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Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 4...

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Autores principales: Almyroudi, Maria Panagiota, Akinosoglou, Karolina, Rello, Jordi, Blot, Stijn, Dimopoulos, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777018/
https://www.ncbi.nlm.nih.gov/pubmed/36553099
http://dx.doi.org/10.3390/diagnostics12123092
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author Almyroudi, Maria Panagiota
Akinosoglou, Karolina
Rello, Jordi
Blot, Stijn
Dimopoulos, George
author_facet Almyroudi, Maria Panagiota
Akinosoglou, Karolina
Rello, Jordi
Blot, Stijn
Dimopoulos, George
author_sort Almyroudi, Maria Panagiota
collection PubMed
description A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.
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spelling pubmed-97770182022-12-23 Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review Almyroudi, Maria Panagiota Akinosoglou, Karolina Rello, Jordi Blot, Stijn Dimopoulos, George Diagnostics (Basel) Review A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements. MDPI 2022-12-08 /pmc/articles/PMC9777018/ /pubmed/36553099 http://dx.doi.org/10.3390/diagnostics12123092 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Almyroudi, Maria Panagiota
Akinosoglou, Karolina
Rello, Jordi
Blot, Stijn
Dimopoulos, George
Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title_full Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title_fullStr Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title_full_unstemmed Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title_short Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review
title_sort clinical phenotypes of covid-19 associated mucormycosis (cam): a comprehensive review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777018/
https://www.ncbi.nlm.nih.gov/pubmed/36553099
http://dx.doi.org/10.3390/diagnostics12123092
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