COVID-19 and Mucormycosis Coinfection: How Challenging It Is
This article is part of Special Issue:
Niranjan Nayak,
Erum Khan,
Debadatta Panigrahi,
Corresponding Author
Niranjan Nayak
Manipal College of Medical Sciences, Pokhara, Nepal manipal.edu.np
Search for more papers by this authorErum Khan
College of Medicine, Ajman University, Ajman, UAE medcol.mw
Search for more papers by this authorDebadatta Panigrahi
College of Medicine, Ajman University, Ajman, UAE medcol.mw
Search for more papers by this authorNiranjan Nayak,
Erum Khan,
Debadatta Panigrahi,
Corresponding Author
Niranjan Nayak
Manipal College of Medical Sciences, Pokhara, Nepal manipal.edu.np
Search for more papers by this authorErum Khan
College of Medicine, Ajman University, Ajman, UAE medcol.mw
Search for more papers by this authorDebadatta Panigrahi
College of Medicine, Ajman University, Ajman, UAE medcol.mw
Search for more papers by this authorAcademic Editor: Matthew Gavino Donadu
Abstract
Recently, cases of rhinoorbital mucormycosis in people diagnosed with COVID-19 have been reported from India particularly. Diabetes mellitus though happens to be an independent risk factor both for severe COVID-19 and mucormycosis, administration of steroids is attributed as a precipitating factor for acquiring the comorbid condition. This opportunistic fungal infection is highly angioinvasive in nature because of which, clinical outcome of infection is invariably poor, especially with rhinocerebral or rhinoorbitocerebral variety of mucormycosis. However, effective management depends upon timely and accurate diagnosis and parenteral administration of amphotericin B. At the same time, judicious use of steroids is a key factor. In addition, glycemic control in those who are severely diabetic is strongly advocated. Exenteration of an eyeball may be indicated if cavernous sinus and intracranial spread are anticipated. Therefore, in order to facilitate faster healing and better penetration of antifungal drugs, surgical debridement of the paranasal sinus cavities and removal of dead tissue from the sinuses are recommended.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
References
- 1 Song G., Liang G., and Liu W., Fungal Co-infections Associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China, Mycopathologia. (2020) 185, no. 4, 599–606, https://doi.org/10.1007/s11046-020-00462-9.
- 2 Singh A. K., Singh R., Joshi S. R., and Misra A., Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India, Diabetes and Metabolic Syndrome. (2021) 15, no. 4, 102146, https://doi.org/10.1016/j.dsx.2021.05.019.
- 3 Prakash H. and Chakrabarti A., Global epidemiology of mucormycosis, Journal of Fungi. (2019) 5, no. 1, https://doi.org/10.3390/jof5010026, 2-s2.0-85064813078.
- 4 Chander J., Kaur M., Singla N., Punia R., Singhal S., Attri A., Alastruey-Izquierdo A., Stchigel A., Cano-Lira J., and Guarro J., Mucormycosis: battle with the deadly enemy over a five-year period in India, Journal of Fungi. (2018) 4, no. 2, https://doi.org/10.3390/jof4020046, 2-s2.0-85056766582.
- 5 Sargin F., Akbulut M., Karaduman S., and Sungurtekin H., Severe rhinocerebral mucormycosis developed after COVID-19, Journal of Bacteriology & Parasitology. (2021) 12, no. 386, 1–3.
- 6 Koehler P., Bassetti M., Chakrabarti A., Chen S. C. A., Colombo A. L., Hoenigl M., Klimko N., Lass-Flörl C., Oladele R. O., Vinh D. C., Zhu L.-P., Böll B., Brüggemann R., Gangneux J.-P., Perfect J. R., Patterson T. F., Persigehl T., Meis J. F., Ostrosky-Zeichner L., White P. L., Verweij P. E., and Cornely O. A., Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance, The Lancet Infectious Diseases. (2021) 21, no. 6, e149–e162, https://doi.org/10.1016/s1473-3099(20)30847-1.
- 7 Prattes J., Wauters J., Giacobbe D. R., Lagrou K., Hoenigl M., Koehler P., Salmanton-García J., Rautemaa-Richardson R., Hatzl S., Maertens J., Debaveye Y., Bourgeois M., Reynders M., Rutsaert L., Van Regenmortel N., Lormans P., Feys S., Reisinger A. C., Cornely O. A., Lahmer T., Valerio M., Delhaes L., Jabeen K., Steinmann J., Chamula M., and Bassetti M., Diagnosis and treatment of COVID-19 associated pulmonary apergillosis in critically ill patients: results from a European confederation of medical mycology registry, Intensive Care Medicine. (2021) 47, no. 10, 1158–1160, https://doi.org/10.1007/s00134-021-06471-6.
