Document Type : Original Research
Authors
- Parisa Khorasani Esmaili 1
- Shahriar Dabiri 1
- Tooraj Reza Mirshekari 2
- Fatemeh Nabipour 3
- Ayeh Shamsadini 4
- Hadi Eslami 5
- Mohammad Ali Damghani 6
- Ali Asghar Arabi 6
- Maryam Amizadeh 6
- Fatemeh Fani 6
- Navid Gharaei 6
- Shiva Pouradeli 7
1 Department of Pathology , Pathology and Stem Cells Research Center, Afzalipour Medical School, Kerman Medical University, Kerman, Iran
2 Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
3 Department of Pathology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
4 Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
5 Department of Otolaryngology and Head and Neck Surgery, Kerman University of Medical Sciences, Kerman, Iran
6 Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
7 Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background & Objective: Mucormycosis (also called black fungus) is an opportunistic serious fungal infection caused by mucormycetes. It can occur in diabetes mellitus patients and other immunosuppressive conditions with recent predisposing factors such as maxillofacial surgery and corticosteroid usage.
Methods: In this study, 14 patients were referred to the otorhinolaryngology or ophthalmology ward of Shafa Hospital (Kerman, Iran) with primary symptoms of nasal fullness and Facial nerve dysfunction; they were admitted to the hospital to rule out the fungal infection. An endoscopic biopsy was taken from facial sinuses or orbit, and a microscopic evaluation was performed using hematoxylin and eosin (H&E) and periodic acid–Schiff (PAS) staining methods to rule out mucormycosis.
Results: In the histopathological examination, broad-based nonseptate branching fungal hyphae were found in nasal sinuses through the endoscopic biopsy. Most of the patients had diabetes mellitus with a primary symptom of facial nerve palsy; also, most of them received corticosteroids (intravenous [IV] or intramuscular [IM] injection). All patients have recently been infected with COVID-19 (less than 1 month ago).
Conclusion: COVID-19 infection could play a predisposing factor for many opportunistic infections, such as fungal elements); thus, the physician should be aware of the dose and day of corticosteroid therapy to prevent these infections.
Keywords
Main Subjects
- Raut A, Huy NT. Rising incidence of mucormycosis in patients with COVID-19: another challenge for India amidst the second wave?. Lancet Respir Med. 2021;9(8):e77. [DOI:10.1016/S2213-2600(21)00265-4] [PMID]
- Chauhan K, Soni D, Sarkar D, Karuna T, Sharma B, Singh S, et al. Mucormycosis after COVID-19 in a patient with diabetes. The Lancet. 2021 Aug 21;398(10301):e10. [DOI:10.1016/S0140-6736(21)01641-X] [PMID]
- Sterne JA, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, Annane D, Azevedo LC, Berwanger O, Cavalcanti AB, Dequin PF. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020 Oct 6;324(13):1330-41. [DOI:10.1001/jama.2020.17023] [PMID] [PMCID]
- Li H, Yan B, Gao R, Ren J, Yang J. Effectiveness of corticosteroids to treat severe COVID-19: A systematic review and meta-analysis of prospective studies. Int Immunopharmacol. 2021;100:108121. [DOI:10.1016/j.intimp.2021.108121] [PMID] [PMCID]
- RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693-704. [DOI:10.1056/NEJMoa2021436] [PMID] [PMCID]
- Crothers K, DeFaccio R, Tate J, Alba PR, Goetz MB, Jones B, et al. Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support. Eur Respir J. 2022;60(1). [DOI:10.1183/13993003.02532-2021] [PMID] [PMCID]
- Russell L, Uhre KR, Lindgaard AL, Degn JF, Wetterslev M, Sivapalan P, et al. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STEROID 2 randomized trial. JAMA. 2021;326(18):1807-17. [DOI:10.1001/jama.2021.18295] [PMID] [PMCID]
- Granholm A, Munch MW, Myatra SN, Vijayaraghavan BK, Cronhjort M, Wahlin RR, et al. Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial. Intensive Care Med. 2022;48:45-55. [DOI:10.1007/s00134-021-06573-1] [PMID] [PMCID]
