Mucor in a Viral Land: A Tale of Two Pathogens
Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures fo...
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Published in | Indian journal of ophthalmology Vol. 69; no. 2; pp. 244 - 252 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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India
Wolters Kluwer India Pvt. Ltd
01.02.2021
Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Wolters Kluwer - Medknow Wolters Kluwer Medknow Publications |
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Abstract | Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival. |
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AbstractList | Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival. PurposeCOVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. MethodsWe conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. ResultsAll patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. ConclusionMucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival. COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. All patients were male, mean age 60.5 ± 12 (46.2-73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86-404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3-42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival. |
Audience | Professional |
Author | Parekh, Ragini Sen, Mrittika Lahane, Sumeet Honavar, Santosh Lahane, Tatyarao |
AuthorAffiliation | 1 Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India |
AuthorAffiliation_xml | – name: Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India – name: 1 Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India |
Author_xml | – sequence: 1 givenname: Mrittika surname: Sen fullname: Sen, Mrittika organization: Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad – sequence: 2 givenname: Sumeet surname: Lahane fullname: Lahane, Sumeet organization: Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra – sequence: 3 givenname: Tatyarao surname: Lahane fullname: Lahane, Tatyarao organization: Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra – sequence: 4 givenname: Ragini surname: Parekh fullname: Parekh, Ragini organization: Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra – sequence: 5 givenname: Santosh surname: Honavar fullname: Honavar, Santosh organization: Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33463566$$D View this record in MEDLINE/PubMed |
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Keywords | COVID-19 diabetes mellitus Corticosteroids mucormycosis |
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References | 33727483 - Indian J Ophthalmol. 2021 Apr;69(4):1002-1004 Mukherjee (R12-9-20240828) 2016; 64 Nithyanandam (R18-9-20240828) 2003; 51 Mehta (R2-9-20240828) 2020; 12 Shah (R6-9-20240828) 2019; 71 Songu (R16-9-20240828) 2008; 22 De Pauw (R4-9-20240828) 2008; 46 Liu (R13-9-20240828) 2013; 38 Fox (R8-9-20240828) 2020; 38 Cornely (R5-9-20240828) 2019; 19 Pelton (R17-9-20240828) 2001; 17 Lee (R7-9-20240828) 2020; 34 Hirabayashi (R19-9-20240828) 2017; 33 Altini (R14-9-20240828) 2015; 18 Hargrove (R15-9-20240828) 2006; 22 Ali (R22-9-20240828) 2020; 68 |
References_xml | – volume: 64 start-page: 337 year: 2016 ident: R12-9-20240828 article-title: Fungal infections of the orbit publication-title: Indian J Ophthalmol doi: 10.4103/0301-4738.185588 contributor: fullname: Mukherjee – volume: 12 start-page: e10726 year: 2020 ident: R2-9-20240828 article-title: Rhino-orbital mucormycosis associated with COVID-19? publication-title: Cureus contributor: fullname: Mehta – volume: 38 start-page: e370 year: 2013 ident: R13-9-20240828 article-title: Utility of 18F-FDG PET/CT in diagnosis and management of mucormycosis publication-title: Clin Nucl Med doi: 10.1097/RLU.0b013e3182867d13 contributor: fullname: Liu – volume: 38 start-page: 1278 year: 2020 ident: R8-9-20240828 article-title: A multidisciplinary educational curriculum for the management of orbital compartment syndrome publication-title: Am J Emerg Med doi: 10.1016/j.ajem.2019.12.002 contributor: fullname: Fox – volume: 22 start-page: 286 year: 2006 ident: R15-9-20240828 article-title: Indications for orbital exenteration in mucormycosis publication-title: Ophthalmic Plast Reconstr Surg doi: 10.1097/01.iop.0000225418.50441.ee contributor: fullname: Hargrove – volume: 22 start-page: 98 year: 2008 ident: R16-9-20240828 article-title: Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome publication-title: Am J Rhinol doi: 10.2500/ajr.2008.22.3121 contributor: fullname: Songu – volume: 33 start-page: e94 year: 2017 ident: R19-9-20240828 article-title: Retrobulbar injection of amphotericin B for orbital mucormycosis publication-title: Ophthalmic Plast Reconstr Surg doi: 10.1097/IOP.0000000000000806 contributor: fullname: Hirabayashi – volume: 17 start-page: 62 year: 2001 ident: R17-9-20240828 article-title: Successful treatment of rhino-orbital mucormycosis without exenteration: The use of multiple treatment modalities publication-title: Ophthalmic Plast Reconstr Surg doi: 10.1097/00002341-200101000-00012 contributor: fullname: Pelton – volume: 68 start-page: 974 year: 2020 ident: R22-9-20240828 article-title: All India Ophthalmological Society-Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic publication-title: Indian J Ophthalmol doi: 10.4103/ijo.IJO_1415_20 contributor: fullname: Ali – volume: 18 start-page: 68 year: 2015 ident: R14-9-20240828 article-title: (18) F-FDG PET/CT contribution to diagnosis and treatment response of rhino-orbital-cerebral mucormycosis publication-title: Hell J Nucl Med contributor: fullname: Altini – volume: 71 start-page: 259 year: 2019 ident: R6-9-20240828 article-title: Orbital exenteration in rhino-orbito-cerebral mucormycosis: A prospective analytical study with scoring system publication-title: Indian J Otolaryngol Head Neck Surg doi: 10.1007/s12070-018-1293-8 contributor: fullname: Shah – volume: 46 start-page: 1813 year: 2008 ident: R4-9-20240828 article-title: Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group publication-title: Clin Infect Dis doi: 10.1086/588660 contributor: fullname: De Pauw – volume: 19 start-page: e405 year: 2019 ident: R5-9-20240828 article-title: Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium publication-title: Lancet Infect Dis doi: 10.1016/S1473-3099(19)30312-3 contributor: fullname: Cornely – volume: 34 start-page: 1640 year: 2020 ident: R7-9-20240828 article-title: Orbital mycoses in an adult subtropical population publication-title: Eye doi: 10.1038/s41433-019-0733-3 contributor: fullname: Lee – volume: 51 start-page: 231 year: 2003 ident: R18-9-20240828 article-title: Rhino-orbito-cerebral mucormycosis.A retrospective analysis of clinical features and treatment outcomes publication-title: Indian J Ophthalmol contributor: fullname: Nithyanandam |
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SubjectTerms | Aged Amphotericin B Biopsy Comorbidity Complications Coronaviruses Corticosteroids COVID-19 COVID-19 - epidemiology Debridement Diabetes mellitus Diagnosis Drug therapy Eye infections Eye Infections, Fungal - epidemiology Eye Infections, Fungal - microbiology Female Fungal infections Humans Immunosuppression Infections Intravenous administration Male Middle Aged Mucorales - isolation & purification Mucormycosis Mucormycosis - epidemiology Mucormycosis - microbiology Opportunist infection Original Pandemics Patient outcomes Patients Posaconazole Retrospective Studies Risk factors SARS-CoV-2 |
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Title | Mucor in a Viral Land: A Tale of Two Pathogens |
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