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Currently, the relevance of the issues of diagnosis and treatment of invasive fungal diseases has increased significantly due to the pandemic of a new coronavirus infection COVID-19 and the massive use of corticosteroids for the treatment. The key success factors in the outcome of invasive fungal diseases are early diagnosis and treatment, including the applying of an adequate systemic antifungal therapy and surgical treatment. Extensive areas of mycotic lesions of the facial bones and paranasal sinuses are life-threatening conditions due to anatomical proximity to brain structures and a high risk of dissemination of I invasive fungal diseases with a fatal outcome. The objective of this work was to study the risk factors, possible pathogenesis, diagnosis and treatment strategy of invasive fungal diseases of the orofacial region in convalescents of COVID-19. We present case-series data on six patients in the clinics of maxillofacial surgery and otorhinolaryngology of the Pavlov First Saint Petersburg State Medical University over the period of 2021-2022. Predisposing factors, clinical and radiological symptoms, features of diagnosis, therapy and surgical strategy were analyzed. The presented observations confirm the relevance and danger of complications after a COVID-19 in the form of the development of invasive fungal diseases with damage to the maxillofacial region caused by mucormycetes and Aspergillus spp., as well as importance of early diagnosis and treatment.Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
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Purpose. The analysis of CT and MR patterns of rhinoorbitocerebral mucormycosis (ROCM) among patients with type 2 diabetes (T2D) after COVID-19. Materials and methods. The study included 11 patients with confirmed COVID-19 and invasive ROCM in the long-term period. CT examinations were performed on Revolution EVO CT scanner (GE, Russia) and MRI on Aera MR scanner 1.5 T (Siemens, Germany). Results. We report several CT and MR patterns for a series of patients: involvement of paranasal sinuses, orbits, optic nerves, large arteries;intracranial spread;involvement bones of cranial base. The features of differential diagnosis and recommendations for standard protocols are presented. Conclusion. CT of paranasal sinuses is the method of choice for suspected fungal infections. MRI is recommended if there is a suspicion of orbital, vascular, and intracranial complications or cavernous sinus extension. The combination of both methods makes it possible to showed soft tissue invasion and bony destruction to choose optimal medical tactics ROCM. © 2022 Russian Electronic Journal of Radiology. All rights reserved.
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Background. Postponed coronavirus infection (COVID-19), accompanied by an immunosuppressive state and associated with the risk of secondary diseases such as mucormycosis. Diabetes mellitus is an independent risk factor for both severe COVID-19 and mucormycosis. Aims - our aim was to experience the diagnosis and treatment of rhino-orbitocerebral mucormycosis in post-COVID-19 patients. Materials. A single-center, observational, non-randomized, cohort comparative study was conducted. We assessed the clinical features, risk factors, diagnosis and outcomes of mucormycosis among recovered COVID-19 patients with hospitalisation in the otorhinolaryngology department of the Samara State Medical University Clinics, Samara, from September-December 2021. CT examinations were performed on Revolution EVO CT scanner (GE, Russia) and MRI on Aera MR scanner 1.5 T (Siemens, Germany). Materials for microbiological and histopathological examination were taken from all examined patients intraoperatively. Results. The experience of diagnosing and treating rhinoorbitocerebral mucormycosis in patients after a new coronavirus infection was analyzed, the influence of the complex use of radiation diagnostic methods, histopathological and microbiological methods on the development and effectiveness of mucormycosis treatment was determined. Conclusions. The effectiveness of disease management directly depends on the early initiation of etiotropic treatment, while the role of complex radiological diagnostics, histopathological and microbiological methods is important for early confirmation of the fungal etiology of the disease.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.
