scholarly journals Breaking the mold: a brief review on the diagnostic and treatment approaches of mucormycosis

2021 ◽  
Author(s):  
Aroop Mohanty ◽  
Pratima Gupta ◽  
Saurabh Varshney ◽  
Ankita Kabi ◽  
Sumeet Angral
Keyword(s):  
Hematological Malignancies ◽  
Indian Subcontinent ◽  
Organ Transplant ◽  
Complete Removal ◽  
Integrated Approach ◽  
Underlying Disease ◽  
Solid Organ ◽  
Susceptible Population ◽  
Uncontrolled Diabetes ◽  
Causative Agents

<p class="abstract">Mucormycosis is a severe emerging angioinvasive fungal infection that occurs predominantly in immunocompromised individuals. The incidence of this disease seems to be increasing in recent years with the emergence of new causative agents and rise of the susceptible population. The present COVID-19 pandemic has seen an un-precented increase in the number of mucormycosis cases all over the world. It has emerged as one of the most common complication of COVID-19 leading to severe morality. Uncontrolled diabetes has been postulated to be the most common underlying disease in developing countries and hematological malignancies in case of the high-income countries. Besides diabetes, chronic renal failure and tuberculosis have also been predisposed in the Indian subcontinent. Rhino-cerebral form is mostly seen in diabetics whereas the pulmonary type is the most common presentation in patients with hematological malignancies and solid organ transplant. Diagnosis and treatment of this rapidly progressive disease is equally challenging. Microscopy and culture are the cornerstone for the diagnosis, but if assisted by imaging and molecular assays, it plays an important role in the correct and early identification of the causative agent. Successful management of mucormycosis is based on an integrated approach, including reversal or discontinuation of underlying risk factors, early administration of antifungal agents, and complete removal of infected tissue and use of various adjunctive therapies.</p>

Mucormycosis

2020 ◽  
Vol 41 (01) ◽  
pp. 099-114 ◽  
Author(s):  
Gail Reid ◽  
Joseph P. Lynch ◽  
Michael C. Fishbein ◽  
Nina M. Clark
Keyword(s):  
Hematological Malignancies ◽  
Organ Transplant ◽  
Developed Countries ◽  
Underlying Disease ◽  
Diagnostic Value ◽  
Therapeutic Trials ◽  
Contaminated Food ◽  
Common Clinical Presentation ◽  
Disseminated Disease ◽  
Immunocompromised Hosts

AbstractMucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

scholarly journals Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dionysios Neofytos ◽  
Carolina Garcia-Vidal ◽  
Frédéric Lamoth ◽  
Christoph Lichtenstern ◽  
Alessandro Perrella ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Survival Data ◽  
Rare Complication ◽  
Organ Transplant ◽  
Underlying Disease ◽  
Solid Organ Transplant ◽  
Diagnostic Tools ◽  
Solid Organ ◽  
Kidney Transplant Recipients ◽  
Diagnosis And Management

Abstract Background Invasive aspergillosis (IA) is a rare complication in solid organ transplant (SOT) recipients. Although IA has significant implications on graft and patient survival, data on diagnosis and management of this infection in SOT recipients are still limited. Methods Discussion of current practices and limitations in the diagnosis, prophylaxis, and treatment of IA and proposal of means of assessing treatment response in SOT recipients. Results Liver, lung, heart or kidney transplant recipients have common as well as different risk factors to the development of IA, thus each category needs a separate evaluation. Diagnosis of IA in SOT recipients requires a high degree of awareness, because established diagnostic tools may not provide the same sensitivity and specificity observed in the neutropenic population. IA treatment relies primarily on mold-active triazoles, but potential interactions with immunosuppressants and other concomitant therapies need special attention. Conclusions Criteria to assess response have not been sufficiently evaluated in the SOT population and CT lesion dynamics, and serologic markers may be influenced by the underlying disease and type and severity of immunosuppression. There is a need for well-orchestrated efforts to study IA diagnosis and management in SOT recipients and to develop comprehensive guidelines for this population.

scholarly journals Shift in Epidemiology of Cryptococcal Infections in Ottawa with High Mortality in Non-HIV Immunocompromised Patients

