Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with COVID 19 infection

Abstract

The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable because of the limited human understanding of the virus with the current literature. In this study, we have tried to correlate the various predisposing factors influencing the clinical profile and treatment outcomes in patients with covid associated mucormycosis (CAM). It is a retrospective analysis of cases of CAM during the second wave of COVID 19 infection, which was managed in the department of Otorhinolaryngology from Dec 1, 2020, to June 10, 2021. The detailed clinical, radiological and management of patients with CAM were collected, recorded, evaluated and correlated with the predisposing factors. Of the total, 46 patients, 44(95.65%) were diabetic and 41 patients had a previous history of steroid intake. When clinical parameters were compared between blood sugar < 200 mg/dl and > 200 mg/dl, the old and newly diagnosed diabetes mellitus in patients with CAM, there was no significant differences in any of the above clinical parameters ( p > 0.05), except the hospital stay ( p = 0,004). Steroid intake in patients with coexisting DM associated with CAM is considered the most important factor for the development of the CAM. There was are no significant difference in any of the clinical/treatment outcomes in patients with CAM with respect to the initial blood sugar, except for the hospital stay. A large sample size with a long-term follow-up period may be needed for a better understanding of common predisposing factors for the development of CAM.

Factors associated with invasive fungal sinusitis in patients with COVID‐19: A systematic review and single‐center case series

“…First, cases of IFSAC are only discussed in case reports, series, and one retrospective case–control study (Table 2). Although these articles are relatively low levels of evidence, the findings of our systematic review are supported by similar observations in the available literature 28–31 . As stated previously, a second limitation is that none of the publications directly addressed or significantly evidenced any changes in IFS incidence prior to and during the pandemic.…”

“…Although these articles are relatively low levels of evidence, the findings of our systematic review are supported by similar observations in the available literature. [28][29][30][31] As stated previously, a second limitation is that none of the publications directly addressed or significantly evidenced any changes in IFS incidence prior to and during the pandemic. We also did not detect a significant change in incidence within our case series, which was limited by a small sample size and only one patient with confirmed IFSAC.…”

“…Recent publications have also suggested the significant interplay between corticosteroid treatment of COVID‐19 in diabetic patients and IFS. A study published out of India found that among 46 patients with COVID‐19 and IFS, about 96% percent had diabetes and approximately 89% percent had recent history of steroid use 28 . Another publication from Bangalore, India similarly found that 16 of 18 patients with maxillofacial and rhino‐cerebro‐orbital fungal infections were given steroids for COVID‐19 treatment.…”

“…A study published out of India found that among 46 patients with COVID‐19 and IFS, about 96% percent had diabetes and approximately 89% percent had recent history of steroid use. 28 Another publication from Bangalore, India similarly found that 16 of 18 patients with maxillofacial and rhino‐cerebro‐orbital fungal infections were given steroids for COVID‐19 treatment. Of these 16 patients, 15 had a known history of diabetes, suggesting a strong association with steroid usage in diabetic patients with COVID‐19 and angioinvasive maxillofacial fungal infections.…”

Diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis: a systematic review and meta-analysis

“…The frequency of cerebral involvement in Covid-19-associated rhino-orbito-cerebral mucormycosis was reported to be 22 per cent. 34,35 The pooled prevalence of intracranial involvement was 13 per cent in the current study.…”