Rhino-Orbito-Cerebral Mycosis and COVID-19

Abstract

Background: There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave. Aims: Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era. Methodology: Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis. Results: There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%. Conclusion: Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.

COVID-19-Associated Mucormycosis

“…During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there has been an unprecedented rise in the number of cases of mucormycosis especially in India during the second wave. [ 1 2 3 4 ] COVID-19-associated mucormycosis (CAM) most commonly involves nasal cavity, para-nasal sinuses, orbits, and at times the central nervous system (CNS); collectively, the disease is known as rhino-orbito-cerebral mucormycosis (ROCM). Otorhinolaryngologists, ophthalmologists, maxillofacial surgeons, and neurologists usually tend to manage these patients along with physicians and infectious disease experts.…”

“…Otorhinolaryngologists, ophthalmologists, maxillofacial surgeons, and neurologists usually tend to manage these patients along with physicians and infectious disease experts. There have been many reports of neurological manifestations of CAM[ 1 2 ] including one in this issue of Annals of Indian Academy of Neurology. [ 5 ]…”

“…These complications have also been reported with CAM. [ 1 2 4 5 11 ] Because the patient who has presented with facial pain, nasal discharge, proptosis, and vision loss can develop additional neurological complications any time during the course of illness, a high level of vigilance is needed to detect them early. Whether CAM has more neurological involvement compared to non-CAM cases has not been looked at in detail.…”

“…Strokes were seen in >10% of CAM in our studies. [ 1 11 ] The clinical features of CAM may begin during the course of COVID-19 and can also appear up to 2 months after recovery from COVID-19. [ 1 ]…”

COVID-19 Associated Neurological Manifestations

“…[ 1 2 3 4 5 ] During the second wave of COVID-19, rhino-orbito-cerebral mucormycosis infection following COVID-19 has been described from India. [ 7 ] Data about neurological manifestations is needed from all parts of world to see if any regional variation exists. A point to note is since the COVID-19 infection is widespread, a neurological manifestation in COVID-19 patient can be incidental, triggered or caused by the virus.…”