2019 ◽  
Vol 5 (4) ◽  
pp. 104 ◽  
Author(s):  
Vishesh Patel ◽  
Marc Desjardins ◽  
Juthaporn Cowan
Keyword(s):  
High Mortality ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Hiv Patients ◽  
Ottawa Hospital ◽  
Cryptococcal Infection

Cryptococcus neoformans is a fungus that can cause life-threatening infections. While human immunodeficiency virus (HIV)-positive status historically had the highest risk for cryptococcal infection and was associated with high mortality rates, there have been changes in HIV treatment and the epidemiology of other acquired immunodeficiencies, such as hematological malignancies. We conducted a retrospective case series analysis of patients who had cryptococcal infections documented at the Ottawa Hospital from 2005 to 2017. The Ottawa Hospital is a tertiary care hospital and provides complex care such as chemotherapy and transplantations. There were 28 confirmed cryptococcal infections. The most common underlying condition associated with cryptococcal infection was hematological malignancy (n = 8, 29%), followed by HIV (n = 5, 18%) and solid organ transplantation (n = 4, 14%). Furthermore, while there was a decrease in the number of cryptococcal infections in HIV patients after 2010 (four to one case), the number of cases in non-HIV immunocompromised patients increased from four in the years 2005–2010 to fourteen in 2011–2017. There were nine cryptococcal-attributable deaths. The case fatality rate was highest among patients with underlying hematological malignancies (63%), followed by solid organ transplant (50%) and HIV patients (20%). In conclusion, this study showed that there may be an epidemiological shift of cryptococcal infection in Ottawa. Additionally, infections may be associated with a worse prognosis in patients with a hematological malignancy and solid organ transplant than in patients with HIV infection in the modern era. Better prevention and/or treatment is warranted for high-risk populations.

scholarly journals Mucormycosis in a Renal Transplant Recipient: Case Report and Comprehensive Review of Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Tamim Hamdi ◽  
Vanji Karthikeyan ◽  
George J. Alangaden
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Uncontrolled Diabetes ◽  
Solid Organ Transplant Recipients ◽  
Disseminated Mucormycosis ◽  
Prompt Diagnosis

Mucormycosis is a rare but devastating infection. We present a case of fatal disseminated mucormycosis infection in a renal transplant patient. Uncontrolled diabetes mellitus and immunosuppression are the major predisposing factors to infection with Mucorales. Mucorales are angioinvasive and can infect any organ system. Lungs are the predominant site of infection in solid organ transplant recipients. Prompt diagnosis is challenging and influences outcome. Treatment involves a combination of surgical and medical therapies. Amphotericin B remains the cornerstone in the medical management of mucormycosis, although other agents have been used. Newer agents are promising.

scholarly journals A Review on Rhinocerebral Mycosis: Dual Infections

2017 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Early Diagnosis ◽  
Organ Transplant ◽  
Dual Infection ◽  
Diagnosis And Treatment ◽  
Rapid Disease Progression ◽  
Uncontrolled Diabetes ◽  
Causative Agents ◽  
Rising Incidence ◽  
Dual Infections ◽  
Compromised Patients

Rhinocerebral mycosis is an opportunistic infection seen in immune compromised patients, patients with uncontrolled diabetes, organ transplant and malignancies. Zygomycetes and Aspergillus are the commonest causative agents infecting para nasal sinuses and have predilection to invade blood vessels. The infection rapidly spreads to orbit and brain. An early diagnosis and treatment is essential to limit the spread to neighbouring structures. Although, cases of rhinocerebralmucormycosis with dual etiology are rare but their numbers are rising due to increase in the number of people living with diabetes, malignancies and other immunodeficiency disorders..This review emphasis the rising incidence of rhinocerebral mycosis with dual infection and also highlights the importance of early diagnosis and treatment in order to prevent the rapid disease progression.

scholarly journals Therapy and Management of Pneumocystis jirovecii Infection

2018 ◽  
Vol 4 (4) ◽  
pp. 127 ◽  
Author(s):  
P. White ◽  
Jessica Price ◽  
Matthijs Backx
Keyword(s):  
Organ Transplant ◽  
Gain Control ◽  
Pneumocystis Pneumonia ◽  
Solid Organ ◽  
Susceptible Population ◽  
Diagnostic Assays ◽  
Resistant Disease ◽  
Mycological Diagnosis ◽  
At Risk Populations ◽  
Hiv Negative

