Treatment Of Mucormycosis Research Articles

Mucormycosis: Current Perspectives on Treatment, Diagnosis, and Advancements

Objective: This review study examines mucormycosis treatment challenges, gaps in medicines, and COVID-19-related effects. This paper examines diagnostic and drug development advances while addressing safety and specificity. Methods: This review study searches PubMed, Web Science, and Scopus for relevant material. Keywords associated with mucormycosis, therapy, diagnosis, medication advancement, and COVID- 19 are used to identify pertinent articles. Data extraction summarizes therapeutic obstacles, diagnostic advances, and innovative drug options. Results: This review article covers mucormycosis therapy, diagnostics, and drug development. It reveals limitations in present medicines, such as selectivity, safety, and resistance mechanisms. Diagnostic advances and mucormycosis in COVID-19 have also been explored. Conclusion: This review emphasizes the need for more secure, specific mucormycosis therapies. It discusses therapy obstacles, diagnostic advances, and new drug techniques. Overall, this research emphasizes improving mucormycosis therapy to enhance patient outcomes.

Clinical characteristics and mortality of mucormycosis in hematological malignancies: a retrospective study in Eastern China

BackgroundMucormycosis is a significant cause of morbidity and mortality in patients with hematological malignancies, but its characteristics are not fully understood. This study aimed to gain a better understanding of the clinical features of mucormycosis in patients with hematological malignancies in eastern China.MethodsA single-center retrospective analysis was conducted on the demographic profile, microbiology, management, and 90-day mortality of mucormycosis patients with hematological malignancies between 2018 and 2023.ResultsA total of 50 cases were included in the study, consisting of 11 proven and 39 probable cases of mucormycosis. The median age of the patients was 39.98 ± 18.52 years, with 52% being male. Among the cases, 46% had acute myeloid leukemia (AML), 16% had acute lymphoblastic leukemia (ALL), and 16% had myelodysplastic syndrome. The most common manifestations of mucormycosis were pulmonary (80%), disseminated (16%), and rhinocerebral (4%). The diagnosis was confirmed through histology, culture, microscopy, and molecular diagnostic techniques. The most commonly identified fungal species were Cunninghamella (40%), Rhizopus (26%), and Rhizomucor (22%). Treatment involved antifungals in 84% of cases and surgery in 10% of cases. The 90-day mortality rate was 76%. Logistic regression analysis revealed that treatment with amphotericin B and surgery was associated with improved survival, while neutropenia and administration of voriconazole prior to diagnosis was associated with higher mortality.ConclusionsMucormycosis continues to have a high mortality rate in patients with hematological malignancies. Early diagnosis using various techniques, including molecular biology, along with the appropriate use of amphotericin B and surgery when possible, is vital for the successful treatment of mucormycosis.

Mucormycosis: An infection caused by a black fungus

The filamentous fungus that causes Mucormycosis is a newly discovered angiogenic infection that is found in large quantities and is a member of the Zygomycete class's Mucorales order. In patients undergoing hematopoietic and allogeneic stem cell transplantation, after candidiasis and aspergillosis, mucormycosis has become the third most common invasive mycosis. Breathing in sporangiospores is a daily need. The remarkably low frequency of Mucorales members in nasal mucus indicates that airborne contamination is either minimal or mucociliary transport removes spores from airway mucus. In this review research, new approaches to assessing the relationships among the host, the fungus, and antifungal drugs are provided. Aerosols and other novel delivery methods might also aid in the treatment of mucormycosis.

Retrospective study of patient characteristics and treatment for mucormycosis in post COVID-19 population in a tertiary care hospital

ObjectivesAlong with the COVID-19 pandemic, another illness wreaking havoc in India is mucormycosis, also known as black fungus. Mucormycosis was previously known as zygomycotic infection, which is a consequential type...

Long-term Outcome of Coronavirus Disease-associated Mucormycosis: 1-year Follow-up Study from India.

