cross Sectional Study

Post covid calamity- Mucormycosis: An overview

Corona virus disease (Covid-19) it had declared an emergency global pandemic1,2,3 that cause terrible effects on respiratory system and killing more than half billion lives.4,5,6 Diabetes has been reported as a risk factor for mucormycosis in 73.5% of cases in India.7 People with diabetes and obesity tend to develop more severe Covid-19 infections. This means they're more expected to take corticosteroids, which are frequently used to treat Covid-19. But the corticosteroids along with diabetes increase the risk of mucormycosis because it has been observed that peoples are affected with mucormycosis due to weekend immunity. Even a short course of steroid (5-14 days) results in mucormycosis.8 Mucormycosis, colloquially known as black fungus, is an infection from the mucormycetes group of fungi. The virus that causes Covid-19 can damage lung tissue and blood vessels, which could also increase susceptibility to different fungal infection. brain, causing headaches or seizures. So, damage to tissue and blood vessels from Covid-19 infection, treatment with corticosteroids, high background rates of diabetes in the population most brutally affected by the coronavirus are also getting affected by life threating fungal infection called as mucormycosis. Several methods have deferred the mortality but still have a challenge in curing mucorales.

COVID-19 associated mucormycosis in Assiut University Hospitals: a multidisciplinary dilemma

Mucormycosis is a life-threatening opportunistic angioinvasive fungal infection. We aimed to describe the frequency, presentations, predictors, and in-hospital outcome of mucormycosis patients in the scope of CoronaVirusDisease-19 (COVID-19) during the third viral pandemic wave. This cross-sectional retrospective study included all patients who fulfilled the criteria of mucormycosis with concurrent confirmed covid19 infection admitted to Assuit University Hospital between March 2021 and July 2021. Overall, 433 patients with definite covid-19 infection, of which 33 (7.63%) participants were infected with mucormycosis. Mucormycosis was predominantly seen in males (21 vs. 12; p = 0.01). Diabetes mellitus (35% vs. 63.6%; p < 0.001), hypertension (2% vs.45.5%; p 0.04), and Smoking (26.5% vs. 54.5%; p < 0.001) were all significantly higher in mucormycosis patients. Inflammatory markers, especially E.S.R., were significantly higher in those with mucormycosis (p < 0.001). The dose of steroid intake was significantly higher among patients with mucormycosis (160 mg vs. 40 mg; p < 0.001). Except for only three patients alive by residual infection, 30 patients died. The majority (62%) of patients without mucormycosis were alive. Male sex; Steroid misuse; D.M.; Sustained inflammation; Severe infection were significant risk factors for mucormycosis by univariate analysis; however, D.M.; smoking and raised E.S.R. were predictors for attaining mucormycosis by multivariate analysis.

Knowledge, attitude, and practice toward mucormycosis among patients presenting to six tertiary eye care hospitals in South India - A multicentric online questionnaire-based survey.

Purpose:To study the awareness on mucormycosis among outpatients who visited six tertiary eye care hospitals at Madurai, Pondicherry, Coimbatore, Tirunelveli, Chennai, and Tirupati.Methods:This was a telephone-based survey conducted using questionnaires consisting of 38 questions in five sections from July 5 to 25, 2021. Patients visiting the eye hospitals for an examination were contacted over their phones and responses were directly entered onto the Google forms platform.Results:A total of 4573 participants were included in the study. Among all participants, a cumulative 83% of participants had some knowledge of mucormycosis. More than 80% of them reported that their prime source of information was through mass communication like television or radio. Around 34.8% of the respondents were aware that it can occur after treatment for coronavirus disease 2019 (COVID-19) infection, only half of them (54.3%) knew that systemic steroids were the main risk factor. The knowledge scores were higher for participants who were diabetics (n = 1235) or had been affected by COVID-19 earlier (n = 456) or whose friends had mucormycosis earlier (n = 312). Knowledge, attitude, and practice (KAP) scores of nonprofessional health-care workers (n = 103) were much better compared to patients.Conclusion:Such KAP studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 83% of participants had some knowledge of mucormycosis and 86% knew that this was an emergency. More than 50% of the participants were not aware that diabetes is a risk factor for mucormycosis.

COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis - An Institutional Series

Invasive fungal infection or mucormycosis is almost always confined to the patients with altered host defenses such as in transplant recipients, diabetics or patients with malignancies. Hypergycemia or uncontrolled diabetes, particularly diabetes acidosis is considered as the strongest and very well known risk factor for mucormycosis. It has spread like fire amongst the active COVID-19 and post COVID-19 diabetic patients. Many studies across the world have established the definitive severity of SARS-CoV-2 infection amongst diabetic patients.