The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP.

scholarly journals Epidemiology of Mucormycosis in India

2021 ◽  
Vol 9 (3) ◽  
pp. 523
Author(s):  
Hariprasath Prakash ◽  
Arunaloke Chakrabarti
Keyword(s):  
Risk Factor ◽  
Organ Transplant ◽  
Disease Process ◽  
Population Based ◽  
Medical Attention ◽  
Solid Organ ◽  
Rhizopus Microsporus ◽  
Transplant Patients ◽  
Causative Agents ◽  
Rhizopus Homothallicus

Mucormycosis is an angioinvasive disease caused by saprophytic fungi of the order Mucorales. The exact incidence of mucormycosis in India is unknown due to the lack of population-based studies. The estimated prevalence of mucormycosis is around 70 times higher in India than that in global data. Diabetes mellitus is the most common risk factor, followed by haematological malignancy and solid-organ transplant. Patients with postpulmonary tuberculosis and chronic kidney disease are at additional risk of developing mucormycosis in this country. Trauma is a risk factor for cutaneous mucormycosis. Isolated renal mucormycosis in an immunocompetent host is a unique entity in India. Though Rhizopus arrhizus is the most common etiological agent of mucormycosis in this country, infections due to Rhizopus microsporus, Rhizopus homothallicus, and Apophysomyces variabilis are rising. Occasionally, Saksenaea erythrospora, Mucor irregularis, and Thamnostylum lucknowense are isolated. Though awareness of the disease has increased among treating physicians, disease-associated morbidity and mortality are still high, as patients seek medical attention late in the disease process and given the low affordability for therapy. In conclusion, the rise in the number of cases, the emergence of new risk factors and causative agents, and the challenges in managing the disease are important concerns with mucormycosis in India.

The gut microbiota resistome provides development of drug resistance in causative agents of human infectious diseases

2017 ◽  
pp. 20-32 ◽  
Author(s):  
Е.Н. Ильина ◽  
Е.И. Олехнович ◽  
А.В. Павленко
Keyword(s):  
Drug Resistance ◽  
Antibiotic Resistance ◽  
Resistance Genes ◽  
Integrated Approach ◽  
Modern Medicine ◽  
Pathogenic Microorganisms ◽  
Human Pathogens ◽  
Potential Source ◽  
Causative Agents ◽  
Bacterial Genes

С течением времени подходы к изучению резистентности к антибиотикам трансформировались от сосредоточения на выделенных в виде чистой культуры патогенных микроорганизмах к исследованию резистентности на уровне микробных сообществ, составляющих биотопы человека и окружающей среды. По мере того, как продвигается изучение устойчивости к антибиотикам, возникает необходимость использования комплексного подхода для улучшения информирования мирового сообщества о наблюдаемых тенденциях в этой области. Все более очевидным становится то, что, хотя не все гены резистентности могут географически и филогенетически распространяться, угроза, которую они представляют, действительно серьезная и требует комплексных междисциплинарных исследований. В настоящее время резистентность к антибиотикам среди патогенов человека стала основной угрозой в современной медицине, и существует значительный интерес к определению ниши, в которых бактерии могут получить гены антибиотикорезистентности, и механизмов их передачи. В данном обзоре мы рассматриваем проблемы, возникшие на фоне широкого использования человечеством антибактериальных препаратов, в свете формирования микрофлорой кишечника резервуара генов резистентности. Over the time, studies of antibiotic resistance have transformed from focusing on pathogenic microorganisms isolated as a pure culture to analysis of resistance at the level of microbial communities that constitute human and environmental biotopes. Advancing studies of antibiotic resistance require an integrated approach to enhance availability of information about observed tendencies in this field to the global community. It becomes increasingly obvious that, even though not all resistance genes can geographically and phylogenetically spread, the threat they pose is indeed serious and requires complex interdisciplinary research. Currently, the antibiotic resistance of human pathogens has become a challenge to modern medicine, which is now focusing on determining a potential source for bacterial genes of drug resistance and mechanisms for the gene transmission. In this review, we discussed problems generated by the widespread use of antibacterial drugs in the light of forming a reservoir of resistance genes by gut microflora.

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