Multimodal analysis of the COVID‐19‐associated mucormycosis outbreak in Delhi, India indicates the convergence of clinical and environmental risk factors

Mycoses, Journal Year: 2023, Volume and Issue: 66(6), P. 515 - 526

Published: Feb. 15, 2023

The aetiology of the major outbreak COVID-19-associated mucormycosis (CAM) in India spring 2021 remains incompletely understood. Herein, we provide a multifaceted and multi-institutional analysis clinical, pathogen-related, environmental healthcare-related factors during CAM metropolitan New Delhi area.We reviewed medical records all patients diagnosed with biopsy-proven (n = 50) at 7 hospitals Delhi, NCR area April-June 2021. Two multivariate logistic regression models were used to compare clinical characteristics cases COVID-19-hospitalised contemporary as controls 69). Additionally, meteorological parameters mould spore concentrations outdoor air analysed. Selected hospital fomites cultured. Mucorales isolates from analysed by ITS sequencing whole-genome (WGS).Independent risk for identified previously or newly diabetes mellitus, active cancer severe COVID-19 infection. Supplemental oxygen, remdesivir therapy ICU admission associated reduced risk. incidence peak was preceded an uptick preceding 3-4 weeks that correlated increasing temperature, high evaporation decreasing relative humidity. Rhizopus most common genus isolated, but also two uncommon Mucorales, Lichtheimia ornata. WGS found no clonal population patient isolates. No cultured fomites.An intersection host contributed emergence CAM. Surrogates access advanced treatment lower

Language: Английский

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Severe mold fungal infections in critically ill patients with COVID-19

Future Microbiology, Journal Year: 2024, Volume and Issue: 19(9), P. 825 - 840

Published: May 31, 2024

The SARS-CoV-2 pandemic put an unprecedented strain on modern societies and healthcare systems. A significantly higher incidence of invasive fungal co-infections was noted compared with the pre-COVID-19 era, adding new diagnostic therapeutic challenges in critical care setting. In current narrative review, we focus mold infections caused by Aspergillus Mucor species critically ill COVID-19 patients. We discuss up-to-date information incidence, pathogenesis, diagnosis treatment these mold-COVID-19 co-infections, as well recommendations preventive prophylactic interventions. Traditional risk factors were often not recognized COVID-19-associated aspergillosis mucormycosis, highlighting role other determinant factors. associated patient outcomes worse patients without co-infection.

Language: Английский

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Invasive Fungal Infections Associated with COVID-19

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(6), P. 667 - 667

Published: June 14, 2023

The COVID-19 pandemic caused >6 million deaths worldwide, often from respiratory failure. Complications frequently occurred in hospitalized patients, particularly the intensive care unit. Among these, fungal infections were a cause of high morbidity and mortality. Invasive aspergillosis, candidiasis mucormycosis most serious these infections. Risk factors included alterations immune defense mechanisms by itself, as well immunosuppression due to various therapies utilized severely ill patients. Diagnosis was challenging lack sensitivity current testing. Outcomes generally poor, significant co-morbidities delayed diagnosis, with mortality rates >50% some studies. High index clinical suspicion is needed facilitate early diagnosis initiation appropriate antifungal therapy.

Language: Английский

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Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India

Mycoses, Journal Year: 2022, Volume and Issue: 65(5), P. 526 - 540

Published: Feb. 25, 2022

The second COVID-19 wave in India has been associated with an unprecedented increase cases of mucormycosis (CAM), mainly Rhino-orbito-cerebral (ROCM).This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, August, 2021, to identify CAM patients assess their management outcomes. primary endpoint incidence all-cause mortality due CAM.59 were diagnosed CAM. Median duration from the first positive RT PCR test diagnosis 17 (IQR: 12,22) days. 90% diabetic 89% having uncontrolled sugar level (HbA1c >7%). All prescribed steroids during treatment for COVID-19. 56% non-hypoxemic, mild (irrational steroid therapy), while 9%, inappropriately high dose. Patients treated a combination surgical debridement (94%), intravenous liposomal Amphotericin B (91%) concomitant oral Posaconazole (95.4%). 74.6% discharged after clinical radiologic recovery 25.4% died. On relative risk analysis, CT severity index ≥18 (p = .017), presence orbital symptoms .002), ketoacidosis .011) cerebral involvement .0004) increased death.CAM is rapidly progressive, angio-invasive, opportunistic fungal infection, which fatal if left untreated. Combination antifungal therapy leads improvement majority cases.

Language: Английский

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Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study

Clinical Microbiology and Infection, Journal Year: 2023, Volume and Issue: 29(10), P. 1298 - 1305

Published: June 20, 2023

To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis.This prospective, pragmatic study included adults with mucormycosis. Patients received short (7-14 days) long (15-28 antifungal therapy (short treatment [SHIFT] [LIFT], respectively) depending on presence absence brain involvement. All patients step-down tablets, debridement, glycemic control. The primary outcome was success at week 14, which determined assessing survival disease progression through clinical evaluation nasal endoscopy. Log-binomial regression analysis (risk ratio 95% CI) performed to assess factors associated outcome.Intravenous administered 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 22 days). Treatment 3 months 88% (217/248; CI, 83-91%): SHIFT group, 93% (189/203; 89-96%); LIFT 62% (28/45; 47-76%). All-cause mortality 12% (30/251): 6% (13/205); 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00-1.05]; p 0.027), diabetic ketoacidosis presentation (2.32 [1.20-4.46]; 0·012), glycated haemoglobin A1c (1.19 [1.03-1.39]; 0.019), stroke (3.93 [1.94-7.95]; 0·0001), involvement (5.67 [3.05-10.54]; < 0.0001) were independently unsuccessful outcomes.Short should be further studied as option mucormycosis in randomized controlled trials.