- Toroghi N, Abbasian L, Nourian A, Davoudi-Monfared E, Khalili H, Hasannezhad M, et al. Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial. Pharmacol Rep. 2022:1-2. [DOI:10.1007/s43440-021-00341-0] [PMID] [PMCID]
- Maskin LP, Bonelli I, Olarte GL, Palizas Jr F, Velo AE, Lurbet MF, et al. High-versus low-dose dexamethasone for the treatment of COVID-19-related acute respiratory distress syndrome: a multicenter, randomized open-label clinical trial. J Intensive Care Med. 2022;37(4):491-9. [DOI:10.1177/08850666211066799] [PMID] [PMCID]
- Rahman FI, Islam MR, Bhuiyan MA. Mucormycosis or black fungus infection is a new scare in South Asian countries during the COVID‐19 pandemic: Associated risk factors and preventive measures. J Med Virol. 2021;93(12):6447. [DOI:10.1002/jmv.27207] [PMID] [PMCID]
- Bhatia M. The rise of mucormycosis in Covid-19 patients in India. Exp Rev Anti-Infect Ther. 2022;20(2):137-8. [DOI:10.1080/14787210.2021.1960822] [PMID]
- Kumar M, Sarma DK, Shubham S, Kumawat M, Verma V, Singh B, et al. Mucormycosis in COVID-19 pandemic: Risk factors and linkages. Curr Res Microb Sci. 2021;2:100057. [DOI:10.1016/j.crmicr.2021.100057] [PMID] [PMCID]
- Bahadori M, Dabiri S, Javadi A, Meymandi SS, Movahedinia S, Meymandi MS, et al. Pathogenesis of COVID-19; acute auto-inflammatory disease (endotheliopathica & leukocytoclastica COVIDicus). Arch Iran Med. 2021;24(5):419-26. [DOI:10.34172/aim.2021.60] [PMID]
- Bhat I, Beg MA, Athar F. A contemporary intimidation for COVID-19 patients coinfected with mucormycosis in India. J Bacteriol Mycol Open Access. 2021;9(2):69-71. [DOI:10.15406/jbmoa.2021.09.00298]
- Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2020;12(9). [DOI:10.7759/cureus.10726]
- Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol. 2021;69(6):1563. [DOI:10.4103/ijo.IJO_310_21] [PMID] [PMCID]
- Pakdel F, Ahmadikia K, Salehi M, Tabari A, Jafari R, Mehrparvar G, et al. Mucormycosis in patients with COVID‐19: a cross‐sectional descriptive multicentre study from Iran. Mycoses. 2021;64(10):1238-52. [DOI:10.1111/myc.13334] [PMID] [PMCID]
- Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15(4):102146. [DOI:10.1016/j.dsx.2021.05.019] [PMID] [PMCID]
- Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses. 2016;59(7):402-15. [DOI:10.1111/myc.12474] [PMID]
- Saldanha M, Reddy R, Vincent MJ. Title of the article: paranasal mucormycosis in COVID-19 patient. Indian J Otolaryngol Head Neck Surg. 2021:1-4. [DOI:10.1007/s12070-021-02574-0] [PMID] [PMCID]
- Bhandari J, Thada PK, Nagalli S. Rhinocerebral mucormycosis.
- Nashibi R, Afzalzadeh S, Mohammadi MJ, Yari AR, Yousefi F. Epidemiology and treatment outcome of mucormycosis in Khuzestan, Southwest of Iran. Arch Clin Infect Dis. 2017;12(1). [DOI:10.5812/archcid.37221]
- Srivastava S R, Ganguly P, Barman D, Das S, Bandyopadhyay M, Ghosh AK, et al. Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital. Inte J Ophthalmol, 2022;15(4):527.
- Keshri A, Mathialagan A, Aishwarya A, Bhuskute G, Kanaujia V, Singh AK, et al. Is mucormycosis the end? A comprehensive management of orbit in COVID associated rhino-orbital–cerebral mucormycosis: preserving the salvageable. European Archives of Oto-Rhino-Laryngology. 2023;280(2):819-27.
- Rani SU, Sivaranjani Y, Kumar MP, Rao GV. Rhinocerebral mucormycosis associated with actinomycosis in a diabetic patient: A rare presentation. Journal of oral and maxillofacial pathology: JOMFP. 2019;23(Suppl 1):122. [DOI:10.4103/jomfp.JOMFP_77_18] [PMID] [PMCID]
- Li MD, Ye JJ. Advance study of rhinocerebralmucormycosis. [Zhonghua yan ke za Zhi] Chin J Ophthalmol. 2019;55(8):629-33.
- Reddy SS, Rakesh N, Chauhan P, Sharma S. Rhinocerebral mucormycosis among diabetic patients: an emerging trend. Mycopathologia. 2015;180(5-6):389-96. [DOI:10.1007/s11046-015-9934-x] [PMID]
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