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      Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

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          Abstract

          Mucormycosis is an aggressive and potentially fatal fungal infection caused by fungi of the order Mucorales. There has been an increase in the number of cases of rhino-orbital mucormycosis in people with COVID-19, particularly in India. Rhino-orbital-cerebral mucormycosis is the most common manifestation of mucormycosis associated with COVID-19. We report the first case of rhino-orbital mucormycosis in a diabetic patient with SARS-CoV-2 infection in Malaysia. The diagnosis of mucormycosis was confirmed by histopathological examination, but the fungal culture and PCR results were negative. He was treated with antifungal therapy and had extensive debridement. Treatment of mucormycosis requires a multidisciplinary approach that includes addressing underlying risk factors, effective antifungal therapy, and surgical debridement.

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          Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India

          Awadhesh Kumar Singh, Ritu Singh, Shashank R. Joshi … (2021)
          Background and aims There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially in India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. We aim to conduct a systematic review of literature to find out the patient's characteristics having mucormycosis and COVID-19. Methods We searched the electronic database of PubMed and Google Scholar from inception until May 13, 2021 using keywords. We retrieved all the granular details of case reports/series of patients with mucormycosis, and COVID-19 reported world-wide. Subsequently we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with COVID-19. Results Overall, 101 cases of mucormycosis in people with COVID-19 have been reported, of which 82 cases were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9%), both in people who were active (59.4%) or recovered (40.6%) from COVID-19. Pre-existing diabetes mellitus (DM) was present in 80% of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9%. Corticosteroid intake for the treatment of COVID-19 was recorded in 76.3% of cases. Mucormycosis involving nose and sinuses (88.9%) was most common followed by rhino-orbital (56.7%). Mortality was noted in 30.7% of the cases. Conclusion An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.
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            Global Epidemiology of Mucormycosis

            Hariprasath Prakash, Arunaloke Chakrabarti (2019)
            Mucormycosis is an angio-invasive fungal infection, associated with high morbidity and mortality. A change in the epidemiology of mucormycosis has been observed in recent years with the rise in incidence, new causative agents and susceptible population. The rise has been perceived globally, but it is very high in the Asian continent. Though diabetes mellitus overshadow all other risk factors in Asia, post-tuberculosis and chronic renal failure have emerged as new risk groups. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis in patients with haematological malignancy and transplant recipients. In immunocompetent hosts, cutaneous mucormycosis is commonly seen following trauma. The intriguing clinical entity, isolated renal mucormycosis in immunocompetent patients is only reported from China and India. A new clinical entity, indolent mucormycosis in nasal sinuses, is recently recognized. The causative agents of mucormycosis vary across different geographic locations. Though Rhizopus arrhizus is the most common agent isolated worldwide, Apophysomyces variabilis is predominant in Asia and Lichtheimia species in Europe. The new causative agents, Rhizopus homothallicus, Mucor irregularis, and Thamnostylum lucknowense are reported from Asia. In conclusion, with the change in epidemiology of mucormycosis country-wise studies are warranted to estimate disease burden in different risk groups, analyse the clinical disease pattern and identify the new etiological agents.
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              Epidemiology and clinical manifestations of mucormycosis.

              George Petrikkos, Anna Skiada, Olivier Lortholary … (2012)
              Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations. The underlying conditions can influence clinical presentation and outcome. This review describes the emerging epidemiology and the clinical manifestations of mucormycosis.
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                Author and article information

                Journal
                Journal ID (hwp): sppsh
                Journal ID (publisher-id): PSH
                Title: Proceedings of Singapore Healthcare
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 2010-1058
                ISSN (Electronic): 2059-2329
                Publication date (Electronic): 12 January 2022
                Publication date Collection: Jan-Dec 2022
                Publication date PMC-release: 12 January 2022
                Volume: 31
                Electronic Location Identifier: 20101058221074112
                Affiliations
                [1 ]Medical Department, Ringgold 69908, universityHospital Selayang; , Batu Caves, Malaysia
                [2 ]Pathology Department, Ringgold 69908, universityHospital Selayang; , Batu Caves, Malaysia
                Author notes
                [*]Chee Yik Chang, Medical Department, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor 68100, Malaysia. Email: ccyik28@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-3104-8168
                https://orcid.org/0000-0002-7791-5212
                Article
                Publisher ID: 10.1177_20101058221074112
                DOI: 10.1177/20101058221074112
                PMC ID: 9189323
                SO-VID: 3c356870-50ce-4715-b1ad-3ae233ff5845
                Copyright © © The Author(s) 2022
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Subject: Short Communications
                Custom metadata
                typesetter ts10
                cover-date January-December 2022

                Keywords: coronavirus disease,covid-19,mucormycosis
                Data availability:
                Keywords: coronavirus disease, covid-19, mucormycosis

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