1710. Profiling Patients with Rare Mucormycosis Infections Using Real-world Data (original) (raw)
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Characterizing patients with rare mucormycosis infections using real-world data
BMC Infectious Diseases, 2022
Background Invasive mucormycosis (IM) is a rare and often life-threatening fungal infection, for which clinical and epidemiological understanding is lacking. Electronic health record (EHR) data can be utilized to elucidate large populations of patients with IM to address this unmet need. This study aimed to descriptively assess data on patients with IM using the Optum® EHR dataset. Methods US patient data from the Optum® deidentified EHR dataset (2007–2019) were analyzed to identify patients with IM. Patients with hematologic malignancies (HM), at high risk of IM, were selected and sorted by IM diagnosis (ICD9 117.7; ICD10 B46). Demographics, comorbidities/other diagnoses, and treatments were analyzed in patients with IM. Results In total, 1133 patients with HM and IM were identified. Most were between 40 and 64 years of age, Caucasian, and from the Midwest. Essential primary hypertension (50.31%) was the most common comorbidity. Of the 1133 patients, only 33.72% were prescribed an ...
BMC infectious diseases, 2016
Mucormycosis is a rare but devastating fungal infection primarily affecting immunocompromised patients such as those with hematological malignancy, bone marrow and solid organ transplantation, and patients with diabetes, and, even more rarely, immunocompetent patients. The objective of this study was to assess the prevalence and burden, both clinical and economic, of mucormycosis among hospitalized patients in the U.S. This is a retrospective study using the Premier Perspective(TM) Comparative Database, with more than 560 participating hospitals covering 104 million patients (January 2005-June 2014). All hospitalizations in the database were evaluated for the presence of mucormycosis using either an ICD-9 code of 117.7 or a positive laboratory result for Mucorales. Hospitalizations were further required to have prescriptions of amphotericin B or posaconazole to be considered as mucormycosis-related hospitalizations. The prevalence of mucormycosis-related hospitalizations among all h...
Epidemiology of mucormycosis: review of 18 cases in a tertiary care hospital
Medical Mycology, 2010
Mucormycosis is an angio-invasive mycosis with high morbidity and mortality rates which mainly affects immunocompromised patients. It is no longer an uncommon disease due to the increased incidence of diabetes and use of immunosuppressive agents in the current era. Our objective was to review all cases of proven and probable mucormycosis-according to EORTC criteria-diagnosed from 2000 until 2007 at the University Hospitals Leuven, a 1900-bed tertiary care hospital, to assess the changing epidemiology of the disease. In 45 patients there was microbiological or histopathological evidence for the presence of a member of Mucorales during the hospital stay of which 12 cases fulfi lled the criteria for proven mucormycosis and 6 for probable mucormycosis. The overall incidence was 0.042 cases per 10,000 patient days. A slight although not statistically signifi cant increase in incidence was noticeable during the study period. The major site of infection was the lungs (78% of the cases), with haematological malignancy the most common underlying disorder and Rhizopus species the most often suspected etiologic agent. Overall mortality was 55% and co-infections with Aspergillus species, proven or probable, noted in 44% of cases. The highest survival rate was achieved with surgery combined with antifungal therapy. Keywords epidemiology, mucormycosis, tertiary care hospital and patients with impairment in phagocytosis (e.g., as a consequence of hyperglycaemia) are accordingly at higher risk for developing mucormycosis [ 3 ]. In addition, patients receiving corticosteroid therapy, or are transplant recipients and those with burn wounds or trauma [ 3 ,4 ] are at risk of infection. Deferoxamine treatment and neutropenia are risk factors for the development of disseminated disease. While the most common predisposing illness for gastrointestinal infection is severe malnutrition [ 5 ], rhinocerebral mucormycosis is often associated with diabetic ketoacidosis [ 3 ,6 ] and cerebral mucormycosis has been diagnosed in AIDS patients and drug addicts [ 4 ,6 ]. Mucorales are unique among fi lamentous fungi in their greater ability to cause infections in a broader, more heterogenous population of human hosts than other opportunistic moulds. The fungal hyphae invade skin, mucosae, and tissues causing thrombosis in blood vessels, infarction, haemorrhage and necrosis [ 7 ]. According to Roden et al ., mucormycosis is most frequently located in sinuses (39%), lungs (24%), skin (19%), brain (9%), gastro-intestinal
International Journal of Research in Medical Sciences , 2022
The pandemic of COVID-19 descended to every possible damage onto the grieving healthcare infrastructure of the nation and beyond, which on its reeling end has now propagated a dark nightmare. In recent times, as the second wave of COVID gained momentum, influx of cases of 'COVID-induced black fungus' has taken the world by storm. An angio-invasive disease characterized by tissue infarction and necrosis, 'mucormycosis' is an invasive calamity caused by mold fungi belonging to genus Mucor, Rhizopus, Rhizomucor and Absidia, cross reacting in immune-compromised hosts. 1 As per Indian Council of Medical Research (ICMR) census, 24872 cases were reported as of 28 December 2021 with Gujarat leading the cascade with 8276 cases. 2 The first episode in Rajasthan was a 18 month old post COVID baby in Bikaner, diagnosed with the brutal ailment on 29 April 2021 post which the state has encountered an epidemic which stands at 4202 cases till date.