Incidence and risk factors for mucormycosis in renal transplant patients

BackgroundRenal transplant patients are at increased risk for mucormycosis. Diabetes, neutropenia, deferoxamine therapy, and immunosuppressive medications have been associated with increased risk of mucormycosis in studies of solid organ transplant...

Risk Factors for Mucormycosis in COVID-19 Patients

: Opportunistic infections, such as mucormycosis, in coronavirus disease 2019 (COVID-19) patients has become a new health challenge. Since opportunistic infections can exacerbate COVID-19 patients' status, it is vital to identify the risk factors to prevent, diagnose, and treat them as soon as possible. Viral, fungal, environmental, and host factors may be responsible for this situation. Long hospital stays, impaired host immune system function due to viral infection, and excessive consumption of glucocorticoids in managing COVID-19 patients are the main risk factors for the increased risk of mucormycosis in COVID-19 patients. Educating health care workers and considering the association between mucormycosis of the paranasal sinuses and different strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of COVID-19 can help prevent invasive fungal sinusitis in COVID-19 patients.

Mucormycosis: An unanticipated progeny of COVID-19.

The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.

Emerging cases of mucormycosis under COVID-19 pandemic in India: Misuse of antibiotics.

COVID‐19's second wave had a significant impact on India, on May 7, 2021, the largest daily recorded case count was a little more than 4 million, and it has since fallen. Although the number of new cases reported has dropped, during the third week of May 2021, India accounted for about 45% of new cases identified globally and around 34% of deaths. As India maintains its present level of stability, a new urgent threat has emerged in the form of coronavirus‐associated mucormycosis. Mucormycosis, an acute and deadly fungal infection caused by Mucorales‐related fungal species, is a fungal emergency with a particularly aggressive propensity for contiguous spread, associated with a poor prognosis if not properly and immediately identified, and treated. Mucormycosis, sometimes referred to as the “black fungus,” has increased more rapidly in India during the second wave of COVID‐19 than during the first wave, with at least 14,872 cases as of May 28, 2021. Uncontrolled diabetic mellitus (DM) and other immunosuppressive diseases such as neutropenia and corticosteroid treatment have traditionally been identified as risk factors for mucormycosis. Therefore, the use of glucocorticoids or high doses of glucocorticoids in mild COVID‐19 cases (without hypoxemia) should be avoided. In addition, drugs that target the immune pathway, such as tocilizumab, are not recommended without clear benefits.

Corticosteroids alter alveolar macrophage control of Lichtheimia corymbifera spores in an ex vivo mouse model.

The aim of this study was to describe the impact of corticosteroids on alveolar macrophage (AM) capacities to control Mucorales growth in a new murine ex vivo model. Corticosteroids enhanced fungal growth of L. corymbifera through AM phagocytosis inhibition and burst oxidative decrease.

Gastrointestinal Mucormycosis Mimicking as Necrotizing Enterocolitis: Case Series of 5 Neonates

Background: Gastrointestinal mucormycosis (GIM) is a rare potentially lethal fungal infection in neonates associated with rapid progression and high mortality. Case Characteristics: We herein report 2 preterm and 3 term cases of GIM; all term neonates had perinatal asphyxia. All cases were preoperatively diagnosed as necrotizing enterocolitis (NEC). Observation: All cases underwent laparotomy, and the diagnosis of GIM was made on postoperative histopathological examination. Results: Asphyxia might be an important risk factor for mucormycosis in term neonates, and to improve outcome, a high index of suspicion of GIM should be kept in cases of NEC in neonates, especially in term neonates.

PH manipulation as a novel strategy for treating mucormycosis.

Mucormycosis is a fatal fungal disease caused by several organisms within the order Mucorales. In recent years, traumatic injury has emerged as a novel risk factor for mucormycosis. Current antifungal therapy is ineffective, expensive, and typically requires extensive surgical debridement. There is thus a pressing need for safe prophylactic treatment that can be rapidly and easily applied to high-risk patients, such as those with major trauma injuries. Acetic acid has been used as a topical treatment for burn wounds for centuries and has proven activity against Gram-negative bacteria. Here, we demonstrate that acetic acid is also highly effective against major pathogenic groups of Mucorales, even at very low concentrations (0.3%). This antifungal effect is not seen with other acids, such as hydrochloric and lactic acid, suggesting that acetic acid activity against Mucorales spores is not solely evoked by low environmental pH. In agreement with this, we demonstrate that the antifungal activity of acetic acid arises from a combination of its ability to potently lower intracellular pH and from pH-independent toxicity. Thus, dilute acetic acid may offer a low-cost, safe, prophylactic treatment for patients at risk of invasive mucormycosis following traumatic injury.

