Risk Based Decision Algorithms for Management of COVID-19 Associated Rhino-orbital Mucormycosis

Abstract

Introduction COVID associated mucormycosis is a challenging problem with significant morbidity and mortality implications. COVID affliction, pre-existing medical conditions especially diabetes and steroid prescription are supposed contributors for development of this opportunistic fungal infection. Surgery remains the mainstay of treatment with adequate post-op anti-fungal therapy. Materials and methods This is a retrospective analysis of prospectively maintained database of all surgical patients between March–May 2021 at a single centre. Prognosticators such as severity of COVID affliction, use of steroids, extent of rhino-orbital mucormycosis, extent of surgery and outcomes were studied. Descriptive statistics was used to analyse frequency of different variables and chi square test was used to analyse prognostic factors. P value < 0.05 were deemed significant. Results 74 patients with an average 30 day follow-up were included. All patients had preceding COVID infection and 71.6% were diabetic and 25.7% were diagnosed during the course of their COVID treatment. Multiple sinus involvement being most common (52.61%), 10.81% underwent orbital exenteration and 24.32% palatectomies were performed. Revision surgeries were warranted in 16.21% patients. 9 patients succumbed to disease/ underlying medical and treatment related complications. Conclusion We propose a risk assessment based on general condition of patient and severity of mucormycosis infection to decide appropriate strategy for surgical intervention. Early detection and timely and adequate surgery are essential pre-requisites to good outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02692-9.

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 23 ] India Retrospective Single-center 70 Apr 2021–Jun 2021 45 [38–56] 60 (42) 70 (49) Gupta NK. [ 24 ] India Retrospective Single-center 74 Mar 2021–May 2021 52 65 (48) 97 (72) Mishra Y. [ 25 ] India Retrospective Single-center 32 Apr 2021–May 2021 58 ± 9 47 (15) 88 (28) Kumari A.…”

“…[ 23 ] 24 (17) 8.6 (6) 2.9 (2) – – – 70 (49) – Gupta NK. [ 24 ] – 6.8 (5) – 1.4 (1) 69 (51) – 91 (67) – Mishra Y. [ 25 ] 50 (16) – 0 (0) – 69 (22) – 94 (30) – Kumari A.…”

Rhino-Orbital Mucormycosis After COVID-19 Recovery: A Case Report

“…Definitive diagnosis relies on microbiological and pathological studies. 9 , 18 However, negative fungal stains and culture are frequent. 18 Indeed, several studies reveal a very low rate of positive results, mostly due to the fragility of the Mucorales structures and the difficulty in its handling and growth in vitro.…”

“… 9 , 18 However, negative fungal stains and culture are frequent. 18 Indeed, several studies reveal a very low rate of positive results, mostly due to the fragility of the Mucorales structures and the difficulty in its handling and growth in vitro. 19 Therefore, in the context of strong clinical suspicion, neither the diagnosis should be excluded nor the therapeutic approach should be delayed or withheld, even with negative results.…”

Mucormycosis and COVID-19: manifestations of the central nervous system and the ocular system

“…Gupta et al 11 in their study reported mucormycosis in 25.7% of patients and the same number were diagnosed during the course of their treatment with COVID-19; however, it may be a post-COVID-10 manifestation. ROCM has mainly been reported, and the paranasal sinuses, central nervous system (CNS) and ocular system have also been affected, the most common manifestations currently being facial pain (unilateral), ptosis, loss of vision, complete ophthalmoplegia, headache, intracranial complications (vasculitis).…”