(Translated) Tweet From Chief Minister of Rajasthan
#15,639
Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection generally seen in severely ill, or immunocompromised patients. Patients taking immune suppressant drugs - such as organ transplant recipients - are at a higher risk of infection.
Over the past week a number of media reports have come out of India citing `dozens' of COVID-linked mucormycosis infections - which they often describe as `Black Fungus' - across the country.
A few links include:
Delhi Hospital Reports COVID-19 Could Trigger Deadly Fungal Infection
FUNGAL INFECTION TRIGGERED BY COVID-19 SEEN IN CITIES ALL OVER INDIA: ALL YOU NEED TO KNOW
COVID-19: Deadly fungal infection causes scare in India
What is Mucormycosis, a black fungal disease, being linked with Covid-19?
While the Indian press has a history of histrionics when it comes to disease reporting, the Tweet From Chief Minister of Rajasthan at the top of this blog adds additional credibility to these reports.
Although this appears to be the largest report of invasive fungal infections linked to COVID-19, we've certainly seen evidence of this before. First stop, a report published last September in Cureus describing a patient in Mumbai, India with Rhino-Orbital Mucormycosis.
Cureus. 2020 Sep; 12(9): e10726.
Published online 2020 Sep 30. doi: 10.7759/cureus.10726
PMCID: PMC7599039 PMID: 33145132
Rhino-Orbital Mucormycosis Associated With COVID-19
Monitoring Editor: Alexander Muacevic and John R Adler
Salil Mehta1 and Abha Pandey2
Copyright © 2020, Mehta et al.
AbstractCoronavirus disease 2019 (COVID-19) infections may be associated with a wide range of bacterial and fungal co-infections. We report the case of a patient with COVID-19 infection, which, during the course of the treatment, developed rhino-orbital mucormycosis.
A 60- year-old male patient, a longstanding diabetic, with a positive reverse-transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was admitted for treatment. He received parenteral meropenem and oral oseltamivir with parenteral methylprednisolone.
Over the course of the admission, he developed signs of orbital cellulitis. Magnetic resonance imaging (MRI) of the brain, orbits, and paranasal sinuses, revealed soft tissue swelling in the right preseptal, malar, premaxillary and retrobulbar regions with paranasal sinusitis. A nasal biopsy revealed broad aseptate filamentous fungal hyphae suggestive of mucormycosis, which was confirmed on culture.
Extensive use of steroids/monoclonal antibodies/broad-spectrum antibiotics may lead to the development/exacerbation of a preexisting fungal disease. Physicians should be aware of the possibility of secondary invasive fungal infections in patients with COVID-19 infection.
Another report, published in November on a patient in Brazil reads:
Clin Endosc. 2020 Nov; 53(6): 746–749.
Published online 2020 Nov 19. doi: 10.5946/ce.2020.180
PMCID: PMC7719411
PMID: 33207116
Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report
Epifanio Silvino do Monte Junior, Marcos Eduardo Lera dos Santos, Igor Braga Ribeiro, Gustavo de Oliveira Luz, Elisa Ryoka Baba, Bruno Salomão Hirsch, Mateus Pereira Funari, and Eduardo Guimarães Hourneaux de Moura
Abstract
The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections.Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.
And finally, a post-mortem study of patients in the UK published last summer cited mucormycosis as a rare complication of COVID-19.
Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study
BrianHanleyMBB ChacProfKikkeri NNareshMDac CandiceRoufossePhDad ProfAndrew GNicholsonDMg JustinWeirFRCPatha ProfGraham SCookeFRCPe ProfMarkThurszMDf PinelopiManousouPhDb RichardCorbettPhDh ProfRobertGoldinMDa ProfSafaAl-SarrajFRC PathiAlirezaAbdolrasouliPhDe Olivia CSwannMRese LauryBaillonBSce RebeccaPennMSce ProfWendy SBarclayPhDe PatriziaViolaMDa MichaelOsbornFRCPathajk
Interpretation
Our series supports clinical data showing that the four dominant interrelated pathological processes in severe COVID-19 are diffuse alveolar damage, thrombosis, haemophagocytosis, and immune cell depletion.
Additionally, we report here several novel autopsy findings including pancreatitis, pericarditis, adrenal micro-infarction, secondary disseminated mucormycosis, and brain microglial activation, which require additional investigation to understand their role in COVID-19.
Given that steroids (which are immunosuppressant) are often given as a treatment for COVID-19 - and and the studies cited above - a rise in secondary fungal infections among COVID patients isn't totally unexpected.
As to what is accounting for the high numbers being reported from India, we'll have to wait for more information.