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OBJECTIVES: To assess the relationship between orbital wall fractures connecting to paranasal sinuses (OWF-PNS) and SARS-CoV-2 ocular surface contamination (SARS-CoV-2-OSC) in asymptomatic COVID-19 patients. METHODS: This was a prospective case-control study enrolling two asymptomatic COVID-19 patient cohorts with vs. without OWF-PNS in the case-control ratio of 1:4. All subjects were treated in a German level 1 trauma center during a one-year interval. The main predictor variable was the presence of OWF-PNS (case/control); cases with preoperative conjunctival positivity of SARS-CoV-2 were excluded to rule out the possibility of viral dissemination via the lacrimal gland and/or the nasolacrimal system. The main outcome variable was laboratory-confirmed SARS-CoV-2-OSC (yes/no). Descriptive and bivariate statistics were computed with a statistically significant P ≤ 0.05. RESULTS: The samples comprised 11 cases and 44 controls (overall: 27.3% females; mean age, 52.7 ± 20.3 years [range, 19-85]). There was a significant association between OWF-PNS and SARS-CoV-2-OSC (P = 0.0001; odds ratio = 20.8; 95% confidence interval = 4.11-105.2; R-squared = 0.38; accuracy = 85.5%), regardless of orbital fracture location (orbital floor vs. medial wall versus both; P = 1.0). CONCLUSIONS: Asymptomatic COVID-19 patients with OWF-PNS are associated with a considerable and almost 21-fold increase in the risk of SARS-CoV-2-OSC, in comparison with those without facial fracture. This could suggest that OWF-PNS is the viral source, requiring particular attention during manipulation of ocular/orbital tissue to prevent viral transmission.
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We present the results of a prospective multicenter study of risk factors, etiology, clinical features, and treatment outcomes for mucormycosis in patients with COVID-19 (COVID-M) in the Russian Federation. The study included 60 adult patients with COVID-M. To analyze risk factors for COVID-M, we conducted a case-control study. The control group included 60 adult patients with COVID-19 without mucormycosis. To analyze the clinical manifestations of COVID-M, we created a control group of hematological patients with mucormycosis examined in 2011-2020. In patients with COVID-19, the risk of developing mucormycosis was significantly increased with diabetes mellitus (OR=49) and overweight (OR=4,75), as well as with the use of high (>=100 mg per day for prednisolone) doses of glucocorticosteroids (OR= 4,762), especially >=10 days (OR=25,4). The main localization of mucormycosis in patients with CO-VID-19 was the paranasal sinuses (95%) and the orbit (68%). Involvement of >=2 organs was identified in 70% of patients. The main causative agents of mucormycosis were Rhizopus arrhizus (43%) and unidentified mucormycetes (36%). 90-days overall survival of patients with mucormycosis and COVID-19 - 71%. The stay in the ICU (p=0,01), the use of mechanical ventilation (p=0,0481), the presence of CVC (p=0,049), CNS damage (p=0,016) and >= 2 organs (p=0,048) significantly worsened the prognosis of the disease. The best prognosis was in patients who received antifungal therapy (p=0,03875) and surgical treatment (p=0,046).Copyright © 2022 Authors. All rights reserved.
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We present the results of a prospective multicenter study of risk factors, etiology, clinical features, and treatment outcomes for mucormycosis in patients with COVID-19 (COVID-M) in the Russian Federation. The study included 60 adult patients with COVID-M. To analyze risk factors for COVID-M, we conducted a case-control study. The control group included 60 adult patients with COVID-19 without mucormycosis. To analyze the clinical manifestations of COVID-M, we created a control group of hematological patients with mucormycosis examined in 2011-2020. In patients with COVID-19, the risk of developing mucormycosis was significantly increased with diabetes mellitus (OR=49) and overweight (OR=4,75), as well as with the use of high (>=100 mg per day for prednisolone) doses of glucocorticosteroids (OR= 4,762), especially >=10 days (OR=25,4). The main localization of mucormycosis in patients with CO-VID-19 was the paranasal sinuses (95%) and the orbit (68%). Involvement of >=2 organs was identified in 70% of patients. The main causative agents of mucormycosis were Rhizopus arrhizus (43%) and unidentified mucormycetes (36%). 90-days overall survival of patients with mucormycosis and COVID-19 - 71%. The stay in the ICU (p=0,01), the use of mechanical ventilation (p=0,0481), the presence of CVC (p=0,049), CNS damage (p=0,016) and >= 2 organs (p=0,048) significantly worsened the prognosis of the disease. The best prognosis was in patients who received antifungal therapy (p=0,03875) and surgical treatment (p=0,046).Copyright © 2022 Authors. All rights reserved.
