Maxillofacial Infections in Covid-19 Era—Actuality or the Unforeseen: 2 Case Reports

Krishna, D. Sai; Raj, Harsha; Kurup, Pranav; Juneja, Mehak

doi:10.1007/s12070-021-02618-5

Cited by 44 publications

(25 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 55 ] India Cross-sectional Single-center 96 Mar 2021–May 2021 49 [21–76] 73 (70) 72 (69) Sen M. [ 7 ] India Case series Single-center 5 Aug 2020–Dec 2020 58 100 (5) 100 (5) Saidha PK. [ 9 ] India Case series Single-center 6 – [29–68] 66 (4) 100 (5) Roushdy T. [ 56 ] Egypt Case series Single-center 2 Jan 2021–Apr 2021 [59–73] 100 (2) 100 (2) Sai Krishna D. [ 57 ] India Case series Single-center 2 – [34–50] 100 (2) 100 (2) Nehara HR. [ 58 ] India Case series Single-center 5 – [33–70] 20 (1) 100 (5) Singh Y.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…On analyzing the sources of the reported cases, India was the most contributing country (55.5%) [46][47][48][49][50]58,69,77,[80][81][82][84][85][86][87][88], followed by Egypt (17.8%) [72,74], Iran (9.9%) [63,64,70,78], Turkey (6.3%) [65,71], and the United States of America (4.7%) [52][53][54][55][56][57]59,75,76]. See Figure 4.…”

Section: Demographic Characteristicsmentioning

confidence: 99%

COVID-19-Associated Mucormycosis (CAM): Case-Series and Global Analysis of Mortality Risk Factors

Riad

Shabaan

Issa

et al. 2021

JoF

View full text Add to dashboard Cite

Background: Since the novel coronavirus disease (COVID-19) outbreak, the cases of COVID-19 co-infections have been increasingly reported worldwide. Mucormycosis, an opportunistic fungal infection caused by members of the Mucorales order, had been frequently isolated in severely and critically ill COVID-19 patients. Methods: Initially, the anamnestic, clinical, and paraclinical features of seven COVID-19-associated mucormycosis (CAM) cases from Egypt were thoroughly reported. Subsequently, an extensive review of the literature was carried out to describe the characteristics of CAM cases globally, aiming to explore the potential risk factors of mortality in CAM patients. Results: Out of the seven reported patients in the case series, five (71.4%) were males, six (85.7%) had diabetes mellitus, and three (42.9%) had cardiovascular disease. All patients exhibited various forms of facial deformities under the computed tomography scanning, and two of them tested positive for Mucorales using the polymerase chain reaction (PCR) testing. Liposomal amphotericin B (LAmB) was prescribed to all cases, and none of them died until the end of the follow-up. On reviewing the literature, 191 cases were reported worldwide, of which 74.4% were males, 83.2% were from low-middle income countries, and 51.4% were aged 55 years old or below. Diabetes mellitus (79.1%), chronic hypertension (30%), and renal disease/failure (13.6%) were the most common medical comorbidities, while steroids (64.5%) were the most frequently prescribed medication for COVID-19, followed by Remdesivir (18.2%), antibiotics (12.7%), and Tocilizumab (5.5%). Conclusions: As the majority of the included studies were observational studies, the obtained evidence needs to be interpreted carefully. Diabetes, steroids, and Remdesivir were not associated with increased mortality risk, thus confirming that steroids used to manage severe and critical COVID-19 patients should not be discontinued. Lung involvement, bilateral manifestation, and Rhizopus isolation were associated with increased mortality risk, thus confirming that proactive screening is imperative, especially for critically ill patients. Finally, surgical management and antimycotic medications, e.g., amphotericin B and posaconazole, were associated with decreased mortality risk, thus confirming their effectiveness.

show abstract

“…Throughout the last two years, COVID-19 has been consistently reported in conjunction with a wide array of confusing extrapulmonary symptoms and complications, including neurologic symptoms (e.g., dysgeusia, anosmia, agitation, Guillain-Barré syndrome, and other neuropathies) [29,30], vascular symptoms (e.g., multisystem inflammatory syndrome, arrhythmias, myocardial injuries, and cardiogenic shocks) [31,32], gastrointestinal symptoms (e.g., diarrhoea, nausea, and abdominal discomfort) [33,34], skin-related symptoms (e.g., chilblains, viral exanthema, erythematous rashes, urticaria, acral ischemia, erythema multiforme, and purpura) [35,36], and oral symptoms (e.g., oral ulcers, cheilitis, mucositis, candidiasis, and halitosis) [37][38][39][40]. The syndromic landscape of COVID-19 is overburdened by the medical comorbidities that increase the risk of mortality among the infected patients and the odds of acquiring coinfections and super-infections [41][42][43][44]. The COVID-19 patients, especially the severely affected ones, had been frequently reported to suffer from opportunistic fungal infections, e.g., aspergillosis, candidiasis, mucormycosis, coccidioidomycosis, histoplasmosis, and blastomycosis, which might be initially confusing for the intensivists due to their clinical similarity with the typical respiratory symptoms of COVID-19 [37,[43][44][45][46][47][48][49].…”

Section: Introductionmentioning

confidence: 99%

“…The syndromic landscape of COVID-19 is overburdened by the medical comorbidities that increase the risk of mortality among the infected patients and the odds of acquiring coinfections and super-infections [41][42][43][44]. The COVID-19 patients, especially the severely affected ones, had been frequently reported to suffer from opportunistic fungal infections, e.g., aspergillosis, candidiasis, mucormycosis, coccidioidomycosis, histoplasmosis, and blastomycosis, which might be initially confusing for the intensivists due to their clinical similarity with the typical respiratory symptoms of COVID-19 [37,[43][44][45][46][47][48][49]. Therefore, antibiotic stewardship, high alertness of the medical staff and laboratory testing are imperative in the critical care of COVID-19 patients [45,48].…”

Section: Introductionmentioning

confidence: 99%

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Hussain

Riad

Singh

et al. 2021

JoF

View full text Add to dashboard Cite

Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2–45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.

show abstract

Maxillofacial Infections in Covid-19 Era—Actuality or the Unforeseen: 2 Case Reports

Cited by 44 publications

References 4 publications

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

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

COVID-19-Associated Mucormycosis (CAM): Case-Series and Global Analysis of Mortality Risk Factors

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About