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ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries.

Publication ,  Journal Article
Rudramurthy, SM; Hoenigl, M; Meis, JF; Cornely, OA; Muthu, V; Gangneux, JP; Perfect, J; Chakrabarti, A; ECMM and ISHAM,
Published in: Mycoses
September 2021

Reports are increasing on the emergence of COVID-19-associated mucormycosis (CAM) globally, driven particularly by low- and middle-income countries. The recent unprecedented surge of CAM in India has drawn worldwide attention. More than 28,252 mucormycosis cases are counted and India is the first country where mucormycosis has been declared a notifiable disease. However, misconception of management, diagnosing and treating this infection continue to occur. Thus, European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) felt the need to address clinical management of CAM in low- and middle-income countries. This article provides a comprehensive document to help clinicians in managing this infection. Uncontrolled diabetes mellitus and inappropriate (high dose or not indicated) corticosteroid use are the major predisposing factors for this surge. High counts of Mucorales spores in both the indoor and outdoor environments, and the immunosuppressive impact of COVID-19 patients as well as immunotherapy are possible additional factors. Furthermore, a hyperglycaemic state leads to an increased expression of glucose regulated protein (GRP- 78) in endothelial cells that may help the entry of Mucorales into tissues. Rhino-orbital mucormycosis is the most common presentation followed by pulmonary mucormycosis. Recommendations are focused on the early suspicion of the disease and confirmation of diagnosis. Regarding management, glycaemic control, elimination of corticosteroid therapy, extensive surgical debridement and antifungal therapy are the standards for proper care. Due to limited availability of amphotericin B formulations during the present epidemic, alternative antifungal therapies are also discussed.

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Published In

Mycoses

DOI

EISSN

1439-0507

Publication Date

September 2021

Volume

64

Issue

9

Start / End Page

1028 / 1037

Location

Germany

Related Subject Headings

  • SARS-CoV-2
  • Practice Guidelines as Topic
  • Mucormycosis
  • Middle Aged
  • Microbiology
  • Male
  • Intensive Care Units
  • Humans
  • Female
  • COVID-19
 

Citation

APA
Chicago
ICMJE
MLA
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Rudramurthy, S. M., Hoenigl, M., Meis, J. F., Cornely, O. A., Muthu, V., Gangneux, J. P., … ECMM and ISHAM, . (2021). ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses, 64(9), 1028–1037. https://doi.org/10.1111/myc.13335
Rudramurthy, Shivaprakash M., Martin Hoenigl, Jacques F. Meis, Oliver A. Cornely, Valliappan Muthu, Jean Pierre Gangneux, John Perfect, Arunaloke Chakrabarti, and Arunaloke ECMM and ISHAM. “ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries.Mycoses 64, no. 9 (September 2021): 1028–37. https://doi.org/10.1111/myc.13335.
Rudramurthy SM, Hoenigl M, Meis JF, Cornely OA, Muthu V, Gangneux JP, et al. ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses. 2021 Sep;64(9):1028–37.
Rudramurthy, Shivaprakash M., et al. “ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries.Mycoses, vol. 64, no. 9, Sept. 2021, pp. 1028–37. Pubmed, doi:10.1111/myc.13335.
Rudramurthy SM, Hoenigl M, Meis JF, Cornely OA, Muthu V, Gangneux JP, Perfect J, Chakrabarti A, ECMM and ISHAM. ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses. 2021 Sep;64(9):1028–1037.
Journal cover image

Published In

Mycoses

DOI

EISSN

1439-0507

Publication Date

September 2021

Volume

64

Issue

9

Start / End Page

1028 / 1037

Location

Germany

Related Subject Headings

  • SARS-CoV-2
  • Practice Guidelines as Topic
  • Mucormycosis
  • Middle Aged
  • Microbiology
  • Male
  • Intensive Care Units
  • Humans
  • Female
  • COVID-19