Perturbations of immune landscape in COVID‐19 associated mucormycosis. Issue 3 (24th November 2022)

• Record Type: Journal Article
• Authors: Desai, Nidhi; Pradhan, Vandana; Chougule, Durga; Tiwari, Smrati; Mandke, Charuta; Yadav, Reetika Malik; Athvale, Amita; Kawle, Juhi; Pai, Vinayak; Pawaskar, Swapnal; Kharkar, Harshada; Bhosale, Snehal; Parab, Ankita; Ansari, Shazia; Kumar, Kinnera Harish; Mhashal, Shashikant; Redkar, Neelam; Madkaikar, Manisha
• Is Part Of: Mycoses. Volume 66:Issue 3(2023)
• Page Start: 226
• Page End: 236
• Publication Date: 2022-11-24
• Subjects: COVID‐19 associated mucormycosis -- immunophenotyping -- invasive fungal infections; Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/myc.13546
• Languages: English
• ISSNs: 0933-7407

Abstract

Abstract: Background: A rise in secondary fungal infections during the COVID‐19 pandemic necessitates a deeper understanding of the associated immunological perturbations. Objectives: To evaluate the clinical and immunological characteristics observed in patients with COVID‐19 associated mucormycosis (CAM) infection. Patients/ Methods: Cases of mucormycosis with or post‐COVID‐19 infection were compared with cases of acute COVID‐19 and convalescent COVID‐19. Lymphocyte subsets, cytokines and other laboratory markers were compared between the groups. Results: The frequency of proposed risk factors for CAM was diabetes mellitus (77%), recent history of steroid use (69%) and hypoxia during COVID‐19 infection (52%). Iron metabolism was dysregulated in CAM patients with low TIBC and total iron. Further, CAM was accompanied with lymphopenia with drastic reduction in B cell counts; however, plasmablasts were not altered. Further, CAM patients had low immunoglobulin levels and antibodies specific to mucor peptide did not increase in CAM suggesting dysfunction in B‐cell response. There was increase in activated effector cytotoxic CD8 T cells and NK cells in CAM compared with COVID‐19 infection and healthy controls. Among T helper cells, Tregs were reduced and Th‐1 frequency was increased in CAM compared with COVID‐19 infection. A distinct cytokine signature was evident in CAM with increase in IL‐1β, IFN‐γ, IL‐6, IL‐22, IL‐17A, IL‐10, IL‐2, IL‐8, IL‐7, IL‐21 and GM‐CSF. Conclusion: This is the first study on immunophenotyping in CAM suggesting the need for long‐term monitoring of B‐cell function after SARS‐CoV‐2 in patients with dysregulated glycaemic control and the possible benefit of therapeutic supplementation with intravenous immunoglobulins in CAM.