Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital

Abstract

Purpose To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India. Patients and Methods A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM. Results The age of patients ranged from 29 to 75 years and male–female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned. Conclusion SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.

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

“…Out of the 37-biopsy samples, soft tissue invasion was noted in 59%, necrosis with no cellular response was noted in 43%, acute suppuration in 5% of cases (n=2), granulomatous inflammation in 11% of the cases. [27] The results of the present study closely match the above study with age, sex and predisposing factor being similar. Soft tissue invasion was seen in a higher percentage with 85% of the specimens, abscess formation in the present study was also noted in only two cases (3.33%).…”

Infectious Diseases and Tropical Medicine

“…Our study was conducted with the aim of evaluating the patient profile and assessing the risk factors involved in secondary mucormycosis infection in COVID-19 patients over a period of 6 months. In this study, the majority were middle aged men (mean age-54.29±10.21, range 36-78 years) as also seen in the studies by Arora et al 13 where median age was 57 years; range 29-75 years and by Pakdel et al 14 where median age was 52 years; range 14-71 years. But as per a study by Bayram et al 15 , the mean age was 73.1±7.7 years (range 61-88 years).…”

“…The male to female ratio of our study group was 10.67:1. Male predominance in incidence was also seen studies by Patel et al 12 (323; 69.5%), Arora et al 13 (45; 75%), Pakdel et al 14 (66%), and Bayram et al 15 (9; 81.8%).…”

Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review

“…In our reviewed studies, the specific indications for retrobulbar injection of the drug were visual loss, signs of orbital apex involvement, and progression of the disease despite appropriate systemic medical and surgical treatments. 25 , 28 – 31 , 33 , 34 Similar indications were elucidated by Hirabayashi et al 19 In addition, we found that this route of the drug administration should be considered in earlier stages, especially in cases that are not good candidates for extensive surgical interventions (i.e., pediatrics and admitted patients to an intensive care unit, ICU). 29 , 31 In the COVID-19 era, many cases are admitted to the ICU and, therefore, are not candidates with favorable outcomes following surgical interventions (including paranasal sinuses and orbital debridements).…”