Rhino Orbital Cerebral Mucormycosis in Covid-19 Crisis

Abstract

Rhino-Orbital cerebral Mucormycosis (ROCM) an angioinvasive fungal infection commonly seen in diabetic and immunocompromised patients. In recent days, due to COVID 19 pandemic mucormycosis has been significantly increased (Smith et al. in Radiol Cardiothorac Imaging 2(5):e200280, 2020). In this study we evaluate the involvement, clinical features, contributing risk factors and outcome of post covid Rhino orbital cerebral mucormycosis. A cross sectional descriptive study was conducted on post covid rhino orbital cerebral mucormycosis patients from May 2021 to October 2021 in Otorhinolaryngology department of Stanley Medical college Chennai. We collected detailed history of Covid-19 hospital stay, treatment taken, co morbidities, Endoscopic findings, management and outcome. 243 cases analysed with median age 51 years (range 28-75 years) and male predominance with M:F ratio 1.6. The median time interval between covid and ROCM was 20 (15-35) days. Based on involvement 111 (46%) Stage-II, 87 (36%) Stage-I, 37 (15%) stage III and 8 (3%) stage IV disease observed. with overall mortality of 5.7%. Among which 230 (94.6%) patients had diabetes mellitus, 111 (45.8%) patients received steroid and 134 (54.3%) had immunomodulators during covid management. Despite of surgical debridement and antifungal therapy 14 (5.8%) patients died from mucormycosis. we conclude that covid be the predisposing factor for mucormycosis especially in patients with diabetes and increased usage of steroids. Treatment needs multimodality approach with antifungals and surgical debridement with surveillance fir good outcome.

Infectious disease for the rhinologist

“…A systematic review and meta-analysis estimated the in-hospital prevalence of COVID-19 among mucormycosis patients to be as high as 57% [23]. While many theories are proposed regarding the etiology of CA-ROCM, including SARS-CoV-2, diabetes mellitus, immunocompromise and thromboembolic phenomena [24], it is likely to be multifactorial and thus difficult to pinpoint any singular cause. Studies evaluating the predisposing factors for COVID-19-associated mucormycosis, including CA-ROCM, identified high-dose systemic steroid use and uncontrolled diabetes as significant factors in the development of the disease [25,26].…”