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      The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries

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          Abstract

          Reports of COVID-19-associated mucormycosis have been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes. Patients with diabetes and hyperglycaemia often have an inflammatory state that could be potentiated by the activation of antiviral immunity to SARS-CoV2, which might favour secondary infections. In this Review, we analysed 80 published and unpublished cases of COVID-19-associated mucormycosis. Uncontrolled diabetes, as well as systemic corticosteroid treatment, were present in most patients with COVID-19-associated mucormycosis, and rhino-orbital cerebral mucormycosis was the most frequent disease. Mortality was high at 49%, which was particularly due to patients with pulmonary or disseminated mucormycosis or cerebral involvement. Furthermore, a substantial proportion of patients who survived had life-changing morbidities (eg, loss of vision in 46% of survivors). Our Review indicates that COVID-19-associated mucormycosis is associated with high morbidity and mortality. Diagnosis of pulmonary mucormycosis is particularly challenging, and might be frequently missed in India.

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          Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

          Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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            Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

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              Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

              Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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                Author and article information

                Journal
                Lancet Microbe
                Lancet Microbe
                The Lancet. Microbe
                The Author(s). Published by Elsevier Ltd.
                2666-5247
                25 January 2022
                25 January 2022
                Affiliations
                [a ]Division of Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Medical University of Graz, Graz, Austria
                [b ]Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
                [c ]Clinical and Translational Fungal Working Group, University of California San Diego, La Jolla, CA, USA
                [d ]Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
                [e ]Department of Internal Medicine, ECMM Center of Excellence for Medical Mycology, University of Cologne, Cologne, Germany
                [f ]German Centre for Infection Research, Partner Site Bonn-Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
                [g ]Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
                [h ]Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
                [i ]PT Government Associate Laboratory, Guimarães, Portugal
                [j ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [k ]Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
                [l ]Environnement et Travail, Univ Rennes, CHU Rennes, Inserm, Institut de Recherche en Santé, Rennes, France
                [m ]Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University Karachi, Karachi, Pakistan
                [n ]Dermatology Service, Hospital General De México Dr Eduardo Liceaga, Mexico City, Mexico
                [o ]Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University named after II Mechnikov, St Petersburg, Russia
                [p ]Department of Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France
                [q ]Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
                [r ]Department of Laboratory Medicine and National Reference Centre for Mycosis, ECMM Center of Excellence for Medical Mycology, University Hospitals Leuven, Leuven, Belgium
                [s ]Department of Medical Microbiology and Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
                [t ]Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
                [u ]Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
                [v ]Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
                [w ]Public Health Wales Mycology Reference Laboratory, UHW, Cardiff, UK
                Author notes
                [* ]Correspondence to: Prof Martin Hoenigl, Division of Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Medical University of Graz, Graz 8036, Austria
                [*]

                Contributed equally

                [†]

                ECMM and ISHAM collaborators are listed at the end of the manuscript

                Article
                S2666-5247(21)00237-8
                10.1016/S2666-5247(21)00237-8
                8789240
                35098179
                0093a5a3-8909-4cbd-a7ce-27b7dbfa6297
                © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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