Cavernous Sinus Thrombosis in COVID-19 Associated Rhino-Orbital Mucormycosis: A Retrospective Audit in the First Wave of the Pandemic

Abstract

Purpose Cavernous sinus thrombosis (CST) is a complication of rhino-orbital-cerebral mucormycosis. The COVID-19 pandemic saw a rapid surge in the cases of acute fungal sinusitis, many of whom also had CST, further contributing to the ophthalmoplegia. This study was a retrospective audit of patients with mucormycosis treated during the first wave of the COVID-19 pandemic.Methods This study was conducted at a tertiary referral centre, and patients with rhino-orbital mucormycosis were included. Relevant laboratory investigations and CT scans of the paranasal sinuses and the cavernous sinus were analysed. Mortality at discharge was calculated.Results 61 cases of invasive mucormycosis were seen, of whom 20 were COVID-19 positive, and 21 had radiological evidence of CST. All patients in the study initially presented with clinical suspicion of mucormycosis, and COVID-19 was diagnosed during pre-admission investigations. 93% of patients had diabetes. A majority of patients received Amphotericin B and surgical debridement. The sphenoid sinus was involved in 32(52%) patients and the orbit in 34(56%). Factors affecting CST, such as platelet counts, were studied. Fifteen (25%) patients succumbed during their treatment.Conclusions 34.4% of patients with mucormycosis developed CST. Being COVID-19 positive led to an increase in mortality; however, there was no significant increase in death due to simultaneous COVID-19 and CST. Sinus involvement was not significant for the development of CST.

Black Fungus Mutilating COVID-19 Pandemic in India: Facts and Immunological Perspectives

“…Specifically, a marked reduction in the lymphocytes count, particularly helper T-cells and cytotoxic T-cells due to COVID-19 infection, seems to make the individual highly exposed to secondary bacterial and fungal co-infections (10,11). Although not common, co-infection with other respiratory viruses such as respiratory syncytial virus (RSV) and influenza virus infection were also reported in the recent past (12). In a contemporary study, it was found that around 7% of hospitalized COVID-19 patients and around 14% of the total ICU patients in India, were affected by bacterial co-infection (12).…”

“…Although not common, co-infection with other respiratory viruses such as respiratory syncytial virus (RSV) and influenza virus infection were also reported in the recent past (12). In a contemporary study, it was found that around 7% of hospitalized COVID-19 patients and around 14% of the total ICU patients in India, were affected by bacterial co-infection (12). The two most common types of COVID-19 associated bacterial co-infections are caused by Acinetobacter baumannii and two Staphylococcus aureus strains, presumably due to their acquired hypervirulence and antibiotic resistance.…”