Are Low Serum Vitamin D Levels a Risk Factor for Advent of COVID-19 Associated Rhinocerebral Mucormycosis: A Preliminary Case Control Study

Abstract

To determine whether low serum vitamin D level is a risk factor for development of Rhinocerebral mucormycosis in COVID-19 afflicted patients. A case control study was conducted in a tertiary care hospital utilizing the archived records of COVID-19 afflicted Rhinocerebral mucormycosis cases and age and gender matched controls. The mean value (± standard deviation) of vitamin D level in patients with Mucormycosis was 19.65 ± 13.07 ng/ml and in control subjects it was 27.88 ± 18.04 ng/ml.There was a significant difference between groups ( p = 0.02). Thus, low Vitamin D level may be implicated as a risk factor for the advent of mucormycosis in a COVID-19 afflicted patient and therefore Vitamin D supplements may be provided to such patients to achieve normal serum levels.

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 48 ] Egypt Retrospective Single-center 26 Apr 2021–Aug 2021 63 [46–70] 54 (14) 96 (25) Meher R. [ 49 ] Iran Prospective Single-center 111 May 2021–Jun 2021 53 ± 12 70 (78) 94 (104) Guzman-Castro S. [ 50 ] UK Retrospective Single-center 6 May 2021 52 [45–57] 83 (5) 83 (5) Kumar H. [ 51 ] India Retrospective Single-center 28 Apr 2021–May 2021 54 [48–59] 79 (22) 75 (21) Yadav T. [ 52 ] India Retrospective Single-center 50 Dec 2020–Jun 2021 50 [28–70] 62 (31) 86 (43) Meshram HS. [ 53 ] India Retrospective Multi-center 61 Nov 2020–Jul 2021 45 [38–54] 89 (54) 49 (30) Popli H. [ 54 ] India Retrospective …”

“…[ 48 ] 27 (7) 12 (3) – – – – 77 (20) – Meher R. [ 49 ] – – – – 27 (30) 5.4 (6) 60 (67) 5.4 (6) Guzman-Castro S. [ 50 ] – – – – 50 (3) 33 (2) 100 (6) – Kumar H. [ 51 ] – – – – 57 (16) 21 (6) 68 (19) – Yadav T. [ 52 ] – – 2.0 (1) – 38 (19) – 44 (22) – Meshram HS. [ 53 ] – 100 (61) 100 (61) – 67 (41) 0 (0) 44 (27) – Popli H. [ 54 ] – – – – – – – …”

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

“…COVID-19 infection exhibits a similar feature of thrombotic microangiopathy (due to upregulation of the prothrombotic CX3CL1 marker), which may have a synergic effect with mucormycosis, responsible for the fulminant spread of infection. [3,10,13,14,16] In this series, the aggressive invasion of the ICA (Case-1) and anterior cerebral artery (Case-2) from paranasal sinuses has resulted in decreased blood flow (ischemic stroke) causing hemispheric and ACA territory infarct. Aspergillosis, another fungal infection, has also angioinvasive characteristics with similar imaging features and predisposing factors.…”

“…Mucormycosis is an invasive fungal infection caused by Zygomycete fungi of the family Mucoraceae. [16] In the present scenario, this invasive fungal infection, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. [1] Mucormycosis can occur by inhalation of spores, ingestion of infected food products, or invasion of damaged surfaces.…”

“…e association of mucormycosis with COVID-19 patients has been seen and etiopathogenesis proposed for its development includes DM, use of steroids, long-term hospital stay, immunological dysfunction caused by a virus, and extended use of antibiotics. [1,2,8,11,16,17,19,24] ROCM management must be a multidisciplinary effort involving an otorhinolaryngologist at the center, as well as an ophthalmologist, neurologist/neurosurgeon, anesthetists, plastic surgeons, and rehabilitation professionals. [8] As intracranial progression of mucor can occur rapidly and is linked to high mortality among patients, [26] this article aims to share the experience of ROCM management from a neurosurgical perspective and emphasize the role of neurosurgeons.…”