Current Fungal Infection Reports
Purpose of Review More than half a billion people have been infected and 6.2 million killed by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) since the start of the pandemic in 2019. Systemic glucocorticoids are a double-edged sword, on the one hand, life-saving in treating COVID-19 complications while on the other hand, potentially leading to life-and-limb-threatening opportunistic fungal infections. Mucormycosis (MM) is caused by the mucormycetes family. Although rare, it is characterized by high mortality and significant morbidity. The gross similarities observed with other fungal infections which respond to different treatment regimens have made it all the more imperative to quickly and sensitively diagnose and treat MM. This review discusses the epidemiology of MM before and during the COVID-19 pandemic, associated risk factors, COVID-19-associated MM, diagnosis, and current therapeutic interventions. Recent Findings There has been a widespread and worrisome trend of rising in cases of MM, worldwide, but more so in the Indian subcontinent, where it is nicknamed the "black fungus." This upsurge has picked up the pace ever since the start of the COVID-19 pandemic. Necrosis is secondary to the angio-invasive and pro-thrombotic nature of the mold resulting in extensive lesions presenting mostly as rhino-orbital MM (ROM) and rhino-orbito-cerebral MM (ROCM). Infection is mostly observed in subjects with underlying risk factors such as uncontrolled diabetes, those receiving hematopoietic stem cell transplant, and/or on corticosteroid or immunosuppressive therapy, although it is widely suspected that other factors such as iron and zinc may play a role in the pathogenesis of MM. The "One world one guideline" strategy advocates both prophylactic anti-fungal therapy along with aggressive, prompt, and individualized treatment with anti-fungal drugs such as amphotericin B in addition to vigorous surgical intervention. High-risk groups need particularly rapid diagnosis although empirical antifungal therapy may not be delayed. Speeding diagnostic turnaround times are essential to institute early therapy, and there is much scope for newer modalities such as PCR, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and whole-genome sequencing in such endeavors. The results of strict monitoring of blood glucose levels along with rational and limited use of steroids and immunomodulatory drugs have proven to be a significant preventive measure. Summary The significant rise in cases of MM worldwide has necessitated viewing each case with a strong index of suspicion. Adoption of rapid diagnostics, early antifungal therapy, and prompt surgical interventions are essential, while high-risk groups need particular focused care which may include prophylactic anti-fungal therapy, limited steroid use, and meticulous control of the underlying disease. Developing quicker and more sensitive diagnostic modalities has great potential to improve the detection and management of MM.
