A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center

COVID-19 and Rhino-Cerebral Mucormycosis: Correspondence

“…Risk of mucormycosis is an interesting new issue on COVID-19-related disorders. Some new reports show a similar finding to the present study [ 2 , 3 ]. Emerging mucormycosis problem exists in many endemic area, and problem already exists during pandemic.…”

Letter: Spectrum of hospitalized NeuroCOVID diagnoses from a tertiary care neurology centre in Eastern India

“…It has been described that this is a risk period where the neuroinflammation caused by SARS-Cov-2 remains active and precipitates the development of complications due to neuroimmunological alterations, which may facilitate the appearance of co-infections [7] , [8] , [9] . This correlates with the invasion of fungal agents belonging to the genera Mucor , Absidia and Rhizopus , reported in different parts of the world [10] , [11] , [12] , [13] , which produce mucormycosis; a condition that has a powerful destructive potential [10] . The most important thing to consider about this disease is that it can go unnoticed and present in advanced stages, compromising a large number of organs and structures [13] .…”

“…The most important thing to consider about this disease is that it can go unnoticed and present in advanced stages, compromising a large number of organs and structures [13] . Interestingly, however, there are cases reports and case series that show that this condition can develop even in those before 21 days (theoretically during the acute phase of COVID-19) [10] , [11] , [12] , [13] . But it should be clarified that there are still no precise cut-off scores for the time between the acute phase transition and post-COVID phase, which is a potential bias in the characterization of these patients [9] .…”

“…Taking into account the heterogeneity in the times of presentation of this condition, it is necessary to define whether rhino-orbito-cerebral mucormycosis is a manifestation of the acute phase of COVID-19, associated with the immune mechanisms involved in the neuroinflammation caused by the neurotropism of SARS-Cov-2, or typical of the post-COVID-19 neurological syndrome, where there is therapeutic remission and risk of complications. This discussion becomes relevant due to the new peaks of COVID-19 cases in the world in the last weeks (November-December 2021) [15] , and the factors associated with the presentation of rhino-orbito-cerebral mucormycosis [16] , [17] , such as the management of the acute phase of COVID-19 with corticosteroids and antibiotics, the high prevalence of diabetic patients or patients with endocrine disorders with off-target hyperglycemia [10] , [11] , [12] , [13] , [14] , [16] , [17] , where an increase in the incidence of this complication, which entails high health costs during management and rehabilitation, morbidity and mortality, is expected.…”

Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center

“…is angioinvasion is the hallmark feature of mucor, leading to thrombosis and subsequent tissue necrosis. [17,24] e worldwide incidence of mucormycosis varies from 0.005 to 1.7/million inhabitants, with India having the highest burden at nearly 80 times the prevalence (0.14/1000) of developed countries. [2,17] is fungal infection has emerged as an epidemic within the COVID-19 pandemic.…”