scholarly journals The rising burden of invasive fungal infections in COVID-19, can structured CT thorax change the game

Author(s):  
Roopak Dubey ◽  
Kamal Kumar Sen ◽  
Sudhansu Sekhar Mohanty ◽  
Sangram Panda ◽  
Mayank Goyal ◽  
...  

Abstract Background The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. Several reports related to rhino-nasal-sinus mucormycosis in COVID patients have been published in recent times; however, very less has been reported about invasive pulmonary fungal infections caused mainly by mucor, aspergillus or invasive candida species. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features. Case presentation The HRCT imaging features of the all 6 patients showed signs of fungal invasion in the form of cavities formation in the pre-existing reverse halo lesions or development of new irregular margined soft tissue attenuating growth within the pre-existing or in newly formed cavities. Five out of six patients were diabetics. Cavities in cases 1, 2, 3 and 4 of mucormycosis were aggressive and relatively larger and showed relatively faster progression into cavities in comparison with cases 5 and 6 of invasive candidiasis. Conclusion In poorly managed diabetics or with other immunosuppressed conditions, invasive fungal infection (mucormycosis, invasive aspergillosis and invasive candidiasis) should be considered in the differential diagnosis of cavitary lung lesions.

2021 ◽  
Vol 8 (4) ◽  
pp. 207-213
Author(s):  
Himanshi Narang ◽  
Amit Patil

The COVID-19 pandemic, which originated from Wuhan, China, has rapidly spread worldwide, including India. As India grappled with the second wave, COVID-triggered fungal infection has suddenly risen tremendously, raising a sense of panic in the country. The fungal infection in COVID-19 includes Mucormycosis and Aspergillosis, as common fungal infections primarily affecting rhino-orbital structures. Many research papers have published postmortem findings in autopsies conducted on COVID-19 decedents, thereby helping to understand this contagious disease's pathogenesis. But, with the arrival of COVID-triggered fungal infection, which is a crucial invasive disease responsible for fatality, very few research papers have commented on the postmortem findings of invasive fungal infections affecting the rhino-orbital and craniocerebral structures in COVID-19 deaths. Therefore, the role of invasive fungal infection due to COVID-19 illness must be established in the causation of deaths in COVID-19 patients. This review research deals with autopsy dissection techniques and possible postmortem findings of invasive fungal infections involving the nasal and paranasal sinuses and orbital structures in COVID-19 deaths. The findings of fungal infection affecting nasal and paranasal systems may not differ in live patients and in a deceased; however, it is essential that correct interpretation of the postmortem findings aided by pre-or post-autopsy investigations is necessary to establish the role of covid triggered fungal infection in such deaths.


2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ashwag Yagoub Aloyouny

Introduction. Palatine tonsils are part of the mucosa-associated lymphoid tissue, located in the oropharyngeal region. Although these tissues protect the body from foreign intruders, they are more prone to infections due to their anatomical structure and location. For instance, the differential diagnosis of a white lesion on the palatine tonsil can range from benign to malignant lesions. Oral lymphoepithelial cysts commonly arise as painless, yellowish nodules on the floor of the mouth and the ventral or lateral surface of the tongue. Case Presentation. This paper presents a rare case of an unusual site of a lymphoepithelial cyst (LEC) in the oral cavity. The lesion was located in the tonsil of a 20-year-old woman with a chief complaint of a painless, white lump in the back of the mouth for nine months. Discussion. The differential diagnosis of a white lesion on the palatine tonsil is caused by several factors, such as bacterial, viral, and fungal infections; trauma; stones; cysts; abscess; or cancer. In this case, both the clinical presentation and extra- and intraoral examinations were highly associated with LEC. Oral LEC etiopathogenesis is uncertain, and several theories have been proposed to discuss the causes of LEC. In addition, oral LEC could be monitored without surgical intervention if the nodule is asymptomatic. Conclusion. We emphasize the importance of a thorough clinical examination of oral and oropharyngeal lesions, which are usually neglected.


