Tackling the emerging threat of antifungal resistance to human health

Nature Reviews Microbiology, Journal Year: 2022, Volume and Issue: 20(9), P. 557 - 571

Published: March 29, 2022

Language: Английский

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Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

Indian Journal of Ophthalmology, Journal Year: 2021, Volume and Issue: 69(7), P. 1670 - 1692

Published: June 25, 2021

COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, including comorbidities, and medications used treat COVID-19, presenting symptoms signs, outcome management. was a retrospective, observational patients ROCM managed or co-managed by ophthalmologists India from January 1, 2020 May 26, 2021. Of 2826 patients, states Gujarat (22%) Maharashtra (21%) reported highest number ROCM. The mean age 51.9 years male preponderance (71%). While 57% needed oxygen support for infection, 87% were treated corticosteroids, (21% > 10 days). Diabetes mellitus (DM) present 78% all patients. Most cases showed onset between day 15 diagnosis 56% developed within 14 days after diagnosis, while 44% had delayed beyond days. Orbit involved 72% stage 3c forming bulk (27%). Overall treatment included intravenous amphotericin B 73%, functional endoscopic sinus surgery (FESS)/paranasal (PNS) debridement 56%, orbital exenteration 15%, both FESS/PNS 17%. Intraorbital injection administered 22%. At final follow-up, mortality 14%. Disease >3b poorer prognosis. Paranasal reduced rate 52% 39% 4 disease intracranial extension (p < 0.05). : Corticosteroids DM are most important predisposing development must be followed up recovery. Awareness red flag high index clinical suspicion, prompt early initiation B, aggressive surgical PNS, exenteration, where indicated, essential successful outcome.

Language: Английский

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Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia

JAMA, Journal Year: 2021, Volume and Issue: 326(18), P. 1807 - 1807

Published: Oct. 21, 2021

A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients severe and critical COVID-19, but a higher may benefit those more disease.To assess the effects 12 mg/d vs COVID-19 hypoxemia.A multicenter, randomized clinical trial was conducted between August 2020 May 2021 at 26 hospitals Europe India included 1000 adults confirmed requiring least L/min oxygen or mechanical ventilation. End 90-day follow-up on 19, 2021.Patients were 1:1 intravenous (n = 503) 497) days.The primary outcome number alive without life support (invasive ventilation, circulatory support, kidney replacement therapy) 28 adjusted stratification variables. Of 8 prespecified secondary outcomes, 5 are this analysis (the 90 days, out hospital mortality ≥1 serious adverse reactions days).Of patients, 982 (median age, 65 [IQR, 55-73] years; 305 [31%] women) data available 971 (491 group 480 group). The median 22.0 (IQR, 6.0-28.0 days) 20.5 4.0-28.0 (adjusted mean difference, 1.3 [95% CI, 0-2.6 days]; P .07). Mortality 27.1% 32.3% relative risk, 0.86 [99% 0.68-1.08]). 32.0% 37.7% 0.87 0.70-1.07]). Serious reactions, including septic shock invasive fungal infections, occurred 11.3% 13.4% 0.83 0.54-1.29]).Among hypoxemia, compared did not result statistically significantly days. However, have been underpowered identify significant difference.ClinicalTrials.gov Identifier: NCT04509973 ctri.nic.in CTRI/2020/10/028731.

Language: Английский

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ECMM/ISHAM recommendations for clinical management of COVID‐19 associated mucormycosis in low‐ and middle‐income countries

Mycoses, Journal Year: 2021, Volume and Issue: 64(9), P. 1028 - 1037

Published: June 16, 2021

Reports are increasing on the emergence of COVID-19-associated mucormycosis (CAM) globally, driven particularly by low- and middle-income countries. The recent unprecedented surge CAM in India has drawn worldwide attention. More than 28,252 cases counted is first country where been declared a notifiable disease. However, misconception management, diagnosing treating this infection continue to occur. Thus, European Confederation Medical Mycology (ECMM) International Society for Human Animal (ISHAM) felt need address clinical management This article provides comprehensive document help clinicians managing infection. Uncontrolled diabetes mellitus inappropriate (high dose or not indicated) corticosteroid use major predisposing factors surge. High counts Mucorales spores both indoor outdoor environments, immunosuppressive impact COVID-19 patients as well immunotherapy possible additional factors. Furthermore, hyperglycaemic state leads an increased expression glucose regulated protein (GRP- 78) endothelial cells that may entry into tissues. Rhino-orbital most common presentation followed pulmonary mucormycosis. Recommendations focused early suspicion disease confirmation diagnosis. Regarding glycaemic control, elimination therapy, extensive surgical debridement antifungal therapy standards proper care. Due limited availability amphotericin B formulations during present epidemic, alternative therapies also discussed.

