Rising concerns of Mucormycosis (Zygomycosis) among COVID-19 patients; an analysis and review based on case reports in literature

Rising concerns of Mucormycosis (Zygomycosis) among COVID-19 patients; an analysis and review based on case reports in literature

Authors

  • Kamleshun Ramphul Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine
  • Renuka Verma Guru Gobind Singh Medical College, Punjab, India https://orcid.org/0000-0002-8090-3319
  • Nomesh Kumar Liaquat University of Medicine and Health Sciences, Jamshroo, Pakistan https://orcid.org/0000-0002-4410-988X
  • Yogeshwaree Ramphul Sir Seewoosagur Ramgoolam National Hospital, Mauritius
  • Stephanie Mejias UNIBE School of Medicine, Santo Domingo, Dominican Republic
  • Petras Lohana Liaquat University of Medicine and Health Sciences, Jamshroo, Pakistan https://orcid.org/0000-0001-8427-1155

Keywords:

Mucormycosis, COVID-19, Fungal infection, Amphotericin B

Abstract

As the world continues to struggle with the pandemic of COVID-19 (coronavirus disease 2019), several cases of mucormycosis have been reported in these patients with a high mortality rate. We conducted a review of literature and found 19 articles with 20 patients who developed mucormycosis during their COVID-19 infection.14 (70%) were males, and 6(30%) were females. While their mean age was 52.2 ± 17.3, affected men were older than females. Ten (50%) patients also had diabetes. Common clinical findings included ophthalmologic complaints, fever, shortness of breath, and facial pain. Amphotericin B was the most common antifungal used and 40% of cases needed surgical management of the infection. Steroid use was reported in around 12 cases (60%). Unfortunately, the mortality rate was 65% in this group of patients. Several changes in care should be brought for a consistent prevention, early diagnosis, and strong management of mucormycosis in COVID-19 patients.

References

Ramphul K, Mejias SG. Coronavirus Disease: A Review of a New Threat to Public Health. Cureus 2020; 12:e7276.

Ramphul K, Ramphul Y, Park Y, Lohana P, Kaur Dhillon B, Sombans S. A comprehensive review and update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19): what do we know now in 2021? Arch Med Sci Atheroscler Dis 2021; 6:5-13.

WHO COVID-19 Dashboard, available online https://covid19.who.int/ (accessed on 13 May 2021)

Ramphul K, Lohana P, Ramphul Y, et al. Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19. Arch Med Sci Atheroscler Dis 2021; 6:30-39.

Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506:145-148.

Aggarwal G, Lippi G, Lavie CJ, Henry BM, Sanchis-Gomar F. Diabetes mellitus association with coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. J Diabetes 2020; 12:851-855.

Cheruiyot I, Henry B, Lippi G, et al. Acute Kidney Injury is Associated with Worse Prognosis In COVID-19 Patients: A Systematic Review and Meta-analysis. Acta Biomed 2020; 91:e2020029.

Arastehfar A, Carvalho A, van de Veerdonk FL, et al. COVID-19 Associated Pulmonary Aspergillosis (CAPA)—From Immunology to Treatment. Journal of Fungi 2020; 6:91.

What is the deadly ‘black fungus’ seen in Covid patients in India?, available online https://www.theguardian.com/global/2021/may/11/what-is-the-dangerous-black-fungus-being-seen-in-covid-patients-in-india-mucormycosis (accessed on 13 May 2021)

Verma R, Ramphul K, Kumar N, Lohana P. Investigating the impact of search results for fever, headache, cough, diarrhea, and nausea on the incidence of COVID-19 in India using Google Trends. Acta Biomed 2021; 92:e2021242.

Rajasthan declares black fungus an epidemic; cases pile up in several states | 10 points, available online https://www.indiatoday.in/coronavirus-outbreak/story/rajasthan-declares-black-fungus-an-epidemic-cases-pile-up-in-several-states-10-points-1804470-2021-05-19 (accessed on 20 May 2021)

Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Jr., Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48:1743-1751.

Mucormycosis, available online https://www.statpearls.com/articlelibrary/viewarticle/25325/?utm_source=pubmed&utm_campaign=CME&utm_content=25325 (accessed on 19 May 2021)

Camara-Lemarroy CR, González-Moreno EI, Rodríguez-Gutiérrez R, et al. Clinical features and outcome of mucormycosis. Interdiscip Perspect Infect Dis 2014; 2014:562610.

Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis 2012; 54 Suppl 1:S16-22.

Chakrabarti A, Ghosh A, Prasad GS, et al. Apophysomyces elegans: an emerging zygomycete in India. J Clin Microbiol 2003; 41:783-788.