2021 ◽  
Vol 30 (3) ◽  
pp. 127-134
Author(s):  
Shaimaa A.S. Selem ◽  
Neveen A. Hassan ◽  
Mohamed Z. Abd El-Rahman ◽  
Doaa M. Abd El-Kareem

Background: In intensive care units, invasive fungal infections have become more common, particularly among immunocompromised patients. Early identification and starting the treatment of those patients with antifungal therapy is critical for preventing unnecessary use of toxic antifungal agents. Objective: The aim of this research is to determine which common fungi cause invasive fungal infection in immunocompromised patients, as well as their antifungal susceptibility patterns in vitro, in Assiut University Hospitals. Methodology: This was a hospital based descriptive study conducted on 120 patients with clinical suspicion of having fungal infections admitted at different Intensive Care Units (ICUs) at Assiut University Hospitals. Direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA) were performed on the collected specimens. Isolated yeasts were classified using phenotypic methods such as chromogenic media (Brilliance Candida agar), germ tube examination, and the Vitek 2 system for certain isolates, while the identification of mould isolates was primarily based on macroscopic and microscopic characteristics. Moulds were tested in vitro for antifungal susceptibility using the disc diffusion, and yeast were tested using Vitek 2 device cards. Results: In this study, 100 out of 120 (83.3%) of the samples were positive for fungal infection. Candida and Aspergillus species were the most commonly isolated fungal pathogens. The isolates had the highest sensitivity to Amphotericin B (95 %), followed by Micafungin (94 %) in an in vitro sensitivity survey. Conclusion: Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, with Candida albicans being the most frequently isolated yeast from various clinical specimens; however, the rise in resistance, especially to azoles, is a major concern.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18008-e18008
Author(s):  
Shagufta Shaheen ◽  
Shivanck Upadhyay ◽  
Creticus Petrov Marak ◽  
Gagan Kumar ◽  
Achuta Kumar Guddati

e18008 Background: Invasive fungal infections are associated with higher mortality in hematopoietic stem cell transplant (HSCT) recipients despite the use of broad spectrum antifungal agents. With the increase in the number of patients undergoing HSCT and a newer array of immunosuppressants, it is necessary to examine the incidence and outcomes of fungal infection in this population. Methods: We used Nationwide Inpatient Sample from years 2000 to 2008 to examine the trends and outcomes of fungal infections in patients admitted for HSCT. We used ICD-9-CM codes to identify those with HSCT. Similarly we identified invasive fungal infection using ICD-9-CM codes. The engraftment period and subsequent admissions were examined separately. Outcomes studied were in-hospital mortality and length of hospital stay. Logistic regression analysis was used to identify independent association of fungal infection with mortality. The model was adjusted for demographic and hospital characteristics, Charlson's co-morbidity index and severity of sepsis using number of organ failures. Results: There were 291,182 admissions with HSCT from 2000 to 2008. Of these, 3.4% patients had invasive fungal infections. They were more frequent in allogenic transplant during the engraftment period (4.2%) and in those with graft versus host disease (GVHD) in subsequent admission (7.1%). The unadjusted in-hospital mortality was significantly higher in those with invasive fungal infection (28% vs. 7%, p<0.001). On adjusted analysis, the odds of mortality were highest for those with mucor (OR 4.3;95%CI 2.5-7.5) and aspergillus (OR 3.7; 95%CI 3.1-4.5) infections while the results did not reach significance for candidemia. The length of hospital stay was significantly longer in those with invasive fungal infections (median 19 days vs. 7 days, p<0.001). Conclusions: Fungal infections are common in HSCT recipients - especially in those with allografts and with GVHD. Mortality is high and is mostly associated with aspergillus and mucor. A higher index of suspicion for fungal infections in HSCT patients, strict isolation precautions and increased surveillance for aspergillus and mucor in HSCT patients may help decrease the length of hospital stay and mortality.


2016 ◽  
Vol 11 (4) ◽  
pp. 336-340 ◽  
Author(s):  
Zain Badar ◽  
Zerwa Farooq ◽  
Daniel Zaccarini ◽  
Sajeev R. Ezhapilli

