Rhino-orbital-cerebral mucormycosis: fungal epidemic in a viral pandemic

Abstract

Background Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery. Methods An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021. Results There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive. Conclusion Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.

Histomorphological features of mucormycosis with rise and fall of COVID-19 pandemic

“…Chouhan et al in their research found 41 patients who satisfied the diagnostic criteria of CAROCM and accordingly, had a male preponderance (n=28), 36 patients had a history of steroid use, 40 patients were diabetics and majority of them had received oxygen while in the hospital. [18] The current study had a similar male preponderance. (88.33%) Two systematic reviews conducted in the past on CAROCM have identified diabetes mellitus as the most common comorbidity followed by hypertension.…”

“…Certain predisposing factors identified for CAROCM include uncontrolled diabetes mellitus, use of systemic corticosteroids, prophylactic broad-spectrum antibiotics that disrupt the nasal commensals enabling invasion of pathogenic fungi, immune-suppressive medications and diseases, organ transplant and hematological malignancies. [2] , [9] , [10] , [18] Interestingly, inhalation of steam, which was widely advised my many practitioners in India to relieve nasal congestion in COVID, was found to damage the delicate nasal mucosa facilitating mucorale invasion. [22]…”

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

“…Scant literature is available including case reports, small data-based case series, and reviews describing an association between COVID-19 and ROCM [ Table 3 ]. [ 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 ] However, the swiftness and ferocity with which this pandemic has engulfed the world and the unprecedented investment of healthcare professionals and resources has made it necessary to evaluate any level of evidence available in the literature not only to guide management strategy but also to plan current and future research. With varied clinical forms of mucormycosis, pulmonary mucormycosis was the predominant clinical form (87.5%) observed, while ROCM was the most common presentation (28.6%) that was noted in developing countries like India.…”

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.…”