Reid G, Lynch JP, 3rd, Fishbein MC, Clark NM. Mucormycosis. Semin Respir Crit Care Med 2020; 41:99-114.

Artis WM, Fountain JA, Delcher HK, Jones HE. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: transferrin and iron availability. Diabetes 1982; 31:1109-1114.

Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus 2020; 12:e10726.

Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med 2021; 42:264.e265-264.e268.

Pasero D, Sanna S, Liperi C, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection 2020:1-6.

Monte Junior ESD, Santos M, Ribeiro IB, et al. Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report. Clin Endosc 2020; 53:746-749.

Mekonnen ZK, Ashraf DC, Jankowski T, et al. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast Reconstr Surg 2021; 37:e40-e80.

Garg D, Muthu V, Sehgal IS, et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia 2021; 186:289-298.

Placik DA, Taylor WL, Wnuk NM. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Rep 2020; 15:2378-2381.

Bellanger AP, Navellou JC, Lepiller Q, et al. Mixed mold infection with Aspergillus fumigatus and Rhizopus microsporus in a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) patient. [¬published online ahead of print, 2021 Jan 27] Infect Dis Now 2021;S2666-9919(21)00030-0.

Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital mucormycosis in a COVID-19 patient: A case report. Int J Surg Case Rep 2021; 82:105957.

Khatri A, Chang KM, Berlinrut I, Wallach F. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient - Case report and review of literature. J Mycol Med 2021; 31(2):101125.

Saldanha M, Reddy R, Vincent MJ. Title of the Article: Paranasal Mucormycosis in COVID-19 Patient. Indian J Otolaryngol Head Neck Surg 2021:1-4.

Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report. Eur J Ophthalmol 2021:11206721211009450.

Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32:64-67.

Karimi‐Galougahi, M, Arastou, S, Haseli, S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID‐19). Int Forum Allergy Rhinol 2021; 1‐ 3.

Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Calleja-Alarcon S, Romero-Gutierrez L. A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19. Cureus 2021; 13:e13163.

Kanwar A, Jordan A, Olewiler S, Wehberg K, Cortes M, Jackson BR. A Fatal Case of Rhizopus azygosporus Pneumonia Following COVID-19. J Fungi (Basel) 2021; 7(3):174.

Zurl C, Hoenigl M, Schulz E, et al. Autopsy Proven Pulmonary Mucormycosis Due to Rhizopus microsporus in a Critically Ill COVID-19 Patient with Underlying Hematological Malignancy. J Fungi (Basel) 2021; 7(2):88.

Hanley B, Naresh KN, Roufosse C, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe 2020; 1:e245-e253.

Revannavar SM, P SS, Samaga L, V KV. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Rep 2021; 14:e241663.

Kowlessur S, Ori B, Zimmet P, Tuomilehto J, Chitson P, Ramphul Y. Tackling the COVID-19 pandemic in paradise: the Mauritian experience. The Lancet Diabetes & Endocrinology 2020; 8:878-879.

Ramphul K, Lohana P, Verma R, Sombans S. The impact of COVID-19 on cardiology departments. Arch Med Sci Atheroscler Dis 2021; 6:1-2.

Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis 2012; 54 Suppl 1:S16-22.

Egi M, Furushima N, Makino S, Mizobuchi S. Glycemic control in acute illness. Korean J Anesthesiol 2017; 70:591-595.

Lee FY, Mossad SB, Adal KA. Pulmonary mucormycosis: the last 30 years. Archives of internal medicine 1999; 159:1301-1309.

Mignogna MD, Fortuna G, Leuci S, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15:e533-540.

Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol 2020; 52:1193-1194.

Brar G, Pinheiro LC, Shusterman M, et al. COVID-19 Severity and Outcomes in Patients With Cancer: A Matched Cohort Study. J Clin Oncol 2020; 38:3914-3924.

Yang L, Chai P, Yu J, Fan X. Effects of cancer on patients with COVID-19: a systematic review and meta-analysis of 63,019 participants. Cancer Biol Med 2021; 18:298-307.

Hong HL, Lee YM, Kim T, et al. Risk factors for mortality in patients with invasive mucormycosis. Infect Chemother 2013; 45:292-298.

Usami E, Kimura M, Kanematsu T, et al. Evaluation of hypokalemia and potassium supplementation during administration of liposomal-amphotericin B. Exp Ther Med 2014; 7:941-946.

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Published

02-09-2021

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REVIEWS/FOCUS ON - SPECIAL COVID19

How to Cite

1.
Rising concerns of Mucormycosis (Zygomycosis) among COVID-19 patients; an analysis and review based on case reports in literature. Acta Biomed [Internet]. 2021 Sep. 2 [cited 2024 Mar. 29];92(4):e2021271. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/11787