ABSTRACT
Coronavirus disease 2019 (COVID-19) has turned out to be the most devastating viral disease that the world has encountered for the past century. The World Health Organization (WHO) declared it a pandemic on March 11, 2020. The disease mainly spreads through respiratory droplets which makes social distancing a primary tool of prevention. Many variant strains have emerged up since the pandemic started and the Delta variant is responsible for recent surge of cases in second wave of COVID-19 in India. Mass vaccination is the most efficacious precautionary measure that can be applied to stop the transmission and generate herd immunity. Vaccination does not give 100% prevention from infection, but it halts the severity of infection. Vaccine is the boon amidst the mayhem. Our study highlights that those vaccinated (particularly two doses) had clinically mild symptoms and mild computed tomography severity score (CTSS) with a speedy recovery. Those unvaccinated had moderate to severe symptoms with moderate to severe CTSS (>8) often requiring hospital admission and having poor prognosis. Thus, vaccine helps reduce the health burden of the already strained health care system. Immunization visit can also be used as an opportunity to disseminate message to encourage behavior, to reduce transmission risk of COVID-19 virus, to identify the signs and symptoms of disease, and to provide guidance on what to do.
ABSTRACT
Background Rhinocerebral mucormycosis is new bandit amidst present COVID-19 pandemic, it is an acute and lethal opportunistic fungal infection affecting immunocompromised and diabetic patients. Since the disease has got high morbidity and mortality despite aggressive treatment, radiologists play a very crucial role in early and accurate diagnosis. Erroneous diagnosis should be refrained by logistic approach and thorough clinico-radiological correlation. Material and methods Ours was a cross sectional study included six cases after taking written informed consent who recently presented with mucormycosis like symptoms and imaging findings during a period of 1 month, but by detailed clinical and radiological evaluation, we concluded that all these cases were either physiological mimics or extraneous artefacts, this helped greatly in relieving undue anxiety of patients and referral physicians and also avoided unnecessary further workup. This study was conducted after approval by the institutional ethical committee. Results Our study included 3 males and 3 females of age ranging from 32 to 62 years, all of which had history of COVID-positive having mild to moderate CT severity score who were treated with steroids and oxygen therapy (except one case). The most common presenting symptom was headache followed by nasal congestion. The mucor mimickers encountered were benign black turbinate sign, artifacts due to cosmetic dermal fillers and dental fillings, hemangioma, prolonged prone ventilation, and fungal ball. Conclusions Amidst the sudden spurt in the number of cases of mucormycosis in our country in the present COVID era, there has been an increase in the number of imaging requisitions. This series of cases aims to sensitize radiologists about the importance of detailed clinical history, thorough clinic-radiological correlation and at times also taking extra efforts to reconnect to patients regarding specific clinical history and avoid fallacious diagnosis.
ABSTRACT
PURPOSE: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation. METHODS: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs. RESULTS: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively. CONCLUSION: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.