- 8 Arastehfar A., Carvalho A., Nguyen M. H., Hedayati M. T., Netea M. G., David S. P., and Martin H., COVID-19-associated candidiasis (CAC): an underestimated complication in the absence of immunological predispositions?, Journal of Fungi. (2020) 6, no. 4, https://doi.org/10.3390/jof6040211.
- 9 Poignon C., Blaize M., Vezinet C., Lampros A., Monsel A., and Fekkar A., Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19, Clinical Microbiology and Infections. (2020) 26, no. 11, 1582–1584, https://doi.org/10.1016/j.cmi.2020.06.026.
- 10 Cornely O. A., Alastruey-Izquierdo A., Arenz D., Chen S. C. A., Dannaoui E., Hochhegger B., Hoenigl M., Jensen H. E., Lagrou K., Lewis R. E., Mellinghoff S. C., Mer M., Pana Z. D., Seidel D., Sheppard D. C., Wahba R., Akova M., Alanio A., Al-Hatmi A. M. S., Arikan-Akdagli S., Badali H., Ben-Ami R., Bonifaz A., Bretagne S., Castagnola E., Chayakulkeeree M., Colombo A. L., Corzo-León D. E., Drgona L., Groll A. H., Guinea J., Heussel C.-P., Ibrahim A. S., Kanj S. S., Klimko N., Lackner M., Lamoth F., Lanternier F., Lass-Floerl C., Lee D.-G., Lehrnbecher T., Lmimouni B. E., Mares M., Maschmeyer G., Meis J. F., Meletiadis J., Morrissey C. O., Nucci M., Oladele R., Pagano L., Pasqualotto A., Patel A., Racil Z., Richardson M., Roilides E., Ruhnke M., Seyedmousavi S., Sidharthan N., Singh N., Sinko J., Skiada A., Slavin M., Soman R., Spellberg B., Steinbach W., Tan B. H., Ullmann A. J., Vehreschild J. J., Vehreschild M. J. G. T., Walsh T. J., White P. L., Wiederhold N. P., Zaoutis T., and Chakrabarti A., 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, The Lancet Infectious Diseases. (2019) 19, no. 12, e405–e421, https://doi.org/10.1016/s1473-3099(19)30312-3.
- 11 Zurl C., Hoenigl M., Schulz E., Hatzl S., Gorkiewicz G., Krause R., Eller P., and Prattes J., Autopsy proven pulmonary mucormycosis due to Rhizopus microsporus in a critically ill COVID-19 patient with underlying hematological malignancy, Journal of Fungi. (2021) 7, no. 2, https://doi.org/10.3390/jof7020088.
- 12 Ketenci İ., Ünlü Y., Kaya H., Somdaş M. A., Kontaş O., Öztürk M., and Vural A., Rhinocerebral mucormycosis: experience in 14 patients, Journal of Laryngology & Otology. (2011) 125, no. 8, https://doi.org/10.1017/S0022215111000843, 2-s2.0-80155147043.
- 13 Arora K. and Panda P. K., Steroid harms if given early in COVID-19 viraemia, BMJ Case Reports. (2021) 14, no. 2, e241105, https://doi.org/10.1136/bcr-2020-241105.
- 14 Horby P., Horby P., Lim W. S., Emberson J. R., Mafham M., Bell J. L., Linsell L., Staplin N., Brightling C., Ustianowski A., Elmahi E., Prudon B., Green C., Felton T., Chadwick D., Rege K., Fegan C., Chappell L. C., Faust S. N., Jaki T., Jeffery K., Montgomery A., Rowan K., Juszczak E., Baillie J. K., Haynes R., and Landray M. J., Dexamethasone in hospitalized patients with COVID-19, New England Journal of Medicine. (2021) 384, no. 8, 693–704, https://doi.org/10.1056/NEJMoa2021436.
