Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic

Kulkarni, Rahul; Pujari, Shripad; Gupta, Dulari; Ojha, Pawn; Dhamne, Megha; Bolegave, Vyankatesh; Dhonde, Pramod; Soni, Anand; Adwani, Sikandar; Diwan, Anand; Duberkar, Dhananjay; Batra, Dhruv; Deshpande, Rushikesh; Aurangabadkar, Kaustubh; Palasdeokar, Nilesh

doi:10.1016/j.jstrokecerebrovasdis.2021.106231

Cited by 21 publications

(25 citation statements)

References 37 publications

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“…[ 37 ] India Prospective Single-center 80 May 2021–Aug 2021 – 69 (55) 90 (72) Ismaiel WF. [ 38 ] Egypt Retrospective Single-center 10 – – – – Avatef Fazeli M. [ 39 ] Iran Retrospective Single-center 9 Oct 2020–Nov 2020 59 33 (3) 78 (7) Goddanti N. [ 40 ] India Retrospective Single-center 300 Apr 2021–Jun 2021 49 ± 12 74 (222) 96 (287) Kulkarni R. [ 41 ] India Retrospective Multi-center 49 Dec 2020–Jun 2021 53 ± 11 71 (35) 82 (40) Dokania V. [ 42 ] India Prospective Single-center 21 Apr 2021–Jun 2021 50 ± 14 71 (15) 90 (19) Nair AG. [ 43 ] India Retrospective Multi-ce...…”

Section: Resultsmentioning

confidence: 99%

“…[ 37 ] 75 (60) 1.3 (1) – – – – – – Ismaiel WF. [ 38 ] – – – – – – – – Avatef Fazeli M. [ 39 ] 44 (4) 22 (2) 11 (1) – – 13 (1) 100 (7) 25 (2) Goddanti N. [ 40 ] – – – – 60 (180) – 79 (237) – Kulkarni R. [ 41 ] 37 (18) – – – – – – – Dokania V. [ 42 ] 0.5 (1) – – – – 4.8 (1) 90 (19) 19 (4) Nair AG. [ 43 ] – – – – 38 (5) – 54 (7) …”

Section: Resultsmentioning

confidence: 99%

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

Watanabe

Mitaka

et al. 2022

Mycopathologia

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The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12–21%, I 2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22–36%, I 2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Watanabe

Mitaka

et al. 2022

Mycopathologia

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“…These complications have also been reported with CAM. [ 1 2 4 5 11 ] Because the patient who has presented with facial pain, nasal discharge, proptosis, and vision loss can develop additional neurological complications any time during the course of illness, a high level of vigilance is needed to detect them early. Whether CAM has more neurological involvement compared to non-CAM cases has not been looked at in detail.…”

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confidence: 99%

“…Strokes were seen in >10% of CAM in our studies. [ 1 11 ] The clinical features of CAM may begin during the course of COVID-19 and can also appear up to 2 months after recovery from COVID-19. [ 1 ]…”

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COVID-19-Associated Mucormycosis

Kulkarni¹,

Pujari²

2022

Annals of Indian Academy of Neurology

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“…Mucormycosis is an angio-invasive disease and was another cause for AIS as well as hemorrhagic strokes during this period. [ 11 ] All acute stroke management protocols including recanalization measures need to be implemented, weighing the risks and benefits of these therapies with the health care givers using personal protection devices. [ 1 ] Patients have suffered AIS on anti-platelet agents and/or heparin and so, comparative trials need to be set up evaluate the role of anti-coagulation in COVID-19 related AIS.…”

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confidence: 99%