COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Dubey, Souvik; Mukherjee, Debaleena; Sarkar, Peyalee; Mukhopadhyay, Pradip; Barman, Debasis; Bandopadhyay, Manimoy; Pandit, Alak; Sengupta, Amitabha; Das, Sudip; Ghosh, Soumitra; Adhikari, Sudhir; Biswas, Partha Sundar; Pal, Pranabananda; Roy, Himadri; Patra, Nilanjana; Das, Amrita; Sinha, Pallab; Mondal, Karimulla; Shrivastava, Smiti Rani; Bhattacharya, Kumkum; Mukhopadhyay, Madhumita; Ahmed, Kamraan; Halder, Tushar Kanti; Saha, Mainak; Ahmed, Kaoshar; Maity, Souvik; Mandal, Arabinda; Chatterjee, Deblina; Saha, Srijana; Chunakar, Arpita; Saha, Alangkar; Ray, Biman Kanti

doi:10.1016/j.dsx.2021.102267

Cited by 42 publications

(59 citation statements)

References 44 publications

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“…This could possibly be due to complete external ophthalmoplegia or associated ptosis, which results in a poor perception of double vision. This was similar to that reported by Dubey S et al in their study on mucormycosis from Eastern India [24]. While unilateral complete ophthalmoplegia was observed in seven patients, one had bilateral ophthalmoplegia.…”

Section: Clinical Features and Complicationssupporting

confidence: 92%

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital

Kamath¹,

Kumar²,

Sarkar³

et al. 2022

Cureus

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Introduction and aimMucormycosis is a lethal opportunistic infection caused by filamentous fungi of the family Mucoraceae (black fungus). There has been a sudden increase in the incidence of these cases during the second wave of the COVID-19 pandemic due to the immunocompromised state caused by the disease and its treatment. Early diagnosis and appropriate medical management are essential to reduce disease morbidity and mortality. Through this study, we aim to study the clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis as well as evaluate the clinical outcomes in each case. Methods and materialsThis was a prospective study that included only confirmed mucormycosis cases admitted in Tata Main Hospital (TMH) from April 2021 to July 2021. A case of mucormycosis was defined as the one in which clinical and radiological features were consistent with mucormycosis and fungus was demonstrated in the tissue by potassium hydroxide (KOH) mount/culture/histopathological examination (HPE). Data relating to epidemiology, risk factors, clinico-radiological features, and outcomes were analyzed and expressed as a percentage of total cases. ResultsOf the total 15 cases, three patients (33.3%) had active COVID-19 infection, eight (53.3%) were in the post-COVID-19 state, two (13.4%) had COVID-19 like illness and two (13.4%) patients did not have COVID-19 in the recent past. There was male predominance with the male to female ratio being 2.75:1. The commonest associated co-morbid condition was diabetes mellitus (13 patients, 86.7%). Amongst the myriad manifestations, periorbital swelling was the commonest symptom (11 patients, 73.3%). Among neurological manifestations, involvement of cranial nerves was found in nine (60%) patients with the third cranial nerve being the most commonly affected nerve (eight patients, 53.3%). Cavernous sinus thrombosis (CST) was found in one (6.7%) patient. Diagnostic nasal endoscopy (DNE) revealed eschar at various sites in 13 patients (86.7%). Central retinal artery occlusion (CRAO) was found bilaterally in one patient (6.7%) while two patients (13.3%) had CRAO on the left. Radiologically, the most commonly involved sinuses were maxillary and ethmoidal (eight patients, 53.3%). Bilateral sinus involvement was more common (46.7%) than unilateral sinus involvement. The average length of stay (LOS) was 17.5±7.8 days. The overall mortality was 40%. Five (33.3%) patients developed secondary bacterial infections. All patients received medical therapy with intravenous amphotericin B. In addition, seven (46.7%) patients underwent functional endoscopic sinus surgery (FESS) with debridement of which, five (71.4%) patients survived and made a good recovery. One patient (6.7%) with pulmonary mucormycosis underwent lobectomy. ConclusionNew-onset headache, black nasal discharge, periorbital swelling, retro-orbital pain, visual diminution, restriction of eye movements should prompt an immediate search for mucormycosis especially in the background of his...

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Section: Clinical Features and Complicationssupporting

confidence: 92%

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital

Kamath¹,

Kumar²,

Sarkar³

et al. 2022

Cureus

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“…[ 27 ] India Prospective Single-center 70 Mar 2020–Dec 2020 [20–75] 67 (47) 100 (70) Patel A. [ 28 ] India Retrospective Multi-center 187 Sep 2020–Dec 2020 57 ± 13 80 (150) 60 (113) Dubey S. [ 29 ] India Retrospective Single-center 46 Apr 2021–Jun 2021 53 ± 10 64 (29) 100 (46) Bhanuprasad K. [ 30 ] India Prospective Single-center 132 Jun 2020–Jul 2021 51 ± 12 77 (101) 98 (129) Selarka L. [ 31 ] India Prospective Multi-center 47 Jan 2021–Mar 2021 55 ± 13 75 (35) 77 (36) Muthu V. [ 32 ] India Retrospective Single-center 31 – 53 [48–58] 76 (23) 75 (21) Pakdel F. [ 33 ] Iran Cross-sectional …”

Section: Resultsmentioning

confidence: 99%

“…[ 27 ] – – 7.1 (5) 2.9 (2) – – – – Patel A. [ 28 ] – – 1.6 (3) 1.1 (2) 56 (74) – 78 (146) 31 (58) Dubey S. [ 29 ] – – – – 72 (33) 0 (0) 52 (24) – Bhanuprasad K. [ 30 ] – 5.3 (7) 1.5 (2) – 14 (19) 2.3 (3) 55 (73) – Selarka L. [ 31 ] – – – – 81 (38) 43 (20) 100 (47) – Muthu V. [ 32 ] 32 (9) – – – 55 (16) 24 (7) 71 (20) – Pakdel F. [ 33 ] 47 (7) – – 13 (2) 60 (9) 6.7 (1) …”

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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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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“…Maximizing survival rates requires rapid diagnostic and therapeutic intervention, including immediate involvement of a multidisciplinary medical, surgical, radiological and laboratory‐based team. Multiple case reports 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 and retrospective cohort studies 7 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 of CAM from India and other countries have already been published. However, description of risk factors, surgical and medical treatment administered, outcomes and complications (especially long‐term complications) in patients with CAM has been scarcely reported.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India

Dravid

Kashiva

Khan

et al. 2022

Mycoses

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Background The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM). Methods This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM. Results 59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. Conclusions CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.

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COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Cited by 42 publications

References 44 publications

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital

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

Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India

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