- 15 Martin H., Seidel D., Carvalho A., Rudramurthy, Amir A., Hoenigl M., Seidel D., Carvalho A., Rudramurthy S. M., Arastehfar A., Nasir J.-P. G., N., Bonifaz A., Araiza J., Klimko N., Serris A., Lagrou K., Meis J. F., Cornely O. A., Perfect J. R., White P. L., Chakrabarti A., ECMM, and ISHAM Collaborators, The emergence of COVID-19 associated mucormycosis: Analysis of 2 cases from 18 countries, The Lancet Microbe. (2022) https://doi.org/10.1016/52666-5247(21)00237-8.
- 16 Morales-Franco B., Nava-Villalba M., Medina-Guerrero E. O., Sánchez-Nuño Y. A., Davila-Villa P., Anaya-Ambriz E. J., and Charles-Niño C. L., Host-pathogen molecular factors contribute to the pathogenesis of Rhizopus spp in diabetes mellitus, Current Tropical Medicine Reports. (2021) https://doi.org/10.1007/s40475-020-00222-1.
- 17 Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z., Xiang J., Wang Y., Song B., Gu X., Guan L., Wei Y., Li H., Wu X., Xu J., Tu S., Zhang Y., Chen H., and Cao B., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, The Lancet. (2020) 395, no. 10229, 1054–1062, https://doi.org/10.1016/s0140-6736(20)30566-3.
- 18 Dilek A., Ozaras R., Ozkaya S., Sunbul M., Sen E. I., and Hakan L., COVID-19 associated mucormycosis: Case report and systematic review, Travel Medicine and Infectious Disease. (2021) 44, 1021–1048, https://doi.org/10.1016/j.tmaid.2021.102148.
- 19 Johnson A. K., Ghazarian Z., Cendrowski K. D., and Persichino J. G., Pulmonary aspergillosis and mucormycosis in a patient with COVID-19, Medical Mycology Case Reports. (2021) 32, 64–67, https://doi.org/10.1016/j.mmcr.2021.03.006.
- 20 Gurumurthy B., Das S. K., Hiremath R., Shetty S., Hiremath A., and Gowda T., Spectrum of atypical pulmonary manifestations of COVID-19 on computed tomography, Egyptian Journal of Radiology and Nuclear Medicine. (2021) 52, no. 1, https://doi.org/10.1186/s43055-021-00448-7.
- 21 Rudramurthy S. M., Hoenigl M., Meis J. F., Cornely O. A., Muthu V., Gangneux J. P., Perfect J., and Chakrabarti A., ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries, Mycoses. (2021) 64, no. 9, 1028–1037, https://doi.org/10.1111/myc.13335.
- 22 Georgiadou S. P., Sipsas N. V., Marom E. M., and Kontoyiannis D. P., The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts, Clinical Infectious Diseases. (2011) 52, no. 9, 1144–1155, https://doi.org/10.1093/cid/cir122, 2-s2.0-79953842942.
- 23 Alexander B. D., Lamoth F., Heussel C. P., Prokop C. S., Desai S. R., Morrissey C. O., and Baddley J. W., Guidance on imaging for invasive pulmonary aspergillosis and mucormycosis: from the imaging working group for the revision and update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC, Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. (2021) 72, no. 2, S79–S88, https://doi.org/10.1093/cid/ciaa1855.
- 24
Hoenigl M.,
Seidel D.,
Carvalho A.,
Rudramurthy S. M.,
Arastehfar A.,
Gangneux J. P.,
Nasir N.,
Bonifaz A.,
Araiza J.,
Klimko N.,
Serris A.,
Lagrou K.,
Meis J. F.,
Cornely O. A.,
Perfect J. R.,
White P. L., and
Chakrabarti A., The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries, The Lancet. Microbe. (2022) https://doi.org/10.1016/S2666-5247(21)00237-8.
10.1016/S2666-5247(21)00237-8 Google Scholar
- 25 Nayak N., Fungal infections of the eye: laboratory diagnosis and treatment, Nepal Medical College Journal. (2008) 10, 48–63.
- 26 Israele V. and Nelson J. D., Periorbital and orbital cellulitis, The Pediatric Infectious Disease Journal. (1987) 6, 404–410.
- 27 Stone N. R. H., Bicanic T., Salim R., and Hope W., Liposomal Amphotericin B (AmBisome): A review of the pharmacokinetics, pharmacodynamics, clinical experience and future directions, Drugs. (2016) 76, no. 4, 485–500, https://doi.org/10.1007/s40265-016-0538-7, 2-s2.0-84955592353.
