COVID-19 & other Diseases

Besides infections such as oropharyngeal candidiasis, pneumonia, etc., doctors have also reported several cases of a serious fungal infection called mucormycosis in COVID-infected patients.

Here, we address some of the myths associated with so-called black fungus and its links with COVID-19. We also outline the facts about mucormycosis.

An overgrowth of skin fungus can lead to a fungal skin infection, such as athlete's foot, jock itch, or ringworm. The most common symptom is a red, itchy rash. Although not serious, these fungal infections can cause discomfort and irritation.

Mycopathologia - Case reports describe the unusual occurrence and complications of diseases, diagnostic challenges, and notable therapeutic successes."

Mucormycosis is an invasive fungal infection caused by filamentous fungi of the Mucoraceae family. The genera most commonly responsible are Mucor or Rhizopus. The disease occurs mostly in association with diabetic ketoacidosis. Mucormycosis has an extremely ...

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One of the least recognized causes of cellular damage during ex vivo preservation of red blood cells is oxidative injury to the hemoglobin. The latter has been associated with hemolysis through the release of toxic substances and oxidation of vital cell components.

Antioxidants and Redox Signaling

The inflammasome as a multiprotein complex has a role in activating ASC and caspase-1 resulting in activating IL-1β in various infections and diseases like corona virus infection in various tissues. It was shown that these tissues are affected by COVID-19 patients. According to the current evidence, melatonin is not veridical while possessing a high safety profile, however, it possesses indirect anti-viral actions owing to its anti-oxidation, anti-inflammation, and immune improving properties. This study aims to assess the impacts of melatonin as the complementary treatments on oxidative stress agents and inflammasome activation in patients with COVID-19. Melatonin supplement (9 mg daily, orally) was provided for the patients hospitalized with a COVID-19 analysis for 14 days. For measuring IL-10, IL-1β, and TNF-α cytokines and malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) level and the expression of CASP1 and ASC genes, blood samples were gathered from the individuals at the start and termination of the therapy. Our findings indicated that melatonin is used as a complementary treatment to reduce the levels of TNF-α and IL-1β cytokines, MDA, and NO levels in COVID-19 patients and significantly increase SOD level, however, the levels of IL-10 cytokine possesses no considerable changes. The findings revealed that genes of CASP1 and ASC were dysregulated by melatonin regulating the inflammasome complex. Based on the findings of the current study, it is found that melatonin can be effective as a medicinal supplement in decreasing the inflammasome multiprotein complex and oxidative stress along with beneficial impacts on lung cytokine storm of COVID-19 patients.

****!!!!****!!!** "Championing the diagnosis, prevention, and treatment of fungal infections for doctors, patients, and care givers"

While three have been reported in Bagalkot, one case has been found in Vijayapura.

"Black Fungi in the Human Respiratory Tract--Most melanized fungi that cause infections are free-living plant saprobes implanted into human tissue as a result of trauma, but respiratory mycoses occur secondary to inhalation of fungal spores. The moulds implicated in respiratory infections belong to the orders Chaetothyriales (Exophiala), Pleosporales (Alternaria, Bipolaris, Curvularia, and Exserohilum), Sordiales (Chaetomium), and Venturiales (Verruconis) of Ascomycota [30]. Among the Pleosporales, Alternaria alternata and species of Bipolaris, Curvularia, and Exserohilum are associated with AFRS, bronchial asthma, hypersensitivity pneumonitis, ABPM, and invasive lung disease"

Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent ...

2021 (Includes suggestions for COVID-preventive nasal and oral treatments and environmental disinfection with chlorine dioxide.}

the Union Health Ministry on Wednesday issued guidelines for the management of Mucormycosis or black fungus disease in children below 18 years.

'“I had a 43-year-old patient with no comorbidities and perfect dental hygiene who came with mucormycosis. When we checked his sugar levels, it was over the roof. The thing is, most COVID-19 patients are unaware about the spike in their blood sugar levels,” Dr Veerabahu adds. " "With some patients with severely affected lungs due to COVID-19 triggered cytokine storms, the Amphotericin B injection can have a serious impact" "it is important to maintain oral hygiene by brushing frequently, wearing fresh masks, etc."