Invasive fungal infections have recently become a public health problem, particularly in India following the second wave of coronavirus disease 2019 (COVID-19). India harbors the world's largest population of patients suffering from diabetes. What prompted the sudden spike of mucormycosis infections in the COVID pandemic needs investigation. To determine if COVID-19 infection prompted the spike in invasive fungal infections in diabetic population. To determine the long-term outcome of COVID-associated mucormycosis. To determine if COVID-19 infection causes diabetes mellitus transiently. The study was a prospective cohort study comprising patients suffering from mucormycosis. The study was planned from 20 May 2021, until 30 November 2022, to investigate the long-term follow-up (1 year) of mucormycosis patients. The study setting was a referral hospital. All the consecutive patients admitted to this hospital for treatment of mucormycosis were included in the study who consented to it. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): All patients suffering with mucormycosis underwent treatment at this hospital with surgery and injectable systemic antifungal drugs alongside diabetes management. Primary outcome measurement was in the form of survival with cure of mucormycosis. Hypothesis being tested was formulated during data collection. The data of 98 participants was collected, but analysis was done after excluding the case of cutaneous mucormycosis (infant patient). Mean age for patients was 55.5 years, varying from 28 to 88 years. In our study, 63.3% of patients with mucormycosis were males and 37.8% were females, of which 55.7% (34) and 58.3% (21) were known diabetics, respectively. Previous history of diabetes mellitus was identified as an underlying comorbid condition in 56.7% of patients, while the rest were diagnosed with new-onset diabetes mellitus. Sugar levels ranged (on admission) from 112 to 494 mg/dL (median 212 mg/dL) for known diabetics and from 132 to 356 mg/dL (median 204 mg/dL) for newly diagnosed diabetics. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma (disease-free). The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose. At the 1-year follow-up, 57.7% of cases were disease-free, 30.9% had expired, and 11.3% were lost to follow-up. The mean glycated hemoglobin (HbA1c) at the time of admission was found to be statistically significant when compared between known diabetics and newly diagnosed ones [confidence interval (CI)-95%, p ≤ 0.01]. A total of seven patients from the newly diagnosed diabetic group no longer required medicines for diabetes at the end of 1 year (CI-95%, p ≤ 0.01). Diabetes mellitus, particularly with poor glycemic control, was the single most important factor associated with and predictor of outcome. Contrary to the popular hypothesis, industrial oxygen and oxygen masks were not the reasons for the mucormycosis pandemic. Additionally, immunization against COVID provided protection not only from severe COVID but also from COVID-associated mucormycosis. It is recommended that patients with mucormycosis be followed for longer periods as a few patients could be suffering from transient diabetes, particularly against the backdrop of a pandemic.

Black fungus – An emerging threat

The term “black fungus” is referred to fulminating, dreadful fungus mucormycosis infection, so-called because of the black-colored necrotic areas it causes due to the black-colored colonies of the fungus, which thrives in infected tissues. Recently, in this COVID-19 pandemic, it has emerged as a new threat to the world. This article enlightens us with the predisposing factors, pathogenesis, types, clinical features, diagnostic modalities, and treatment of Mucormycosis.

Efficacy of an oral lipid nanocrystal formulation of amphotericin B (MAT2203) in the neutropenic mouse model of pulmonary mucormycosis.

Invasive mucormycosis (IM) is associated with high mortality and morbidity. MAT2203 is an orally administered lipid nanocrystal formulation of amphotericin B, which has been shown to be safe and effective against other fungal infections. We sought to compare the efficacy of MAT2203 to liposomal amphotericin B (LAMB) treatment in a neutropenic mouse model of IM due to Rhizopus arrhizus var. delemar or Mucor circinelloides f. jenssenii DI15-131. In R. arrhizus var. delemar-infected mice, 15 mg/kg of MAT2203 qd was as effective as 10 mg/kg of LAMB in prolonging median survival time vs placebo (13.5 and 16.5 days for MAT2203 and LAMB, respectively, vs 9 days for placebo) and enhancing overall survival vs placebo-treated mice (40% and 45% for MAT2203 and LAMB, respectively, vs 0% for placebo). A higher dose of 45 mg/kg of MAT2203 was not well tolerated by mice and showed no benefit over placebo. Similar results were obtained with mice infected with M. circinelloides. Furthermore, while both MAT2203 and LAMB treatment resulted in a significant reduction of ~1.0-2.0log and ~2.0-2.5log in Rhizopus delemar or M. circinelloides lung and brain burden vs placebo mice, respectively, LAMB significantly reduced tissue fungal burden in mice infected with R. delemar vs tissues of mice treated with MAT2203. These results support continued investigation and development of MAT2203 as a novel and oral formulation of amphotericin for the treatment of mucormycosis.