Immunotherapeutic strategies against mucormycosis in haematopoietic stem cell transplantation.

Mucormycoses remain a serious complication in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). In these patients, mortality rates of mucormycosis reach up to 90%, which is due, at least in part, to the severe and prolonged immunosuppression after transplantation. Although prolonged neutropaenia is one of the most important risk factors for mucormycosis, other cell populations, such as CD4(+) T cells may also provide critical defence mechanisms against this infection. The management of mucormycosis includes antifungal therapy, surgery and, most importantly, the control of the underlying predisposing conditions, such as the correction of an impaired immune system. Here, we review the current data of granulocytes, antifungal T cells and natural killer cells regarding their activity against mucormycetes and regarding a potential immunotherapeutic approach. It is hoped that further animal studies and clinical trials assessing immunotherapeutic strategies will ultimately improve the poor prognosis of allogeneic HSCT recipients suffering from mucormycosis.

A mucormycosis case presented with orbital apex syndrome and hemiplegia in a renal transplant patient

Solid organ transplantation is a risk factor for mucormycosis. Mucormycosis is a necrotizing opportunistic fungal infection with high morbidity and mortality. We report a fatal mucormycosis case with rhino-orbital-cerebral involvement in a renal transplant patient, which presented with orbital apex syndrome and hemiplegia.

Baseline Serum Ferritin Predicts Rate of Infection in Patients with Acute Myelogenous Leukemia and High-Risk Myelodysplastic Syndrome.

Abstract 1611Poster Board I-637Excess iron adversely affects the phagocytic, chemotactic and bactericidal activities of neutrophils and monocytes; inhibits the activity of natural killer cells and macrophages, and enhances the ability of microbes to grow in various host tissues. Iron overload has also been described to be an important risk factor for the development of mucormycosis. Serum ferritin is a surrogate marker of iron overload. Studies in recipients of bone marrow transplantation showed that elevated pre-transplant serum ferritin levels (as markers of iron overload) were associated with a high incidence of infection-related mortality. Objective1) To evaluate iron overload as a predictor of infection in patients with acute myelogenous leukemia (AML) or high risk myelodysplastic syndrome (HR-MDS) undergoing chemotherapy (CHEMO); 2) to compare baseline bone marrow iron stores (BMIS) versus baseline serum ferritin as predictor of infections. MethodsPatients with AML or HR-MDS who underwent induction or first salvage CHEMO were included in this prospective observational study. BMIS was analyzed at baseline (prior CHEMO) in bone marrow aspirate smears by standard staining techniques. BMIS was evaluated using a light microscope and graded on a scale of 0 to 6, with a score of 1 to 3 considered normal. Serum ferritin levels were measured at baseline. Invasive fungal infections (IFI) were defined as probable or proven according to the EORTC-MSG criteria. Bacterial infections were defined by the presence of fever and positive culture from a sterile site. Ferritin values were considered normal if they fell in the range of 10ng/mL – 291ng/mL. Results112 patients were evaluated. Median age was 69 years (23-84 years) and 49% were female; 97% received induction CHEMO for AML. Forty–six patients developed at least one infectious episode from day 1 of chemotherapy until chemotherapy response was assessed (median days to response = 28). Nineteen patients developed bacterial infections, 9 patients developed fungal [2 candidiasis; 3 proven and 4 probable aspergillosis] and 18 patients had clinically but not microbiologically documented infections (cellulitis, pneumonia, neutropenic colitis). Baseline BMIS and serum ferritin were evaluable in 83 and 112 patients, respectively (Table 1). [Display omitted] Median baseline ferritin was significantly higher in patients who developed any infection compare to that of patients without infections (p = 0.018). In addition, patients who developed IFI had higher median baseline ferritin to those without IFI (p=0.039). There were no significant differences in the baseline BMIS between patients without infection and those who developed any infection (p= 0.94) or an IFI (p= 0.71).Conclusions:a.To our knowledge, this is the first report that shows that serum baseline ferritin can be used as predictor of infection, including bacterial, fungi and non- microbiologically documented infections, in patients with acute leukemia.b.Although iron overload has been described to be a risk factor for mucormycosis; our data shows that iron overload may be a risk factor for any type of IFI, including yeast and mold infections.c.Baseline serum ferritin seems to be a better predictor of infections than baseline bone marrow iron stores.d.These results indicate that the treatment of iron overload may have a potential role in the prevention of infections in patients with acute myelogenous leukemia or high risk myelodysplastic syndrome undergoing chemotherapy. DisclosuresMattiuzzi:Novartis: Research Funding.