" SARS-CoV-2 has been shown to affect the beta cells of the pancreas, resulting in metabolic derangement, possibly causing diabetes mellitus" "Tocilizumab use in COVID-19 has been reported as a risk factor for invasive candidiasis" "inappropriate glucocorticoid use was independently associated with late CAM. Among 187 CAM cases, 61 (32.6%) had COVID-19 as the only underlying disease; 13 of those cases were not treated with glucocorticoid or other immunomodulatory therapies. Whether COVID-19 itself causes immune dysregulation and predisposes patients to invasive mucormycosis remains an unproven possibility" " We found no difference in the risk factors, site of involvement, and outcome of mucormycosis complicating COVID-19 cases compared with non–COVID-19 cases."

Dr Randeep Guleria, Director, AIIMS, on Monday said there is no definite link between oxygen therapy and catching the Mucormycosis (black fungus) infection as in 90 to 95% of the patients are found to be diabetics and/or taking steroids

On Tuesday afternoon, the Civil Hospital had 220 active patients of mucormycosis. The cases have got halved from its peak of about 450 active cases in

AIIMS Director Dr Randeep Guleria shares his thoughts on how to combat black fungus, its symptoms, treatment and much more.

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"Mucor spp. can grow over a wide range of temperatures, aerobically use many carbon sources [including lactic acid but not citric acid??], ferment carbohydrates and use ammonia"

**** 1992 "Rhizopus species vary markedly in their sensitivity to chemicals: for example DCNA (dichloran, Botran ) controls R. stolonifer but is not effective against R. circinans and R. arrhizus ." "Solutions containing chlorine dioxide and ozone have been less effective than chlorinated water. With both of these chemicals, concentrations over 2 fil^l are difficult to establish and maintain. Furthermore, the release of chlorine and ozone, both highly toxic to humans, makes the use of these materials in enclosed packing sheds questionable. Currently, chlorine dioxide in foam for sterilisation of packing house equipment shows promise." "In the preparation ofchlorine water, the pH of the solution determines the concen-tration of the hypochlorous acid (active ingredient) with aneutral or slightly basic solution preferred. Acidic chlorinesolutions have a tendency to release chlorine gas, and basicsolutions are less effective as the concentration of hypochlor-ous acid is reduced."

As the COVID-19 pandemic has developed, concern for invasive fungal infections in critically ill COVID-19 patients with acute respiratory distress syn… "bronchoalveolar lavage or serum is supported by expert groups in Europe pending further research [8]. Experience with empirical or directed use of antifungal agents in the setting of COVID-19 is required, particularly in regards to efficacy, duration of treatment and possible adverse drug reactions in the setting of hepatotoxicity (a not uncommon feature of severe COVID-19), renal compromise, renal dialysis, arrhythmias, and electrolyte imbalance. Drug interactions with concurrent critical care agents or new or proposed COVID-19 specific therapies may influence the choice of an antifungal agent."

{Includes causative organisms and prevalence}

"increasingly reported as complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to Candida. This suggests that relevant clinical factors, including prolonged ICU stays, use of central venous catheters and often broad-spectrum antibiotics may dominate over immune-mediated mechanisms... Echinocandins and azoles are the primary antifungal used to treat invasive candidiasis, yet therapeutic failures exerted by prominent nosocomial pathogens such as C. auris and C. glabrata calls for the development of new antifungal drugs with novel mechanisms of action." "non-albicans Candida (NAC) species, with intrinsic resistance to antifungals and/or with a propensity to rapidly acquire antifungal resistance [12]. More troubling is the recent emergence of multidrug-resistant (MDR) Candida species, including C. glabrata and C. auris [13][14][15][16], the increasing trend of fluconazole-resistant C. parapsilosis and C. tropicalis [13][17], and inherently resistant C. krusei, which notoriously affect the efficacy of antifungal treatment."

Lv et al. associate the gut mycobiota with clinical features and the bacterial microbiota by comparing COVID-19 patients to those infected with H1N1 and healthy controls. They find that gut mycobiota dysbiosis occurs in both COVID-19 patients and those infected with H1N1 and that it does not improve until patients no longer require medical attention, providing insights into a better healthcare guideline.