The changing trend of fungal infection in invasive rhinosinusitis in the COVID era.

SARS-COV virus operates as a significant risk factor for invasive fungal aspergillosis and mucormycosis. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical or surgical interventions to prevent the high morbidity and mortality associated with the disease process. 1. To isolate and identify different species of fungi among acute rhinosinusitis patients. 2. To assess the association of risk factors causing fungal rhinosinusitis. 3. To assess the changing trend in fungal rhinosinusitis during the COVID era. This is a retrospective observational study conducted from May 2020 to October 2022, attending the ENT department and relevant data were collected from the medical records department of ABVIMS and Dr RML Hospital, New Delhi, a Tertiary Care Referral Centre in India. The major risk factors studied were age, gender, COVID-19 infection and underlying diseases (such as diabetes mellitus, ischaemic heart disease, hypertension, malignancies, chronic kidney DISEASES, etc.); details of corticosteroid use of all patients were recorded in the datasheet. The pandemic data was divided into three distinct time periods/waves/eras, i.e., first, second, and third waves, each of which included ten months, to examine the changing trend in fungal rhinosinusitis in the pandemic era of COVID-19. A total of 412 patients out of which 236 patients were clinically diagnosed with fungal sinusitis based on revised EORTC criteria. The most common site involved was the orbit with paranasal sinus and eye 86/236 (36.4%), followed by involvement of nasal and paranasal sinus alone 68/236 (28.8%). The most prevalent age range affected was 40 to 50 years. The most commonly associated comorbidity was diabetes mellitus (DM) in 176 (74.5%), followed by head and neck malignancies in 22 (9.32%) patients. Thirty-eight (50.6%) Rhizopus species and 18 (24%) Aspergillus flavus were the most common isolated fungal species on culture, followed by Mucor spp. 14 (18.6%) and Aspergillus fumigatus 5 (6.6%) in the period. In the second wave of COVID, there was a surge in Zygomycetes cases 36 (45%) and after the second wave, the Aspergillus cases increased by 14 (19%) during Jan-Oct 2022. With the continuing coronavirus pandemic, there is an unprecedented and discernible rise in the prevalence of acute invasive fungal sinusitis certainly a spike in cases of Aspergillus infection was observed, probably due to unprecedented usage of Amphotericin B for the treatment of mucormycosis during the third wave This underlines the importance of the need to tailor our treatment protocol as per the etiological agents hence the right antifungal drugs combined with urgent surgical procedures on a case-to-case basis may certainly increase the chances of survival.

Analysis Of the Results of Surgical Treatment of Adults with Rhinocerebral Mucoromycosis

This article summarizes the experience of surgical treatment of mucormycosis of the rhinocerebral type. The work is based on the results of complex treatment of 134 patients with mucoromycosis of the rhinocerebral type, who were treated in the department of ENT and maxillofacial surgery of the MMC of the Andijan region, as well as in the department of neurology of the Republican Center for Emergency Medicine of the Andijan branch from 2019 to 2022, aged from 45 to 65 years. Of these, 33 (24.6%) patients were male and 101 (75.3%) were female. The main affected areas were the nasal cavity, the maxillary sinus and the upper jaw of the facial skeleton (118 patients (88.1%)). In the long-term period from 3 months to 2 years, 52 (41.9%) patients showed good, 59 (47.6%) satisfactory and 13 (10.5%) unsatisfactory results

“Black Fungus Unveiled”: Exploring the Menace and Medication

In recent years, there has been significant progress in treating mucormycosis. Beginning therapy as early as possible is crucial to achieve better outcomes. Therefore, maintaining a high level of suspicion and performing biopsies on possible lesions aggressively is essential. Whenever feasible, surgical removal of infected or necrotic tissue should be performed as the data supports its need. Lipid formulations of amphotericin B are now the standard treatment for mucormycosis as they are superior in safety and efficacy. Posaconazole may be useful as salvage therapy, but there is insufficient data to recommend it as the primary therapy. Preclinical and limited retrospective clinical data suggest that the combination of lipid formulations of amphotericin and echinocandin improves survival during mucormycosis. Therefore, additional studies are required to explore the potential of iron acquisition abrogation as an adjunctive treatment of mucormycosis. Combination polyene-posaconazole therapy was not beneficial in preclinical studies. For selected patients, adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered. Large-scale, prospective, randomized clinical trials are necessary to define optimal management strategies for mucormycosis.[1]

Experimental Models to Study the Pathogenesis and Treatment of Mucormycosis.