Language: Английский

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Mucormycosis and COVID‐19: An epidemic within a pandemic in India

Mycoses, Journal Year: 2021, Volume and Issue: 64(10), P. 1253 - 1260

Published: July 13, 2021

Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis outcomes for mucormycosis among patients with COVID-19 infection. This prospective, observational, multi-centre study included 47 consecutive mucormycosis, diagnosed during their course illness, between January 3 March 27, 2021. Data regarding demography, underlying medical conditions, illness treatment were collected. Clinical presentations imaging biochemical characteristics outcome recorded. Of the 2567 admitted to tertiary centres, (1.8%) Mean age was 55 ± 12.8years, majority suffered from diabetes mellitus (n = 36, 76.6%). Most not vaccinated 31, 66.0%) 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All received corticosteroids broad-spectrum antibiotics most 37, 78.7%) at least one anti-viral medication. time elapsed 12.1 4.6days. Eleven (23.4%) subjects succumbed disease, mostly 8, 72.7%) within 7 days diagnosis. Among who died, 10 (90.9%) pre-existing mellitus, only 2 (18.2%) just vaccine dose all requiring oxygen supplementation mechanical Mucormycosis can occur patients, especially poor glycaemic control, widespread injudicious use antibiotics, Owing high mortality, index suspicion is ensure timely appropriate in high-risk populations.

Language: Английский

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Diagnosis of invasive fungal infections: challenges and recent developments

Journal of Biomedical Science, Journal Year: 2023, Volume and Issue: 30(1)

Published: June 19, 2023

The global burden of invasive fungal infections (IFIs) has shown an upsurge in recent years due to the higher load immunocompromised patients suffering from various diseases. role early and accurate diagnosis aggressive containment infection at initial stages becomes crucial thus, preventing development a life-threatening situation. With changing demands clinical mycology, field diagnostics evolved come long way traditional methods microscopy culturing more advanced non-culture-based tools. advent powerful approaches such as novel PCR assays, T2 Candida, microfluidic chip technology, next generation sequencing, new biosensors, nanotechnology-based tools, artificial intelligence-based models, face is constantly for better. All these advances have been reviewed here giving latest update our readers most orderly flow.A detailed literature survey was conducted by team followed data collection, pertinent extraction, in-depth analysis, composing sub-sections final review. review unique its kind it discusses molecular methods; serology-based biosensor technology; machine learning-based all under one roof. To best knowledge, there no covering fields (especially technology learning using intelligence) with relevance infections.The will undoubtedly assist updating scientific community's understanding advancements that are on horizon may be implemented adjuncts diagnostic algorithms.

Language: Английский

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COVID-19 and mucormycosis superinfection: the perfect storm

Infection, Journal Year: 2021, Volume and Issue: 49(5), P. 833 - 853

Published: July 24, 2021

The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated steroids. surge in cases COVID-19 India during second wave pandemic increased reporting invasive post COVID-19. There are multiple case series describing In this review, we included most reported case-series describe clinical features outcome. Many were eported from India, who recovered patients. commonly infection sites rhino-orbital/rhino-cerebral mucormycosis. Those diabetic corticosteroids therapy for controlling severity COVID-19, leading to a higher fatality complicating scenario. triad severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use uncontrolled diabetes mellitus have evident significant increase incidence angioinvasive maxillofacial addition, presence spores other factors might play role well. With ongoing increasing number infected SARS-CoV-2, it is important develop risk-based approach at risk based on epidemiological burden mucormycosis, prevalence mellitus, immune modulating agents including combined immunosuppressive cancer transplants.

Language: Английский

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Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Diabetes & Metabolic Syndrome Clinical Research & Reviews, Journal Year: 2021, Volume and Issue: 15(5), P. 102235 - 102235

Published: July 28, 2021

Language: Английский

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COVID-19-associated opportunistic infections: a snapshot on the current reports

Clinical and Experimental Medicine, Journal Year: 2021, Volume and Issue: 22(3), P. 327 - 346

Published: Aug. 23, 2021

Language: Английский

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COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

PLoS neglected tropical diseases, Journal Year: 2021, Volume and Issue: 15(11), P. e0009921 - e0009921

Published: Nov. 18, 2021

Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos India. As daily infection rates rise alarmingly, number of severe cases increased dramatically. The country encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, seen sudden surge patients with COVID-19. rhino-orbital-cerebral form is most common type observed. In particular, approximately three-fourths them had diabetes as predisposing comorbidity received corticosteroids treat Possible mechanisms may involve immune inflammatory processes. Diabetes, when coupled COVID-19–induced systemic change, tends cause decreased immunity risk secondary infections. Since comprehensive data on this fatal opportunistic are evolving against backdrop major pandemic, prevention strategies primarily managing comorbid conditions high-risk groups. recommended treatment included surgical debridement antifungal therapy using Amphotericin B selected azoles. Several India-centric clinical guidelines have emerged rightly diagnose characterise presentation, understand pathogenesis involved, track disease course. Code Mucor one, which proposes simple but reliable staging system form. A recently been proposed, dedicated registry started. critical review, we extensively analyse recent evidence guidance COVID-19–associated mucormycosis

Language: Английский

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