Breaking the mold: a brief review on the diagnostic and treatment approaches of mucormycosis (original) (raw)
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International Journal of Innovative Research in Technology, 2021
The diagnosis and treatment of mucormycosis are challenging. The incidence of the disease seems to be increasing. Mucormycosis is an angio invasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middleincome countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. The main aim and purpose of this review related to overview and Etiopathogenesis of Mucormycosis, fatality of rhinocerebral Mucormycosis, recent advances in diagnostic and treatment methods.
COMPREHENSIVE OVERVIEW ON MUCORMYCOSIS WITH RECENT ADVANCEMENT IN TREATMENT
ijetrm journal, 2021
Mucormycosis is a life-threatening infection caused by the fungus Mucorales belonging to zygomycetes class. In India in 2021 it has become an epidemic in midst of the covid-19 pandemic , Mucormycosis is causing high mortality in patients with underlying predisposing risk factors like diabetes mellitus ,hematological malignancy, transplantation,immunocompromised individuals and covid associated mucormycosis is seen in patients treated with concurrent glucocorticoid therapy. This infection is non communicable, so it does not spread from one person to another. Early diagnosis and early initiation of treatment is required for preventing further spread of the disease and death. This infection is difficult to diagnose as the symptoms shown overlaps with many other known infections Management therapy includes treatment with antifungal medications and surgical debridement of the infected necrotic tissue. Preventionof the infection is possible only by the management of underlying risk factors like by better control of diabetes, restricted use of glucocorticoids, antibiotics
During the current pandemic of COVID-19, a myriad of manifestations and complications have emerged. Although fungal infections are typically condidered as opportunistic infections, patients suffering from severe COVID 19 infection have shown an increased incidence of pulmonary Aspergillosis at the start of the pandemic. Numerous cases of Mucormycosis have been reported across many countries. Mucormycosis is known to cause life-threatening infections in immuno compromised individuals like uncontrolled diabetes mellitus, hematological malignancies and other conditions. It is an angioinvasive fungal infection with high mortality andhas evidenced a surge in the COVID-19 pandemic.Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.
Clinicopathological Study of Mucormycosis in Post Covid Patients, an Epidemic in Pandemic
Medical Laboratory Technology Journal, 2022
Mucormycosis is an angio-invasive disease caused by saprophytic fungi of the order Mucorales. Mucormycosis has been established and recognized as a complication of the SARS-CoV-2 infection. Mucormycosis, well known as "black fungus" is creating an epidemic within a global pandemic. The use of different dose regimens, prominent steroids, and multiple comorbidities like Diabetes Mellitus and post-COVID could predispose to mucormycosis. The aim of the study was to study the increase in cases and morphological features of mucormycosis infection in hospitalized post-COVID patients. This prospective study was done for four months, from May 1st, 2021, to August 31st, 2021. All the suspected cases of mucormycosis specimens sent to the Department of Pathology, J.J.M. Medical College, Davangere, for histopathological diagnosis were considered. For microscopic examination, the collected samples were fixed in 10% formalin solution, processed, and stained with Haematoxylin and Eosin. Periodic Acid-Schiff special staining was done. Thirty cases of mucormycosis were collected from patients who had recovered from COVID-19. Mean age 63±12 (37-80) years with Male:Female ratio being 1.3:1. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 23.5±10 (7-60) days. Rhino-orbital mucormycosis was the most typical presentation. Out of 30 cases, 28 cases (93.3%) were Type 2 Diabetes Mellitus, and 2 cases (6.6%)were nondiabetic. All patients received corticosteroids for the treatment of COVID-19. Trinity of COVID-19, Diabetes Mellitus, and Corticosteroid treatment was significant for the rise in mucormycosis cases. Mucormycosis is an invasive fungal infection and had seen a sudden surge during the second wave of COVID-19. In our study, most patients had a history of diabetes, and corticosteroid therapy with rhino-orbital mucormycosis was the most typical presentation. As the severity of the necrosis increases, the presence of fungal hyphae also increases, which leads to extensive destruction of tissue. Extra vigilance in immunosuppressed patients helps in reducing the morbidity and mortality due to mucormycosis in Post COVID era.
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.
Current Diagnosis and Management of Mucormycoses
Current Fungal Infection Reports, 2010
Due to the rising incidence of diabetes mellitus, the increasing populations of immunocompromised individuals of varied etiologies, and the progresses that have been made in the management of the critically ill, the incidence of invasive fungal infections, in particular those caused by the Mucorales, is increasing. Currently available diagnostics frequently miss this infection. Knowledge of the factors placing individuals at risk for and the varied clinical presentations of mucormycosis should alert clinicians of the possible presence of this infection. Survival of individuals with mucormycosis is dependant on prompt diagnosis and aggressive therapy with antifungal agents; surgical debridement; and, if possible, reversal of the risk factors predisposing the individual to this infection. It is hoped that improved diagnostic testing, improvements in pharmacotherapy, and adjunctive therapies will improve the morbidity and mortality of mucormycosis.
"Mucormycosis" The Emerging Global Threat -A Complete Review
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.6\_June2021/IJRR-Abstract023.html, 2021
Mucormycosis is a life-threatening invasive fungal infection that affects people who are immunocompromised (haematological malignancies, solid organ transplantation, diabetes mellitus). Pulmonary, rhinocerebral, cutaneous, and disseminated infections are the most common. Controlling mucormycosis requires reversing the underlying problems. Treatment for mucormycosis also includes quick and vigorous surgery. Extensive surgical debridement of necrotic tissues is required. Finally, an antifungal treatment is required. High-dose liposomal amphotericin B (5 mg/kg/day) is the first-line treatment for mucormycosis. Antifungal chemotherapy has no set length; instead, it is determined by the remission of all related symptoms and results (usually 6-8 weeks). Posaconazole maintenance therapy/secondary prophylaxis should be recommended in patients who have a persistently weakened immune system.
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
A Review on Fungal Disease Mucormycosis
International Journal for Research in Applied Science & Engineering Technology (IJRASET), 2023
As the fight against the deadly Covid 19 pandemic continues worldwide, several complications were being reported in patients who have recovered from Covid. One such deadly complication that has been reported recently in patients in India who were tested positive for Covid-19 and are gradually recovering was a fungal disease called mucormycosis, or black fungus. As hundreds of cases had been reported across the country, this had caused an additional wave of panic among the population.
Mucormycosis in COVID-19 Patients Poses a Challenge to Public Health
Mucormycosis is an emerging and re-emerging mycosis that is reported from many countries of the world including India. The disease is caused by filamentous fungi that belonged to the genus Absidia, Cunninghamella, Mucor, Rhizomucor, and Rhizopus. These fungi are widely prevalent in our environment, and have the potential to invade any organ of the body including the sinuses, lung, brain, heart, kidney, joint and others. The source of infection is exogenous, and the respiratory tract is considered as the prime portal of entry of the fungi. Mucormycosis can occur in sporadic as well as in epidemic form. The maximum cases of mucormycosis are caused by Rhizopus oryzae. Globally, disease due to Rhizopus oryzae affects over 10,000 persons each year. The recent pandemic of COVID-19 has posed a great challenge to the public health authorities. Mucormycosis in COVID-19 patients are reported from India, and also other nations. Rhino-orbital-cerebral form of mucormycosis is frequently encountered in clinical setting throughout the world. Diabetes mellitus and steroid therapy are the most important risk factors that predispose the patients to mucormycosis. The laboratory help is imperative to confirm an unequivocal diagnosis of disease. Liposomal amphotericin-B and posaconazole are the antifungal drugs that are recommended for the treatment of mucormycosis the patients.