Mucormycosis presents a formidable challenge to clinicians and researchers. Animal models are an essential part of the effort to decipher the pathogenesis of mucormycosis and to develop novel pharmacotherapeutics against it. Diverse model systems have been established, using a range of animal hosts, immune and metabolic perturbations, and infection routes. An understanding of the characteristics, strengths, and drawbacks of these models is needed to optimize their use for specific research aims.

Maxillary Mucormycosis in a Juvenile Diabetic Patient: A Case Report

One of the most fulminant and quickly spreading types of fungal infection, mucormycosis typically starts in the nose and paranasal sinuses after inhaling spores. Orbital and intracranial structures may become infected either directly or through blood vessels, leading to life-threatening complications. This infection most commonly manifests in the rhinomaxillary area, particularly in individuals with immunocompromised conditions like diabetes. Even with appropriate treatment, the disease’s mortality rate can exceed 40%, and it is challenging to detect. The standard treatment plan involves surgical debridement combined with systemically active antifungal medications, depending on the site of infection and risk factors. As a first-line treatment, lipid-based amphotericin B is recommended; however, posaconazole also shows promise. Hereby, the authors present a case report of a 15-year-old male patient with juvenile diabetes mellitus who had been experiencing pain and diffuse swelling in his left malar area for the previous two months. Following a histological analysis and clinical and radiographic evaluation by a multidisciplinary team, the patient was diagnosed with maxillary mucormycosis. Because of the abundant blood supply in the maxillofacial regions; however, more virulent fungi like Mucor can get past this obstacle. The purpose of present article is to show how early detection and treatment of mucormycosis in a young patient could prevent major morbidity and mortality from this potentially fatal illness . Additionally, it aimed to contribute to the local epidemiology of mucormycosis and raise awareness among stakeholders attention to the difficulties in treating this serious condition.

Role of Amphotericin B in the Treatment of Mucormycosis.

Regardless of the most recent inclusion of mold-active agents (isavuconazole and posaconazole) to antifungal agents against mucormycosis, in conjunction with amphotericin B (AMB) items, numerous uncertainties still exist regarding the treatment of this rare infection. The order Mucorales contains a variety of fungi that cause the serious but uncommon fungal illness known as mucormycosis. The moulds are prevalent in nature and typically do not pose significant risks to people. Immunocompromised people are affected by it. This article's primary goal is to highlight the integral role that AMB plays in this condition. Like sinusitis (including pansinusitis, rhino-orbital, or rhino-cerebral sinusitis) is one of the many signs and symptoms of mucormycosis. The National Center for Biotechnology Information (NCBI) produces a variety of online information resources for review articles on the topic-based mucormycosis, AMB, diagnosis of mucormycosis and the PubMed® database of citations and abstracts published in life science journals. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov. The article provides a summary of the pharmacological attributes of the various AMB compositions accessible for systemic use. The article demonstrates the traits of the drug associated with its chemical, pharmacokinetics, stability, and other features, and illustrates their most useful characteristics for clinical application.