Author(s):  
Vikas Devra ◽  
Varsha Varshney

Background: COVID 19 or severe acute respiratory syndrome (SARS-CoV-2) evolved as global pandemic since December 2019 when it was first reported in Wuhan, China. Coinfection in patients with COVID-19 has been reported in multiple studies, being bacterial in origin the most frequent; and fungal infection being reported only in severe cases. Methods: This study was conducted at the department of E.N.T. at PanditDeenDayalUpadhyay Medical College, Churu. Cases presented to E.N.T. OPD with clinical features of invasive rhino-orbital fungal infection for the period of two month from 1st June 2021 were included in the study. Patients were clinically evaluated, HRCT, MRI scans and with KOH mount and culture of involved tissue ere done. Patient’s COVID-19 status was ascertained. The clinicopathological association of occurrence of invasive fungal infections in post covid and non-covid patients along with other risk factors like diabetes mellitus, immune compromised state and long-term steroid use was done using statistical methods Results: We studied 21 patients who attended our OPD with features of invasive fungal infection. Most common presentation was swelling and pain in the cheek region and red eye and swelling around the eye, three patients presented with maxillary swelling with blackish discoloration of teeth. Radiological findings were suggestive of fungal etiology in all patients. KOH mount showed fungal hyphae in 20 cases. Total 20 cases were post COVID status. Old DM was there in 12 patients whereas 9 patients showed new onset hyperglycemia. Conclusions: COVID-19 is associated with a significant incidence of secondary infections, both bacterial and fungal probably due to immune dysregulation. The widespread use of steroids/monoclonal antibodies/broad-spectrum antibiotics as part of the management protocols against COVID-19 may lead to the exacerbation of preexisting fungal diseases or development of new infection. Treating Physicians should make themselves aware and prepare for the possibility of invasive secondary fungal infections in patients with COVID-19 infection especially in patients with preexisting risk factors and should enable early diagnosis and treatment with the subsequent reduction of mortality and morbidity. Keywords: Coronavirus, COVID-19, mucormycosis, invasive fungal infections


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Joshua Wolf ◽  
Joshua Wolf ◽  
Gabriela Maron ◽  
Kathryn Goggin ◽  
Kim J Allison ◽  
...  

Abstract Background Diagnosis of invasive fungal infections (IFIs), a life-threatening complication of cancer therapy or hematopoietic cell transplantation (HCT) can be challenging, and IFI has poor outcomes. Prediction or early non-invasive diagnosis of IFI in high-risk hosts before onset of symptoms could reduce morbidity and mortality. Because non-invasive plasma mcfDNA NGS can detect invasive fungal infections, and may predict bloodstream infections in immunocompromised patients, we hypothesized that mcfDNA NGS might also predict invasive fungal infection before clinical presentation. Methods In a prospective study, serial remnant plasma samples were collected from pediatric patients undergoing treatment for relapsed or refractory leukemia. IFI events were classified according to EORTC criteria by 2 independent experts, and episodes empirically treated for suspected IFI, but not meeting ‘possible’ criteria were classified as ‘suspected’. All samples collected within 30 days before clinical diagnosis of non-fungemic IFI were tested for fungal DNA by mcfDNA NGS using a research-use only assay by Karius, Inc. optimized for fungi; because of overlapping clinical syndromes, non-fungal DNA was not considered in this study. Results There were 15 episodes of suspected IFI in 14 participants with ≥1 sample available from either diagnostic (within 1 day of diagnosis) or predictive (2 to 30 days prior to diagnosis) periods (5 “suspected”, and 4 probable and 6 proven by EORTC definitions). Of 10 probable or proven IFIs, 6 (60%) had a relevant fungal pathogen identified mcfDNA NGS at diagnosis. In each of these cases the fungal DNA was also detectable prior to clinical onset of IFI (Range 2 to 41 days; Figure 1). In an additional case, manual review of sequence data identified the fungal DNA at diagnosis and during the prior month. Of 5 “suspected” IFI episodes, all were determined by expert review as not representing fungal infection; fungal DNA was identified by mcfDNA NGS in 2/54 (3.7%) of samples from these episodes. Table 1. Characteristics of Invasive Fungal Infections Conclusion mcfDNA NGS can identify fungal pathogen DNA before clinical onset of IFI, so might predict IFI in immunocompromised hosts, and may help differentiate fungal infection from other etiologies of lung nodules or infiltrates. Disclosures Joshua Wolf, MBBS, PhD, FRACP, Karius Inc. (Research Grant or Support) Joshua Wolf, MBBS, PhD, FRACP, Nothing to disclose Radha Duttagupta, PhD, Karius inc (Employee) Lily Blair, PhD, Karius Inc. (Employee) Asim A. Ahmed, MD, Karius, Inc. (Employee)


2021 ◽  
Vol 42 (03) ◽  
pp. 471-482
Author(s):  
Cassie C. Kennedy ◽  
Kelly M. Pennington ◽  
Elena Beam ◽  
Raymund R. Razonable

AbstractInvasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant invasive fungal infections, but cost, adverse effects, and absorption issues are barriers to effective prophylaxis. Trends in fungal infection diagnostic strategies utilize molecular diagnostic methodologies to complement traditional histopathology and culture techniques. While lung transplant recipients are susceptible to a variety of fungal pathogens, Candida spp. and Aspergillus spp. infections remain the most common. With emerging resistant organisms and multiple novel antifungal agents in the research pipeline, it is likely that treatment strategies will continue to evolve.


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