Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis

Ashraf, Davin C.; Idowu, Oluwatobi O; Hirabayashi, Kristin E.; Kalin-Hajdu, Evan; Grob, Seanna; Winn, Bryan J.; Vagefi, M. Reza; Kersten, Robert C.

doi:10.1016/j.ajo.2021.05.025

Cited by 45 publications

(58 citation statements)

References 42 publications

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“…All-cause mortality from mucormycosis alone ranges from 40% to 80% depending on underlying conditions. 6 The mortality rate from CAM in this study was 53% at 21 days. At the 30-day time point, more than 50% of patients had either stable or progressive disease and only 7 had regressed disease.…”

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confidence: 51%

Rhino-Orbital-Cerebral Mucormycosis—Another Deadly Complication of COVID-19 Infection

2022

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SARS-CoV-2, which causes the clinical disease COVID-19, has now affected more than 200 million patients worldwide with close to 5 million deaths. 1 Ophthalmic manifestations of COVID-19 are wide-ranging and present in up to 10% of patients, most commonly as conjunctivitis. 2 The enormous number and high acuity of infected patients have placed significant burdens on health care systems worldwide. The resulting deferral of medical care for other life-threatening conditions such as cancer and heart disease may lead to additional morbidity and mortality.In this issue of JAMA Ophthalmology, Choksi et al 3 join other authors in focusing our attention on another potentially lethal complication of SARS-CoV-2 infection, rhinoorbital-cerebral mucormycosis (ROCM) associated with COVID-19, that is, COVID-19-associated mucormycosis (CAM). Prior to the pandemic, mucormycosis was considered a rare disease, with an incidence of 0.005 to 1.7/million. 4 Fewer than 10 cases are encountered annually at Mayo Clinic Rochester (N. Wengenack, PhD, oral communication, October 15, 2021). The current series, by contrast, includes 73 cases of CAM treated over a 3-month period. The authors' experience confirms the massive increase in ROCM cases in India associated with COVID-19, with more than 15 000 cases as of May 2021. 5 Hematological malignancy, diabetes, pharmacological immunosuppression, high-dose steroid therapy, and HIV infection are well-established risk factors for ROCM. 4 In this study, the main risk factors for CAM were diabetes and steroid use. Three-quarters of patients had diabetes, with more than half with disease characterized as uncontrolled. More than 80% received steroids, either intravenous (IV) or oral, to offset the massive cytokine response driving COVID-19-related pneumonitis and acute respiratory distress syndrome. Supplemental oxygen or ventilatory support was required in 82% of patients. Vaccine information was available for 47 patients, of whom 89% were unvaccinated and none were fully vaccinated.Care for patients with ROCM often involves a multidisciplinary and resource-intensive approach combining surgical debridement by otolaryngologists, neurosurgeons, and orbital surgeons, as well as treatment by specialists in infectious disease, endocrinology, nephrology, laboratory medicine, pharmacology, and pathology. Medical management includes glucose control and administration of IV liposomal amphotericin B, possibly combined with azole-class agents. The daily cost of the latter antifungal medications alone may approach $1000, not including hospital admission costs. Such costs, as well as limited availability of drugs due to pandemicrelated supply chain disruptions, may complicate the delivery of care. The authors and other caregivers in India have

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confidence: 51%

Rhino-Orbital-Cerebral Mucormycosis—Another Deadly Complication of COVID-19 Infection

2022

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“…Rhino-orbital-cerebral mucormycosis is the most common disease form affecting up to 55% of the diabetic patients with COVID-19. 2 There has been a marked increase in Mucormycosis in diabetic patients who develop COVID-19. 5,6 Werthman-Ehrenreich A 4 reported a case of a 33year-old COVID-19 positive female with altered mental status and proptosis who had developed orbital Mucormycosis.…”

Section: Discussionmentioning

confidence: 99%

“…Published data shows that Diabetes mellitus, lung diseases, old age and critically ill patients requiring ventilator support are more prone to fungal and bacterial coinfections. 1,2 Aspergillosis is widely suspected among fungal infections in COVID-19 patients. However, COVID -19 associated Mucormycosis (CAM) are often under diagnosed and need to be understood with respect to the clinical features, outcomes, and risk factors for the early diagnosis of this lethal condition.…”

Section: Introductionmentioning

confidence: 99%

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Acute Rhino-orbital-cerebral Mucormycosis in a Patient with COVID – 19

et al. 2021

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COVID-19 patients are known to have immunosuppression due to decreased lymphocytes and increased susceptibility to co-infections (Bacterial and fungal). We present a case of 61-year-old patient who had diabetes, hypertension and ischemic heart disease with COVID-19 infection admitted after RT-PCR positive result. He developed rhino-orbital Mucormycosis during treatment. He received Remdesivir with parenteral Methylprednisolone and Meropenem. While admitted in the ward, he developed signs of orbital cellulitis. Magnetic resonance imaging (MRI) of the brain, orbits, and paranasal sinuses revealed right frontal, ethmoidal, and maxillary sinusitis with the extension of the sinisuidal disease to the orbit. A nasal biopsy revealed broad aseptate filamentous fungal hyphae suggestive of Mucormycosis. Long-term use of steroids/monoclonal antibodies/broad-spectrum antibiotics may contribute to the predisposition to fungal disease. Early diagnosis and prompt management are warranted to avoid morbidity. Key Words: Mucormycosis, COVID – 19, Orbital Cellulitis.

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“…3 There are few reports that found transcutaneous retrobulbar amphotericin B (TRAMB) may be associated with lower exenteration rate (RR=0.28) in patients with orbital mucormycosis. 7 In summary, COVID-19 is probably an important emerged risk factor for mucormycosis. Acknowledgment and alarming the association between SARS-Cov-2 infection and sinu-orbital mucormycosis among all physicians from different disciplines and healthcare providers is an important step to control the uprising incidence of this devastating and lethal disease.…”

Section: An Old Disease With a New Risk Factormentioning

confidence: 99%

How COVID-19 Impacted on Rhino-Orbital-Cerebral Mucormycosis

Pakdel¹

2021

IJCEO

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Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis

Cited by 45 publications

References 42 publications

Rhino-Orbital-Cerebral Mucormycosis—Another Deadly Complication of COVID-19 Infection

Rhino-Orbital-Cerebral Mucormycosis—Another Deadly Complication of COVID-19 Infection

Acute Rhino-orbital-cerebral Mucormycosis in a Patient with COVID – 19

How COVID-19 Impacted on Rhino-Orbital-Cerebral Mucormycosis

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