key: cord-0701252-tp9f8blz
authors: Shanshal, M.
title: Lessons from India's COVID‐19 crisis: Meyerozyma guillermondii presenting in a mucormycosis‐like picture
date: 2022-04-22
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.18159
sha: b3672a979841ea5adb878a915a587bb59647dca5
doc_id: 701252
cord_uid: tp9f8blz

nan

smelling black necrotic plaque involving the mid-face and extending to involve the nasal and oral mucosae. No other areas were affected by the rash (Fig. 1) .

The initial clinical impression was mucormycosis. This was based on the clinical picture of the rash, the patient's age, background of chronic kidney disease and COVID-19 status. Because of this, a tissue swab was obtained due to high clinical suspicion, and intravenous amphotericin was initiated after liaising with the microbiology team. An urgent referral was then arranged to oral and maxillofacial surgeons for consideration of surgical debridement. Computed tomography (CT) of the head was ordered, and it revealed no acute intracranial pathology with normal sinuses.

Meyerozyma (Candida) guillermondii was subsequently isolated from the tissue obtained by debridement using a nuclear ribosomal repeat region sequencing PCR test.

After 1 week of intravenous amphotericin and surgical debridement, the rash significantly improved with only minimal residual erythema. The medical team performed a confusion screen, which revealed a negative blood culture and a heavy mixed growth urinary tract infection. Following a course of intravenous antibiotics, the patient was discharged after a dramatic improvement in consciousness.

The devastating pandemic of COVID-19 was started by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. It has been reported to infect over 300 million people and killed over 5 million as of January 2022. Fungal infections can exacerbate the clinical course of COVID-19 and are linked to a higher mortality rate, particularly in vulnerable patients who require intensive care. 1 COVID-19-related immunosuppression, hypoxia, invasive mechanical ventilation, hyperglycaemia and prolonged hospitalisation may all contribute to the higher incidence of fungal co-infections. 2 Pulmonary aspergillosis, invasive candidiasis, fungal pneumonia and mucormycosis are among the most commonly reported fungal infections in COVID-19 patients. 3 The clinical presentation of our case, COVID-19 status, background of chronic kidney disease and very high ferritin levels on admission supported the clinical diagnosis of mucormycosis. This therefore indicated the initiation of intravenous antifungal therapy while awaiting laboratory results. This lesson was learned from the COVID-19 disaster in India, where multiple cases of COVID-19-related mucormycosis had been reported with a 30% mortality rate. 4 The pan-fungal PCR assay identified Meyerozyma guillermondii (previously known as Candida guilliermondii) on the debridement tissue specimen by nuclear ribosomal repeat region sequencing. Meyerozyma guillermondii is a rare fungal isolate from environmental sources. It can cause opportunistic fungal infections in immunosuppressed hosts, including onychomycosis, superficial cutaneous infections, osteomyelitis and invasive infections. 5 Candida guilliermondii exhibits decreased susceptibility to azole antifungals, which are the most common agents for the treatment of Candida infections. 6 The microorganism has a variable susceptibility to amphotericin B, which explains the dramatic clinical response of our case after 1 week of antifungal treatment. 7 Invasive and oropharyngeal candidiases caused by other species like Candida albicans, tropicalis, parapsilosis, glabrata, dubliniensis and krusei were also reported in COVID-19 patients. 8, 9 The report emphasises the significance of COVID-19 fungal co-infections, which necessitates a high index of clinical suspicion for early detection and treatment. This is needed in combination with the prudent use of corticosteroids in COVID-19 patients to minimise the catastrophic complications and fatalities imposed by these co-infections.

The authors declare no conflicts of interest.

None.

Invasive fungal infections complicating COVID-19: a narrative review

Root causes of fungal coinfections in COVID-19 infected patients

Pulmonary aspergillosis and mucormycosis in a patient with COVID-19

Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India

Candidemia due to Candida guilliermondii in an immuno-compromised infant: a case report and review of literature

Amphotericin B: spectrum and resistance

Candida guilliermondii, an opportunistic fungal pathogen with decreased susceptibility to fluconazole: geographic and temporal trends from the ARTEMIS DISK antifungal surveillance program

Fungal co-infection in COVID-19 patients: should we be concerned?

Oropharyngeal candidiasis in hospitalised COVID-19 patients from Iran: species identification and antifungal susceptibility pattern

The patients provided written informed consent for publication of their case details, including the use of images.

Non applicable.

Foundation Trust, Essex, UK *Correspondence: M. Shanshal. E-mail: mohammed.shanshal@nhs.net