In silico studies on Epicoccum spp. Secondary metabolites as potential drugs for mucormycosis

Mucormycosis is a rare and severe form of fungal infection caused by some fungal species belonged to mucormycetes that mainly infects skin but also eyes and other organs of the human body. The COVID-19 pandemic has demonstrated the rise in mucormycosis cases due to usage of industrial grade oxygen and overuse of steroids particularly in developing nations, where the pandemic has stressed the medical system to its limit. The major aim of this study was to screen potential antifungal compounds produced by Epicoccum spp. against target enzyme lanosterol 1,4-alpha demethylase of Rhizopus arrhizus var. delemar (strain RA 99–880 / ATCC MYA-4621 / FGSC 9543 / NRRL 43880), to evaluate potential drug candidates using in silico approach, compounds that may be explored further for the treatment of mucormycosis. Sequence of enzyme was retrieved from the UniProtKB database and ligands from PubChem database. 3D structure was obtained using protein homology modelling (SWISS-MODEL server). The target enzyme was prepared along with ligands using ADT software and then subjected to molecular docking using Autodock Vina. The results and protein-target interactions were studied using the BIOVIA Discovery studio. After virtual screening of secondary metabolites produced by Epicoccum spp. and after comparing them with the results of control drugs, the compound curvularin specifically showed potential interactions with amino acid residues of target enzymes. It is also exclusively binding to the iron atom of the hemoglobin (HEME) group with binding affinity of −12.3 kcal/mol, where the hemoglobin is the main target of current existing drugs used for treating patients. The stability of molecular complexes can be measured through molecular dynamic simulation and root mean square fluctuation (RMSF) values. In this study, stable complexes were formed with curvularin and rostratin A having the highest RMSF values of 4.3 Å and 4.5 Å, respectively. Lower RMSF values indicate stability, while higher values indicate flexibility. The ADMET score gave an outlook about the absorption, distribution, metabolism, excretion and toxicity of the ligands. All the drug candidates used in this study passed the basic Lipinski rule of five except orevactaene. Curvularin and rostratin A were predicted as enzyme inhibitors by a bioactivity prediction tool (Molinspiration). In vitro and in vivo studies will be a way to go further.

Incidence and Management of Fungal Infections in Oral and Maxillofacial Surgery

Mucormycosis are life-threatening fungal infections especially affecting immunocompromised or diabetic patients. This review provides an update on mucormycosis management. The latest recommendations strongly recommend as first-line therapy the use of liposomal amphotericin B (≥ 5mg/kg) combined with surgery whenever possible. Isavuconazole and intravenous or delayed-release tablet forms of posaconazole have remained second-line. Many molecules are currently in development to fight against invasive fungal diseases but few have demonstrated efficacy against Mucorales. Despite in vitro efficacy, combinations of treatment have failed to demonstrate superiority versus monotherapy. New approaches assessing relationships between host, fungi, and antifungal drugs, and new routes of administration such as aerosols could improve mucormycosis treatment.

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).

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.

SAT058 Diabetes Complicated By DKA, Mucormycosis And Covid-19

Abstract Disclosure: A. Gordon: None. Background: Mucormycosis is an invasive opportunistic fungal infection, that although rare, has an estimated all-cause mortality of 54%. Even with aggressive treatment, significant tissue necrosis and bone destruction can occur. Risk factors include diabetes, acidosis (as in diabetic ketoacidosis), excess iron, transplant, malignancy, kidney and liver disease, immunosuppressant and corticosteroid use - and in more recent times, the Covid-19 infection. We present a case of invasive rhino-orbital cerebral mucormycosis in the setting of DKA, uncontrolled diabetes and Covid-19. Case: A 60-year-old female with history of uncontrolled type 2 diabetes (HbA1c 14.3%) presented after being found unresponsive. Her exam was significant for encephalopathy, complete left eye ophthalmoplegia and right-sided hemiparesis. She was hemodynamically stable without fever. Initial labs showed significant hyperglycemia with an elevated anion gap and beta-hydroxybutyrate indicative of diabetic ketoacidosis (DKA). She had a lumbar puncture which showed leukocytosis with neutrophilia (146 WBC, 39% neutrophils), elevated glucose and normal protein; CSF culture was negative for growth. She also tested positive for Covid-19 although CXR was unremarkable and she did not require treatment. Initial CT/CTA head/neck showed complete occlusion of the left cervical internal carotid artery with associated acute/subacute infarcts in the left frontal, parietal, temporal and occipital lobes. CT sinuses showed severe frontal, maxillary and ethmoid sinus mucosal wall thickening with left premaxillary soft tissue swelling and leftward nasal septum deviation. Finally, orbital imaging showed left cavernous sinus thrombosis, left superior ophthalmic vein thrombosis, and necrosis vs devascularization of the extraocular muscles. She was initially treated with fluids, an insulin infusion and broad-spectrum antibiotics and was evaluated by neurology, ophthalmology, infectious disease and otolaryngology. She underwent surgical debridement with left maxillary antrostomy, left total ethmoidectomies and septoplasty. Sinus cultures were positive for MSSA (methicillin sensitive staph aureus) and tissue pathology showed angioinvasive fungal disease compatible with Mucor/Rhizomucor species. Antimicrobial coverage was changed to intravenous Nafcillin and Amphotericin B, and she underwent further surgical debridement twice more. Repeat brain imaging to evaluate for disease progression is pending. Discussion: Early detection and aggressive treatment of Mucormycosis with surgical debridement and Amphotericin B can improve patient outcomes, however the mortality rate is still significant. Therefore, tight glycemic control in high risk groups is imperative, particularly in those with uncontrolled diabetes complicated by DKA and Covid-19 infection (with or without steroid treatment). Presentation: Saturday, June 17, 2023