Cureus
Background: The COVID-19 pandemic along with its treatment has brought myriad potential complications including the heightened risk of secondary fungal infections like mucormycosis. Mucormycosis is a rare angioinvasive fungal infection that has traditionally been highly fatal despite surgical intervention and antifungal medications. Aim: To re-evaluate the risk factors, epidemiology, and possible COVID-19-associated conditions on a larger sample size than the existing data. Methodology: We studied the possible risk factors, clinical presentations, treatment, and outcome of 203 patients with mucormycosis in a single-center retrospective-prospective observational study for three months at a tertiary care hospital after obtaining due permission from the institutional ethics committee. Results: The mean age of patients was 52 ± 11.5 years, and 92.61% had a history of COVID-19 infection. Around 86.7% of patients were suffering from diabetes mellitus with 50% being already known cases whereas the other 50% developed post-COVID-19 infection; 65.02% of patients were administered corticosteroids during their COVID-19 treatment. About 51.72% of patients required hospital admission and among them, 16.25% of patients required ICU support. The mean oxygen saturation (SpO2) levels on admission were 84.61 ± 12.96%, and 38.92% of patients required mechanical respiratory support. The mean duration between COVID-19 infection and the onset of mucormycosis was 18.80 ± 16.61 days. The most common clinical presentations were facial pain and swelling (26.6%) and ophthalmic symptoms including eye swelling, pain, and ptosis (25.12%). Antifungal treatment was given to all the patients and 89.36% of the patients underwent surgical debridement of fungal mass. At the end of three months, 60.59% of the 188 patients survived with improvement, 13.30% had no improvement and/or deterioration of health, and 18.72% succumbed to mucormycosis. Intracranial involvement and leukocytosis were positively associated with mortality whereas surgical intervention was significant for positive outcomes at the end of three months in patients with mucormycosis (p<0.05). Conclusion: The sudden rise of mucormycosis during the second wave of COVID-19 can be attributed to uncontrolled blood sugar levels along with high corticosteroid usage as well as various nosocomial factors during the COVID-19 treatment. Early and aggressive treatment with surgical intervention and antifungal drugs can improve disease outcomes.
Increasing Incidence of Mucormycosis in Spanish inpatients from 1997-2018
2021
Background: Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. Methodology: A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). Principal findings: A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55±18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and hematological malignancy (36.3%) were the main factors involved. Conclusions: Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in t...
Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic
Folia Microbiologica, 2022
Mucormycosis is a deadly opportunistic disease caused by a group of fungus named mucormycetes. Fungal spores are normally present in the environment and the immune system of the body prevents them from causing disease in a healthy immunocompetent individual. But when the defense mechanism of the body is compromised such as in the patients of diabetes mellites, neustropenia, organ transplantation recipients, and other immune-compromised states, these fungal spores invade our defense mechanism easily causing a severe systemic infection with approximately 45-80% of case fatality. In the present scenario, during the COVID-19 pandemic, patients are on immunosuppressive drugs, glucocorticoids, thus are at high risk of mucormycosis. Patients with diabetes mellitus are further getting a high chance of infection. Usually, the spores gain entry through our respiratory tract affecting the lungs and paranasal sinuses. Besides, they can also enter through damage into the skin or through the gastrointestinal route. This review article presents the current statistics, the causes of this infection in the human body, and its diagnosis with available recent therapies through recent databases collected from several clinics and agencies. The diagnosis and identification of the infection were made possible through various latest medical techniques such as computed tomography scans, direct microscopic observations, MALDI-TOF mass spectrometry, serology, molecular assay, and histopathology. Mucormycosis is so uncommon, no randomized controlled treatment studies have been conducted. The newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate) may be beneficial in patients who are refractory to or intolerant of Liposomal Amphotericin B. but due to lack of early diagnosis and aggressive surgical debridement or excision, the mortality rate remains high. In the course of COVID-19 treatments, there must be more vigilance and alertness are required from clinicians to evaluate these invasive fungal infections.
Mucormycosis in COVID-19 Patients: A Hospital-based Study
Journal of BP Koirala Institute of Health Sciences
Background: Fungal infections are increasingly being seen and mucormycosis is increasingly being isolated in COVID-19 patients, especially in those needing prolonged hospitalization. This cross-sectional study was carried out to isolate different fungi and identify their species in COVID-19 patients admitted for more than one month. Methods: Sputum samples were taken from all the consecutive COVID-19 patients admitted in the hospital for more than one month and their health condition not improving despite the administration of antibiotics during May to July 2020. The samples were subjected to 10% KOH mount and Gram’s stain, and cultured onto Sabouraud Dextrose Agar. This was visualized under direct microscopy. Fungus was identified based on its morphology. Results: Out of the 100 patients enrolled during the study period, 74 were male and 26, female. The different species of fungi were isolated from eight samples (8%) out of which two cases were confirmed to be mucormycosis (2%). Co...