COVID-19-Associated Mucormycosis in a Tertiary Care Hospital in India: A Case Series

Abstract

Mucormycosis is a disease that usually occurs in immunocompromised patients or those with uncontrolled diabetes mellitus. The second wave of the coronavirus disease 2019 (COVID-19) pandemic in India was accompanied by an unexpected rise in mucormycosis cases, ranging from the most commonly occurring Rhino-orbital-cerebral mucormycosis (ROCM) to rare cases of pulmonary and gastrointestinal mucormycosis. The majority of cases that presented to our hospital were individuals with underlying diabetes mellitus who received steroids for COVID-19 before being diagnosed with mucormycosis.In this case series, we present five rhino-orbital-cerebral mucormycosis cases that were histopathologically positive and treated at a tertiary-care hospital in India. Magnetic resonance imaging (MRI) of all of the patients demonstrated orbital apex syndrome and diffuse or focal infiltration of the cavernous sinus. Cases were treated with anti-fungal drugs, transcutaneous retrobulbar injection of amphotericin B (TRAM B), along with appropriate surgical excision and debridement of the involved tissue.The essential elements for successfully managing this fatal infection are control of the predisposing factors, early detection, anti-fungal drugs, and surgical debridement of the involved tissues.

The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India

“…In 2020 during and post the first wave of COVID-19, cases of mucormycosis reported were quite exiguous; however, the second wave in 2021 led to a multifold rise in cases of mucormycosis [12]. The aftermath of the COVID-19 second wave in India inundated acute infections, post-infective pneumonia, and a plethora of opportunistic infections particularly in immunocompromised patients, having comorbidities such as diabetes mellitus type 2, patients having received high-dose (oral) or intravenous steroids, and even those on mechanical ventilation [13].…”

Imaging Features of Invasive Fungal Rhinosinusitis: A Systematic Review

“…[37][38][39][40] Other sites of involvement include the orbit (27%-92% of cases), intracranial (2%-60% of cases), the cavernous sinus (8%-100% of cases), the infratemporal fossa (21%-71% of cases), and the internal carotid artery in 6% to 60% of cases. 38,39,[41][42][43][44][45][46][47][48][49][50][51] The distinction between imaging modalities for identifying COVID-associated ROCM is poorly defined in the current literature.…”

Artificial Intelligence: A Next-Level Approach in Confronting the COVID-19 Pandemic

“…The study used five variables such as obesity, nasal discharge, myalgia, de novo diabetes, and anosima to show the possibility of mucormycosis infection [ 64 ]. Recent studies showed uncontrolled diabetes favored mucormycosis infection in post-COVID-19 patients [ 13 , 15 ]. Similarly, an AI-based modified deep learning algorithm strategy known as tha “hydrid learning-based neural network classifier” (HLNNC) was used to identify the CAM, with the help of popular techniques such as the convolutional neural network (CNN) and support vector machine (SVM).…”

“…Similarly, COVID-19 has brought about a variety of secondary infections and co-infections in patients. Many reports exhibited that secondary infections such as mucormycosis [ 13 , 14 , 15 ], blood coagulation [ 16 , 17 ], blood stream infections [ 18 , 19 ], urinary track infections (UTI) [ 20 , 21 , 22 ], and antibiotic resistance [ 23 , 24 , 25 , 26 ] were reported in COVID-19 patients during hospitalization or occurred post-infection. The coronavirus infection initially affects the lungs and disrupts the epithelial cell, leading to organ failure.…”