Language: Английский

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Part 1: Mucormycosis: prevalence, risk factors, clinical features, and diagnosis

Expert Review of Anti-infective Therapy, Journal Year: 2023, Volume and Issue: 21(7), P. 723 - 736

Published: June 1, 2023

Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into nares, oropharynx, or lungs, ingestion contaminated food water, inoculation disrupted skin wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. contrast, developing/low income most cases occur persons with poorly controlled diabetes mellitus some immunocompetent subjects following trauma. exhibits a propensity to invade blood vessels, leading thrombosis infarction tissue. Mortality rates associated invasive are high exceed 90% disseminated disease. be classified as one six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal renal (5); disseminated; (6) uncommon (focal) sites.The authors discuss prevalence, risk factors, clinical features mucormycosis. A literature search was performed via PubMed (up November 2022), using key words: invasivefungal infections; mold; mucormycosis;Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis.Mucormycosis progress rapidly, delay initiating treatment even few days worsens outcomes.

Language: Английский

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Post COVID-19 mucormycosis in critical care settings: A prospective cohort study in a tertiary care center in Egypt

Journal of Infection and Public Health, Journal Year: 2024, Volume and Issue: 17(10), P. 102523 - 102523

Published: Aug. 23, 2024

The emergence of mucormycosis as a life-threatening fungal infection after the coronavirus disease 2019 (COVID-19) is major concern and challenge, but there limited information on risk factors for mortality in patients. We conducted prospective cohort study from May 2021 to April 2022 determine in-hospital outcomes post-COVID-19 during intensive care unit (ICU) stay. sample was collected consecutive sampling using all accessible patients period. Statistical Package Social Sciences (SPSS), version 25 (IBM, Chicago, Illinois, USA) used statistical analysis. Among 150 with mucormycosis, majority had primary sinus (86.0 %), while 11.3 % both ocular infections, 2.7 cutaneous infections. Around 21 (n = 31) deceased staying ICU median (range) 45.0 (10.0-145.0) days. who pneumonia patches computed tomography (CT) (90.3 %) none were discharged (p < 0.001). group higher rates pulmonary embolism (93.5 compared surviving groups (21.8 %). In multivariate Cox regression analysis, death older above 60 years old (hazard ratio (95 %CI): 6.7 (1.73-15.81)), increase among patient history steroid administration 5.70 (1.23-10.91)), facial 8.76 (1.78-25.18)), uncontrolled diabetes 10.76 (1.78, 65.18)), total leukocytic count (TLC>10 ×103 mcL) 10.03 (3.29-30.61)). Identifying high-risk especially diabetic corticosteroid detecting their deterioration quickly crucial reducing rates, these must be considered when developing treatment quarantine strategies.

Language: Английский

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Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

Diagnostics, Journal Year: 2022, Volume and Issue: 12(12), P. 3092 - 3092

Published: Dec. 8, 2022

A mucormycosis surge was reported during the COVID-19 pandemic in India. literature search until 14 July 2022, with aim of updating COVID-19-associated (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India 8388 patients, Egypt 208 Europe 40. Rhino-orbito-cerebral (ROCM) among 8082 (98.3%) followed by 98 (1.2%) pulmonary. In India, 82.6% patients had diabetes mellitus, 82% receiving corticosteroids. Europe, 75% presented pulmonary CAM, 32.5% 40% were immunocompromised. CAM at a median 17.4 days (IQR 7.5 days) post diagnosis, PCR performed five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents cavernous sinus thrombosis, meningitis cerebrovascular disease. Symptoms usually overlap severe pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement ROCM) are mainstay therapy. The mortality rate estimated to be 21.4% 31.9%), increased presence (80% 50%) or (50% 63.9%). summary, different clinical phenotypes need distinguished, influenced geographical presentation. Opportunities exist for diagnosis therapy optimization, based on earlier high-dose antifungal therapy, source control, strict glycemic control restriction steroids oxygen requirements.

Language: Английский

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Airway management, procedural data, and in-hospital mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19)

Journal de Mycologie Médicale, Journal Year: 2022, Volume and Issue: 32(4), P. 101307 - 101307

Published: July 2, 2022

Language: Английский

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Factors affecting clinical outcome in COVID-associated rhino-orbito-cerebral mucormycosis (CAROM) patients—An ambispective, single-arm, observational study

American Journal of Otolaryngology, Journal Year: 2023, Volume and Issue: 44(6), P. 103975 - 103975

Published: July 16, 2023

Language: Английский

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