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Background: Tracheobronchial mucormycosis is a fatal opportunistic infection that mainly causes airway stenosis and is difficult to manage clinically., Case Presentation: We report a case of severe tracheal stenosis caused by tracheobronchial mucormycosis in a 37-year-old female with a history of hyperthyroidism. She developed agranulopenia after oral methimazole administration and subsequently experienced asthma with dyspnea. Bronchoscopy, sputum culture, colony mass spectrometry, and microscopic cotton orchid staining confirmed tracheobronchial mucormycosis. The patient received venous-venous extracorporeal membrane oxygenation (VV-ECMO) and prolonged intratracheal instillation of amphotericin B (AmBD), combined with amphotericin B liposome (L-AmB) and isavuconazole intravenous infusion, ultimately resulting in successful treatment., Conclusion: VV-ECMO combined with prolonged intratracheal instillation of AmBD is an effective method for the treatment of tracheobronchial mucormycosis., Competing Interests: Declarations Ethical approval and consent to participate This study received approval from the Ethics Committee of Drum Tower Hospital affiliated with the Medical School of Nanjing University (ethical code: 2022-261-01).Due to the retrospective nature of the study, the requirement for individual patient informed consent was waived. Consent for publication Written informed consent for publication was obtained from all participants. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM., Methods: We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor., Results: We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors., Conclusions: While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone., (Copyright © 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

This document is a research letter published in the journal Lung India. It describes a very rare case of anomalous systemic arterial supply to the lung without sequestration. The patient presented with abnormal vessels extending from the celiac trunk to the inferior vena cava, supplying the lung. This condition is a congenital abnormality that is usually associated with pulmonary sequestration, but in this case, the sequestration was absent. The document provides a brief overview of bronchopulmonary sequestration and discusses the rarity of systemic arterial supply to the lung without sequestration. [Extracted from the article]

Background: Mucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation. Case presentation: Here we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission. Conclusions: The diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment. [ABSTRACT FROM AUTHOR]

The article discusses a rare case of isolated tracheal mucormycosis in a patient with diabetes mellitus. The authors highlight the importance of bronchoscopic management in treating this condition, as nearly 30% of patients with isolated tracheobronchial mucormycosis may require therapeutic bronchoscopy. They describe a case in which a 49-year-old man with poorly controlled diabetes presented with airway obstruction due to mucormycosis and required airway stenting. The patient was successfully treated with a combination of bronchoscopic intervention and antifungal therapy. The article emphasizes the need for a high index of suspicion and appropriate management strategies for this uncommon condition. [Extracted from the article]

This document discusses a rare case of anomalous systemic arterial supply to the lung without sequestration. The case involves a 43-year-old male who was incidentally diagnosed with this congenital anomaly during a routine medical examination. The patient had a history of hemoptysis 10 years prior, which was managed conservatively. The article provides an overview of systemic arterial supply to the lung and emphasizes the rarity of this specific anomaly. [Extracted from the article]

We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02-0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03-16], itraconazole [0.03-16], posaconazole [0.03-8], and isavuconazole [0.03-16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus. [ABSTRACT FROM AUTHOR]

Mucormycosis is a potentially fatal fungal infection that can affect various parts of the body, including the sinuses. Isolated maxillary sinus involvement usually indicates an early diagnosis of Mucormycosis. The aim of the study was to present a case series on the clinical presentation and management outcomes in patients with isolated maxillary sinus involvement in Mucormycosis to emphasize on the early diagnosis and management of the condition. A retrospective study of 10 patients who presented to the RGGGH ENT department with isolated maxillary sinus involvement in Mucormycosis that was confirmed by diagnostic nasal endoscopy, CT scan and fungal KOH swab and who were managed by endoscopic sinus surgery. In our study, out of 10 cases, two patients had unilateral symptoms and eight patients had bilateral symptoms. Most common presentation was nasal obstruction, nasal discharge, and facial pain. Complete disease clearance was achieved in all cases by endoscopic sinus surgery with debridement. Diabetes was the most common underlying comorbidity, present in all 10 patients. All patients were treated with a combination of antifungal therapy and surgical debridement. All patients showed improvement on followup, with no recurrence or mortality reported during the follow-up period. Mucormycosis with isolated maxillary sinus involvement is a timely presentation of mucormycosis but potentially life-threatening due to the nature of the disease to spread rapidly. Prompt diagnosis and management are crucial for improving outcomes in these patients. A combination of antifungal therapy and surgical debridement appears to be an effective treatment approach in these patients. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of fungal pneumonia causing a mycotic subclavian aneurysm. The patient, a 52-year-old female farmer with asthma and recently diagnosed diabetes, presented with symptoms of cough, shortness of breath, and hemoptysis. Imaging revealed a subclavian artery aneurysm and lung abnormalities consistent with mucormycosis. Despite treatment with antifungals and planned surgical repair, the patient experienced a cardiac arrest and did not survive. The article highlights the challenges in diagnosing and managing pulmonary mucormycosis and emphasizes the importance of early empirical therapy and aggressive surgical intervention. [Extracted from the article]

We performed a case-control study across 25 hospitals in India for the period of January-June 2021 to evaluate the reasons for an COVID-19-associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004-1.007) and zinc supplementation (OR 2.76, 95% CI 2.24-3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002-1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31-17.40], diabetes mellitus [OR 6.72, 95% CI 5.45-8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03-9.60]), and rural residence (OR 2.88, 95% CI 2.12-3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM. [ABSTRACT FROM AUTHOR]

Introduction: COVID associated mucormycosis is a challenging problem with significant morbidity and mortality implications. COVID affliction, pre-existing medical conditions especially diabetes and steroid prescription are supposed contributors for development of this opportunistic fungal infection. Surgery remains the mainstay of treatment with adequate post-op anti-fungal therapy. Materials and methods: This is a retrospective analysis of prospectively maintained database of all surgical patients between March–May 2021 at a single centre. Prognosticators such as severity of COVID affliction, use of steroids, extent of rhino-orbital mucormycosis, extent of surgery and outcomes were studied. Descriptive statistics was used to analyse frequency of different variables and chi square test was used to analyse prognostic factors. P value < 0.05 were deemed significant. Results: 74 patients with an average 30 day follow-up were included. All patients had preceding COVID infection and 71.6% were diabetic and 25.7% were diagnosed during the course of their COVID treatment. Multiple sinus involvement being most common (52.61%), 10.81% underwent orbital exenteration and 24.32% palatectomies were performed. Revision surgeries were warranted in 16.21% patients. 9 patients succumbed to disease/ underlying medical and treatment related complications. Conclusion: We propose a risk assessment based on general condition of patient and severity of mucormycosis infection to decide appropriate strategy for surgical intervention. Early detection and timely and adequate surgery are essential pre-requisites to good outcomes. [ABSTRACT FROM AUTHOR]

During September-December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)-associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September-December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use. [ABSTRACT FROM AUTHOR]