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      COVID-19 associated mucormycosis: Staging and management recommendations (Report of a multi-disciplinary expert committee)

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          Abstract

          Even before the onslaught of COVID-19 pandemic could settle, the unprecedented rise in cases with COVID-19 associated mucormycosis has pushed the medical health to the fringe. Hyperglycaemia and corticosteroids appear to be the most consistent associations leading to the commonest manifestation of mucormycosis, Rhino-Orbito-Cerebral Mucormycosis. To address challenges right from categorisation and staging of the disease to the management of relentless progression, a multi-disciplinary expert committee was formed to handle the task in an evidence-based format to enforce best practices. The report of the committee on one hand attempts to succinctly present the currently available evidence while at the other also attempts to bridge the evidence-deficient gaps with the specialty-specific virtuosity of experts.

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          The trinity of COVID-19: immunity, inflammation and intervention

          Matthew Tay, Chek Meng Poh, Laurent Rénia … (2020)
          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.
          Article 0 comments Cited 2120 times – based on 0 reviews     Review now
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            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

            Oliver Cornely, Ana Alastruey-Izquierdo, Dorothee Arenz … (2019)
            Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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              Epidemiology and outcome of zygomycosis: a review of 929 reported cases.

              M M Roden, T. E. Zaoutis, W L Buchanan … (2005)
              Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
              Article 0 comments Cited 460 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Oral Biol Craniofac Res
                Journal ID (iso-abbrev): J Oral Biol Craniofac Res
                Title: Journal of Oral Biology and Craniofacial Research
                Publisher: Craniofacial Research Foundation. Published by Elsevier B.V.
                ISSN (Print): 2212-4268
                ISSN (Electronic): 2212-4276
                Publication date PMC-release: 11 August 2021
                Publication date (Electronic): 11 August 2021
                Affiliations
                [a ]Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
                [b ]Department of Microbiology, King George's Medical University, U.P, Lucknow, 226003, India
                [c ]Oral and Maxillofacial Surgery, King George's Medical University, U.P, Lucknow, 226003, India
                [d ]Department of Infectious Diseases, King George's Medical University, U.P, Lucknow, 226003, India
                [e ]Department of Radiodiagnosis, King George's Medical University, U.P, Lucknow, 226003, India
                [f ]Department of Otorhinolaryngology, King George's Medical University, U.P, Lucknow, 226003, India
                [g ]Department of Ophthalmology, King George's Medical University, U.P, Lucknow, 226003, India
                [h ]Department of Anaesthesiology, King George's Medical University, U.P, Lucknow, 226003, India
                [i ]Department of Pathology, King George's Medical University, U.P, Lucknow, 226003, India
                [j ]Department of Plastic and Reconstructive Surgery, King George's Medical University, U.P, Lucknow, 226003, India
                [k ]Department of Neurosurgery, King George's Medical University, U.P, Lucknow, 226003, India
                [l ]Department of Hospital Administration, King George's Medical University, U.P, Lucknow, 226003, India
                [m ]Department of Medicine, King George's Medical University, U.P, Lucknow, 226003, India
                [n ]King George's Medical University, U.P, Lucknow, 226003, India
                Author notes
                [∗ ]Corresponding author.
                Article
                Publisher Item ID: S2212-4268(21)00084-1
                DOI: 10.1016/j.jobcr.2021.08.001
                PMC ID: 8354814
                PubMed ID: 34395187
                SO-VID: 7692e6db-0a59-4263-b10f-62da06a7ff43
                Copyright © © 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 7 July 2021
                Date revision received : 28 July 2021
                Date accepted : 4 August 2021
                Categories
                Subject: Review Article

                Keywords: covid-19,mucormycosis,rhino-orbital-cerebral mucormycosis,anti-fungal,amphotericin,staging
                Data availability:
                Keywords: covid-19, mucormycosis, rhino-orbital-cerebral mucormycosis, anti-fungal, amphotericin, staging

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