Case Report: Metagenomics Next-Generation Sequencing for Diagnosing Cerebral Infarction and Infection Caused by Hematogenous Disseminated Mucormycosis in a Patient With Acute Lymphoblastic Leukemia

Disseminated mucormycosis, a serious complication, is associated with high mortality in patients with acute leukemia after chemotherapy. Blood cultures are always negative because of recurrent empirical antifungal treatments. The identification of pathogens is important for diagnosis and therapy. In this case report, we diagnosed culture-negative disseminated mucormycosis with Rhizomucor miehei infection leading to cerebral infarction in a patient with leukemia using metagenomics next-generation sequencing (mNGS) form peripheral blood, cerebral spinal fluid, and bronchoalveolar lavage fluid. mNGS technology can be applied to precisely diagnose culture-negative disseminated mucormycosis.

Mucormycosis: A challenge with COVID-19

Mucormycosis is an aggressive opportunistic fungal infection caused by fungi of the Phycomycetes class including Rhizopus species and Mucor species. The pathogen can be present in the environment, on the skin, and in the orifices of the body. There are several types including Rhinocerebral, Pulmonary, Gastrointestinal, Cutaneous, and Disseminated Mucormycosis.1 The spores infect the paranasal sinuses and nasopharynx, extending to the orbit and brain cavity in persons who have reduced cellular and humoral defenses. During the ongoing COVID-19 pandemic, a surge in the cases of rhino-orbital mucormycosis has become a life-threatening combination. Early diagnosis and intervention in the only way to save the vision and life of the affected patient.

Case Report: Metagenomics Next-Generation Sequencing Can Be Performed for the Diagnosis of Disseminated Mucormycosis

Mucormycosis is an infection caused by a group of filamentous molds with in the order Mucorales. In developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or subjects with normal post-traumatic immune function. Mucormycosis exhibits a marked propensity for invading blood vessels. The mortality rate of invasive mucormycosis is very high (>30–50%), and 90% of mortality is related to disseminated diseases. We report a 62-year-old man with underlying diseases, such as diabetes and psoriatic arthritis, with a history of trauma before admission. Chest CT showed multiple cavities. Based on the suspected clinical manifestation of mucormycosis infection, the patient received a microbiological culture of bronchoalveolar lavage fluid, and metagenomics next generation sequencing (mNGS) was performed. The results suggested Klebsiella pneumoniae infection. However, Rhizopus microsporus strains were shown by the mNGS of transpulmonary puncture tissue. Therefore, we report a case in which rare pathogens are identified by mNGS.

Mucormycosis (Black fungus): An alarming sign for COVID-19 patients

Mucormycosis (also known as zygomycosis) is a dangerous but uncommon fungal infection caused by a fungus known as mucormycetes. Mucormycosis can be caused by a variety of fungi. Mucormycetes are fungi that belong to the Mucorales scientific order. Molds can be found all over the place. Mucormycosis is a fungal infection that primarily affects persons who have health issues or who use medications that reduce the body's capacity to resist infections and illness. After inhaling fungal spores from the air, it most usually affects the sinuses or lungs. The majority of people are unaffected by these fungus. Breathing in mucormycete spores, on the other hand, can induce an infection in the lungs or sinuses, which can spread to other regions of the body in patients with compromised immune systems. It can also happen as a result of a cut, a burn, or another sort of skin injury. The fatality rate varied based on the patient's underlying condition, the type of fungus, and the affected body part (for example, the mortality rate was 46 percent among people with sinus infections, 76 percent for pulmonary infections, and 96 percent for disseminated mucormycosis). Antifungal medicines such as amphotericin-B, isavuconazole, posaconazole, and various combinations are used to inhibit the growth. Mucormycosis was studied for its spread, symptoms, treatment, prevention, and consequences.

Mucormycosis-a Fungal Infection in Patient Recovered from COVID-19

Recently, a fungal disease, “Mucormycosis,” has created a huge fury in everybody’s mind. It is prevalent in immunocompromised individuals, such as people suffering from Covid 19, cancer, HIV, prolonged use of steroids, immunomodulators, and diabetes. It is caused by a group of molds called mucoromycetes found in damp soil, bread, decaying fruits and vegetables, compost piles, animal waste, and moist, dusty construction sites. It can invade the human body through several routes, such as inhalation, injury site, or food/water intake. The ICMR recommends wearing a mask while visiting dusty construction sites, wearing shoes, long trousers, a full sleeve shirt, and gloves when handling soils, moss, or manure, and maintaining personal hygiene, including a good scrub bath. This article further covers the history, pathogenesis, role of Iron, GRP78, and CotH, pathophysiology, geographical spread, and treatment of this rare but fatal disease. Overall, the mortality rates account for 54%, which is further varied depending upon the patient condition, type of fungus & body site infected, speaking of which, as reported, 96% mortality rate alone accounts for the disseminated Mucormycosis.

Mucormycosis and its implication in COVID-19

Mucormycosis is a life-threatening fungal infection caused by a group of moulds known as mucormycetes. It is a viral disease, increasingly progressive, rapidly triggers in diabetic, immunocompromised and trauma patients. Diabetic patients seem to have the classic rhinocerebral variant. Rhinocerebral mucormycosis begins as a nasal cavity, paranasal sinus, and orbital soft tissue infection. In immunocompetent patients, direct injection also induces cutaneous form. Cutaneous mucormycosis occurs in soft tissue and may infect underlying tissues. Mucormycosis is more frequent in people with major underlying disorders such as diabetic acidosis or acute leukaemia and those taking corticosteroids or cytotoxic drugs. This disease occurs in patients by inhaling fungus spores. Mucormycosis occurs in clinical manifestations. Disseminated mucormycosis is a rare form of mucormycosis, affecting individuals with compromised immune systems. The disease travels to other areas of the body, thereby being prevalent. Brain, core, spleen, eyes, and other organs are among the organs that may be affected. Mucormycosis is a dangerous infection that requires antifungal drugs such as amphotericin B, posaconazole, or isavuconazole. This compilation addresses conceptual background on medicines used to treat mucormycosis, especially in India.