Mucormycosis in COVID-19 patients: A cross-sectional study at IGIMS, Patna

Introduction: During the second wave of COVID-19, the incidence of mucormycosis has increased more rapidly. The most common causes attributed to the rise of mucormycosis in COVID-19 are uncontrolled diabetes, the excessive use of corticosteroids, and long-term stays in the intensive care unit, organ or bone marrow transplantation, etc. Objective: To determine the sociodemographic and associated risk factors, pattern of disease, treatment of mucormycosis and outcome of individual at time of discharge and after three months and six months of follow-up. Methodology: This cross-sectional study included all treated mucormycosis cases with prior COVID-19 infection. Data collected from medical records using purposive sampling. Survivors followed up at 3 and 6 months after discharge. Results: In our study, we analyzed 161 mucormycosis cases identified through positive RTPCR/Rapid Antigen reports. Among them, 72% were males and 28% were females. Diabetes mellitus was present in 71.4% and hypertension in 29.8% of patients. The case-fatality rate was 6.8% at discharge, increasing to 18.6% after 3 months and 28% after 6 months of follow-up. Statistical analysis was conducted using SPSS version 15. This analysis helped us draw meaningful conclusions from the data, highlighting the impact of comorbidities and time on mucormycosis outcomes. Conclusion: Post-COVID mucormycosis in India was primarily observed in patients with uncontrolled diabetes, immunodeficiency due to other comorbidities, and dysfunctional immune systems.

Mucormycosis in COVID-19 Pandemic: Study Involving Tertiary Hospitals in Aurangabad District, India

Introduction: An abrupt increase in the mucormycosis patients in india during the COVID 19 pandemic was observed. A collective study was conducted in tertiary care hospitals in Aurangabad.
 Materials and Methods: A retrospective descriptive study was conducted in Aurangabad (Maharashtra), in association with the Aurangabad Municipal Corporation (AMC), oralcare.co.in and SNDH Hospital, Aurangabad. Data was collected by AMC from 3 major tertiary hospitals present in Aurangabad where treatment of Mucormycosis was done from May 2021 to July 2021. The data of total 135 patients with Mucormycosis was received by the AMC were included in the study. It included demographics of the patients, medical and clinical history, history of COVID 19, treatment of COVID 19, type of Mucormycosis, treatment and outcomes of Mucormycosis.
 Results: In the present study, 74.7% of Mucormycosis patients were males. 77.4% of Mucormycosis patients were above 50 years of age. It was seen that about 67% of patients with Mucormycosis had diabetes mellitus as the most common risk factor. About 87.4% of patients had a history of COVID-19. Majority of the patients in the study population were diagnosed with the rhino-maxillary-orbital type of Mucormycosis which is 39%, followed by the rhino-cerebral type-25%. Only 1% patients showed rhiono-nasal -orbital type of Mucormycosis. 30% patients were not categorised into any type. All the patients in the study population received amphotericin B and surgical treatment. About 84.4% patients were discharged after the Mucormycosis treatment. 15.6% patients died during or after the treatment.
 Conclusion: Mucormycosis was predominantly seen in male above the age of 50 years, COVID-19 infection and diabetes mellitus was common risk factor for Mucormycosis.