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Mucormycosis is an Acute Invasive Fungal Rhinosinusitis (AIFR). Omnipresent fungi and their interaction with humans are both boon and a bane. Fungal rhinosinusitis is now becoming an alarming situation in today's world, especially in India. It can be classified further into invasive or non invasive and acute or chronic. Categorisation helps us with its diagnosis and management. The invasion of the hyphae portrays mucormycosis into sinus tissue within less than four weeks. It comes with various predisposing factors such as underlying systemic disease, drug therapy, transplantation, and local lesion. Clinical manifestations such as headache, sinonasal congestion, black lesions on the nasal bridge, and facial inflammation associated with pain are prevalent in immunocompromised patients. Crucial steps such as early identification, definite treatment with a multidisciplinary integrated approach of various departments such as ENT, medicine, and radiology should be made. Intraorbital and intracranial complications can be prevented by treating disease process in the early stage.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.
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Background: Mucormycosis is a fungal infection caused by filaments of Mucoraceae which invades blood vessels culminating in a lethal opportunistic infection. During the second wave of COVID-19, all over India a spurt of increased reporting of Mucoraecea infection was experienced. Compromised individual immunity system was suspected. Its early diagnosis and suitable surgical intervention were essential to decrease morbidity and mortality. Aim of the Study: To study the demography, clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis and to evaluate the clinical outcomes in each case. Materials: A cross sectional study from the Department of ENT of Government Medical College Hospital, Ongole;350 COVID-19 RT-PCR positive patients presented with clinical symptoms and signs of Mucormycosis between February 2021 and February 2022 were analyzed. All age groups and genders were included. Mucormycosis proved on microscopic examination of the aspirate or histopathologies of tissue specimens were included. Clinical findings, risk factors, comorbidities, outcome of the disease, biochemical and hematological investigations, radiological signs, nature of fungal elements isolated, treatment instituted were noted. Surgical procedures included were Functional Endoscopic sinus surgery, extended Endoscopic sinus surgery, Medial maxillectomy, ethmoidectomy, Sphenoid exploration, frontal sinusotomy, Orbital exenteration and Skull base surgeries. Antifungal treatment consisted of administration of liposomal Amphotericin B and posaconazole. Result(s): 350 patients included in this study;268/350 (76.57%) males and 82/350 (23.42%) females with a male to female ratio of 3.26:1. 211 (60.28%) patients living in rural areas and 139 (39.71%) living in the urban areas. 324 (92.57%) patients were positive for COVID-19 (RT-PCR) test and 26 patients were negative. There were 233 (66.57%) patients who were obese with more than 30 BMI index and 117 (33.42%) who were with less than 30 BMI index. 299 (85.42%) patients were diabetic and 51 (14.57%) patients were non diabetic. Vaccination was taken 188 (53.71%) of the patients and not taken by 162 (46.28%) of the patients. Mortality rate was 09/350 (02.57%). It was observed that the variables such as Living area, COVID-19 (RT-OCR) test positivity, obesity, Diabetes mellitus and usage of steroids were significantly associated with Mucormycosis in this study. Conclusion(s): Mucormycosis was found to be common in males, from the rural areas. Other significant risk factors for Mucormycosis were COVID-19 (RT-OCR) test positivity, obesity, Diabetes mellitus and usage of steroids. The most common clinical symptoms and signs among were nasal obstruction with noisy breathing, blood stained nasal discharge, headache, periorbital swelling, reduced vision, Ptosis, external ophthalmoplegia, and facial pains were common. Surgical management reduced the morbidity and mortality of Mucormycosis in this study.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Purpose. The analysis of CT and MR patterns of rhinoorbitocerebral mucormycosis (ROCM) among patients with type 2 diabetes (T2D) after COVID-19. Materials and methods. The study included 11 patients with confirmed COVID-19 and invasive ROCM in the long-term period. CT examinations were performed on Revolution EVO CT scanner (GE, Russia) and MRI on Aera MR scanner 1.5 T (Siemens, Germany). Results. We report several CT and MR patterns for a series of patients: involvement of paranasal sinuses, orbits, optic nerves, large arteries;intracranial spread;involvement bones of cranial base. The features of differential diagnosis and recommendations for standard protocols are presented. Conclusion. CT of paranasal sinuses is the method of choice for suspected fungal infections. MRI is recommended if there is a suspicion of orbital, vascular, and intracranial complications or cavernous sinus extension. The combination of both methods makes it possible to showed soft tissue invasion and bony destruction to choose optimal medical tactics ROCM.Copyright © 2022 Russian Electronic Journal of Radiology. All rights reserved.
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Since the Coronavirus Disease (COVID-19) pandemic, there have been several unusual presentations of mucormycosis in India, especially amongst immune-competent adults. COVID-19 infection has been found to have profound effects on the patient's immunity and some patients, though asymptomatic for COVID-19, can be infected by mucormycosis and develops dangerous complications. Skin involvement of the orbital, zygomatic and maxillary areas is a common occurrence in extensive cases of rhino-orbital mucormycosis, however, isolated involvement of the alar skin is an extremely rare occurrence in such patients. Paediatric cutaneous mucormycosis is by itself a rare entity, seen majorly in children with history of allogeneic hematopoietic stem cell transplantations, chemotherapeutic treatment, or patients with human immunodeficiency virus infections, herpes and other life-threatening viral infections. Patients receiving long-term steroid therapy are also predisposed to invasive fungal infections. This case was about a 10-year-old boy presented with a black crusted lesion over the nose to the otolaryngology outpatient department. The patient had history of contact with a COVID-19 positive individual. Examination revealed a necrotic patch over the palate and Non Contrast CT Scan of (NCCT) the paranasal sinuses showed pansinusitis. A KOH mount showed fungal elements and the patient underwent emergency debridement of nasal skin with endoscopic sinus and palatal debridement. Injectable liposomal Amphotericin-B was started. Over a period of one month, the patient showed significant clinical improvement. Though rare, sinonasal mucormycosis can present in the form of a cutaneous lesion which is an unconventional symptom. A general awareness amongst healthcare professionals, with a multidisciplinary approach, timely diagnosis and specialist intervention can improve outcomes in this sinister disease.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.
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Sinonasal cancer accounts for roughly only 3% of upper respiratory tract malignancies and generally presents as a primary malignancy. Although extremely rare, the sinonasal cavity is also a known location for metastasis, with 8% of these cases originating from primary breast cancer. When attempting to differentiate primary disease from metastasis, immunohistochemical analyses play a crucial role in reaching the correct diagnosis. To date, there are a handful of reports describing metastasis involving the paranasal sinuses but even fewer reporting primary sinonasal cancer with coexisting primary malignancy. Here we present a case of primary sinonasal adenocarcinoma in the setting of a long-standing history of breast cancer. The patient, a 73-year-old female, was diagnosed with T1cN1aM0, progesterone receptor positive and estrogen receptor negative ductal carcinoma in situ of the left breast in November 2019. She subsequently underwent bilateral mastectomy and treated with 3 cycles of chemotherapy and anastrozole, which were both discontinued due to intolerance. Of note, in March 2019, MRI of the head incidentally found a 3 x 2 cm mass in right nasal cavity extending into ethmoid sinus. One year later, she presented with mild right sided nasal obstruction and drainage, and biopsy revealed squamous and respiratory mucosa with chronic inflammation. The patient elected to cancel initial surgical resection of the mass due to the COVID-19 pandemic. The patient returned in March 2022 with complaints of eye pressure, double vision, headaches, and worsening nasal obstruction. PET/CT scan was negative for distant metastasis but demonstrated increased uptake in sinus cavity. MRI showed a larger 5 x 3.7 cm mass impressing on medial inferior margins of orbit. Imaging also suggested evidence of dehiscence of lamina and irregular neo-osteogenesis of the skull base. She underwent approach and resection of the mass with histology demonstrating a well differentiated, low grade non-intestinal mucinous adenocarcinoma. Immunohistochemistry was positive for pankeratin and CK7, favoring a primary sinonasal origin. It was estrogen receptor negative and negative for GATA3, a sensitive and fairly specific stain in mammary carcinoma. Adjuvant radiation was recommended postoperatively, however the patient declined this therapy. This case highlights the role of immunohistochemistry to discriminate a new primary cancer from metastasis in patients with a history of breast cancer. Clinically, patients with sinonasal metastasis can present with symptoms ranging from unilateral nasal obstruction, facial pain, diplopia, and decreased vision. On imaging, suspicion of malignancy is raised when there is evidence of destruction of bony boundaries and invasion of surrounding tissues such as the orbit and anterior skull base, as found in our patient. Notably, metastasis to the paranasal sinuses can mimic a primary cancer of the nasal cavity, with both tumors showing epithelial differentiation. However, primary tumors often show neoplastic changes in the overlying respiratory epithelium and do not express estrogen receptor, progesterone receptor, or HER2 positivity, which are known to be correlated with breast cancer. In this setting, GATA3 and estrogen receptor negativity allowed us to diagnose primary nasal cancer more confidently. Therefore, clinicians should be aware of metastatic disease and expand immunohistochemistry panels when appropriate.
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Introduction/Background: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss Syndrome, is a rare, small to medium vessel ANCA associated vasculitis. Hallmarks of EGPA include asthma, chronic rhinosinusitis, and peripheral neuropathy. EGPA is characterized by a prodrome of asthma and allergic rhinitis, followed by peripheral blood hyper-eosinophilia and accumulation of extravascular eosinophils, and finally systemic vasculitis. Extrapulmonary involvement is common, sometimes with fatal outcomes. The onset of EPGA is typically between 25-50 years;however, EGPA also occurs during childhood and has a significant morbidity and mortality. Description/Method: Our patient presented to the emergency department with a 2-week history of lethargy, wheeze and left sided neck swelling. After testing COVID-19 positive eight months prior to this, she developed wheezy episodes and was subsequently diagnosed with asthma which was managed with bronchodilators as required. She was reviewed by an allergist who confirmed a dust mite allergy and prescribed Montelukast. She remained well during the summer months however during winter she had 3 distinctive episodes of wheeze and cough which were managed by antibiotics and prednisolone. In the emergency department, an echocardiogram was performed which showed a cardiac tamponade. She was transferred to CICU where she had a pericardial drain inserted. The fluid was abundant with inflammatory cells. Multiple investigations were performed as follows: Hb: 135g/L, wbc: 20.30 x 10 9/L, Eosinophils: 12.77 x 10 9/L, CRP: 51 mg/L, ESR: 75 mm/hr, LDH: 1188 IU/L, IgE: 8000 UI/ml, ANA, ANCA: negative. CT chest showed mediastinal lymphadenopathy and patchy bilateral infiltrate and cardiac MRI showed myopericarditis and LV fibrosis. BMA showed no malignant cells and sinusitis was confirmed by CT. On examination, she was underweight. Her nasal mucosa looked inflamed. Otherwise systemic examination was unremarkable. In the context of poor ejection fraction (20%) with LV fibrosis, urgent MDT was arranged and concluded that our working diagnosis was EGPA. The decision was made to start IV methylprednisolone 10mg/kg/day for 3 days and Ivermectin. That night our patient had a VF arrest which required a single shock conversion 4J/kg. There was 7-minute downtime. Treatment was escalated to include cyclophosphamide, rituximab and plasmapheresis. The patient made a remarkable recovery, extubated and transferred to a normal ward. Her eosinophils count and inflammatory markers improved dramatically following treatment. However, she developed severe neuropathic left leg pain and NCS confirmed peripheral neuropathy Discussion/Results: EGPA is a very rare disease and diagnosis can be challenging especially with the absence of histopathology diagnosis. Early empirical treatment especially in a very ill child in intensive care unit can save lives and divert the progress of the disease. This patient has fulfilled the American College of Rheumatology criteria to diagnose EGPA including asthma, eosinophil count > 10% of upper normal, peripheral neuropathy, pulmonary infiltrates on CT thorax and paranasal sinuses abnormalities. Cardiac biopsy of the fibrotic mass may be a useful tool for diagnosis;however, this invasive procedure may expose this patient with high risk of fatal arrhythmias. Since other causes of eosinophilia were ruled out including parasitic infections, lymphoproliferative disorders, and rare primary immunodeficiency syndromes (hyper-IgE syndrome due to STAT3 or DOCK8 deficiency and Omenn syndrome) and the patient responded well to treatment, the diagnosis of EGPA was supported. Key learning points/Conclusion: Asthma not responding to bronchodilator could be another diagnosis Eosinophilia should be interpreted with caution. Defer the need for histopathology diagnosis in critically ill children Cardiac involvement is a life-threatening marker Early diagnosis prevents life threatening complications.
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Computed tomography is one of the medical imaging tests in diagnosis. Multiple images of the inside of the body get captured in CT, like in traditional x-ray, but in various planes, can reformat the generated images. In CT, more excellent images are captured than in x-rays, especially for soft tissue and blood vessels. Four pairs of sinuses are there in the body, and small openings connect each to the nasal cavity. Out of the four sinuses, the paranasal sinus, a hollow and air-filled space, is located within the bones of the face. A vital role is played by Computed Tomography (CT) in the study of Paranasal Sinuses to diagnose and determine the various diseases related to paranasal sinuses. For example, multiple conditions like inflammatory, malignant neoplastic, and benign affect the paranasal sinus;all these conditions are diagnosed by CT Scans which directly help reduce the mortality and morbidity in patients suffering from diseases that affect the paranasal sinus. Besides this, CT Scans of paranasal sinus before functional endoscopic sinus surgery also help evaluate paranasal sinus disease and many more. The article aims to study the pathologies for which paranasal sinuses are affected and CT features of paranasal sinus diseases. Paranasal sinus computed tomography scans are performed for the measurements of - the volume of the nasal cavity. CT scan is also essential in evaluating anatomical variations to prove the correlation between the extent of disease and disease process in Sinonasal polyposis patients. Also, because of CT, paranasal sinus anatomy is delineated. This is the overview of the role of CT in paranasal sinus study (diagnostic, anatomical). Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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BACKGROUND: An epidemic of Mucorales was reported following the second wave of COVID-19 in India, and intracranial extension of the same was one of the most dreadful complications. METHODS: A total of 62 patients with cerebral mucormycosis were recruited and followed up till 12 weeks to evaluate the risk factors, incidence, clinical manifestations, management, and prognosis of cerebral mucormycosis. FINDINGS: A median age of 51.5 years with male predominance (74%) was noted. The majority of subjects reported a history of COVID infection (93.5%) and diabetes mellitus (83.87%). The first symptom of mucormycosis appeared after a mean period of 17.63 ± 8.9 days following COVID. Facial swelling and ptosis were the most common symptoms. Only 55% of patients had neurological presentations, and hemiparesis was the most common neurological sign (30.6%). Radiologically, the involvement of maxillary sinus (90.32%) and ethmoid sinus (87.10%) was commonly noted. Cerebral findings included temporal lobe (50%) and parietal lobe (30.06%) involvement, cavernous sinus thrombosis (30.06%), and internal carotid artery thrombosis (22.58%). Acute cerebral infarction was notable in 37% of subjects (p-value=0.0015, significant association with the outcome). Conventional and liposomal amphotericin B were used in 91.94% and 53.23% of patients, respectively. Retrobulbar amphotericin injections used in 11.3% of subjects significantly affected the outcome (p-value=0.03, significant). Posaconazole step-down therapy was used in 72.5% of subjects (p-value=0.0005, significant). Surgical interventions were performed in 53 (85.48%) subjects (p-value=0.004, significant). Functional endoscopic sinus surgery was the most common (in 64.52% of subjects), followed by maxillectomy (20.97% of subjects) and craniotomy (17.7% of subjects). At the end of 12 weeks, 33.87% of patients died and 59.68% were alive; the rest (6.45%) were lost to follow-up. INTERPRETATION: The absence or late presentation of neurological symptoms led to a delayed diagnosis of cerebral mucormycosis. The presence of acute cerebral infarction indicated a worse prognosis. However, there was a significant influence of step-down posaconazole therapy, retrobulbar amphotericin injections, and surgical intervention on the prognosis of cerebral mucormycosis.
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Objective: To explore risk factors of mucormycosis in COVID-19 recovered patients. Methods: A total of 101 patients, who were diagnosed with mucormycosis after recovery from COVID-19 and admitted to the Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital in India, were included in the study. The presenting clinical features and associated risk factors were assessed and analyzed subsequently. Results: Of 101, 68 (67.3%) were males, and 33 (32.7%) were females. A total of 89 (88.1%) patients were between 46 and 65 years old. The most common subtypes were rhino-ocular (61.4%), followed by paranasal sinuses (16.8%), rhino-ocular cerebral (16.8%), ocular (3.0%), and pulmonary (2.0%). Diabetes mellitus was present in 71% of cases of mucormycosis as co-morbidities. A total of 76.2% of patients were given systemic corticosteroids in oral or intravenous form during COVID-19 treatment. Severe COVID-19 was present in 45.5% of patients with mucormycosis, while the moderate infection was present in 35.6% of mucormycosis. Most patients had gap between the onset of mucormycosis and COVID-19 <15 d. Conclusions: A lethal confluence of uncontrolled diabetes mellitus, corticosteroid usage, and COVID-19 could cause a dramatic rise in mucormycosis. So, clinicians must be aware of these risk factors in patients suffering as well as recovering from COVID-19 to prevent mucormycosis.
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Mucormycosis is a potentially fatal disease caused by a fungus of the order Mucorales, most commonly involving the nasal sinuses, orbits, brain, lungs, and skin. The disease affects mostly immunosuppressed individuals and patients with chronic diseases such as diabetes. The prevalence of mucormycosis is 80 times higher (0.14 per 1000) in India compared to developed countries. Since the outbreak of the COVID-19 pandemic, there has been a sudden surge in the number of mucormycosis cases, especially on the Indian subcontinent. This can be attributed to what we consider to be the perfect iatrogenic recipe: a combination between the immunosuppression caused by COVID-19, the large prevalence of uncontrolled diabetes and the simultaneous use of corticosteroids. Other factors include the excessive use of antibiotics, antifungal drugs and zinc supplements, invasive ventilation, poor hygiene and sanitization as well as the use of industrial oxygen in hospitals. As a result, an overwhelmingly large number of COVID-19 patients have developed mucormycosis during the pandemic. A review of the literature suggests that all efforts should be made to keep tight control of glycemia in COVID-19 patients along with judicious use of corticosteroids. The treatment of mucormycosis involves a combination of medical and surgical therapy, with the early initiation of antifungal drugs and aggressive surgical debridement of the affected tissues. Copyright © 2022 Mandip Singh Bhatia et al., published by Sciendo.
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Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to an rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male.
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Introduction: Mucormycosis is an opportunistic filamentous fungal infection that can progress rapidly. Different clinical pictures may occur depending on tissue and organ where the involvement is seen. Rhinoserebral mucormycosis, is the most common clinical form. We aimed to examine the patients diagnosed with rhinocerebral mucormycosis followed in our hospital with literature. Materials and Methods: Patients treating in our hospital between August 2009 and November 2020 with microbiologically and / or histopathologically confirmed rhinocerebral mucormycosis were evaluated retrospectively. Results: 2 (25%) of the patients were female and 6 (75%) of them were male. The average age was 56.37 ± 9.318. All patients had at least one predisposing factor. Fever and headache symptoms were the most common. Surgical debridement and antifungal treatment were applied to all patients. 4 (50%) of the patients developed diffuse visual impairment and were discharged with sequelae. One (12.5%) of them was discharged with full recovery. 3 (37.5 %) of them died on the 12th day of hospitalization. Hemoglobin and Glaskow coma scores of patients with ex were significantly lower than the patients who were discharged, and SOFA scores were higher (p= 0.025, 0.031, 0.023, respectively). Conclusion: Nowadays, when the COVID-19 pandemic has not been controlled yet, most of the patients who receive immunosuppression due to COVID-19 also carry additional risk factors such as DM in terms of mucormycosis. Our article has contributed to raising awareness by drawing attention to risk factors, clinical signs and symptoms in mucormycosis. Training meetings should be organized for all medical doctors on this subject. In this way, mortality and sequelae rates can be improved with early diagnosis and treatment.
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Rationale and Objectives-At present, sinonasal mucormycosis is most worrisome COVID-19 related complication in India while western countries have relatively stayed aloof. But given the pervasive nature of fungi and presence of all predisposing conditions even in western countries, it is imperative to have knowledge about the imaging patterns and staging of the disease. In this study, we try to single out factors responsible for the sudden increment in the incidence of sinonasal mucormycosis among covid-19 patients and discuss their imaging features. Patients and Methods-The case records of 30 patients, between January to May, 2021, with positive RT-PCR for COVID-19 and biopsy proven sinonasal mucormycosis were retrospectively evaluated. Results – Out of 30 patients, 28 had raised random blood glucose level and 24 had raised ferritin level. On imaging, nasal cavity involvement was seen in 18 patients. Paranasal sinuses were involved in 28 patients. The disease process also showed involvement of orbit, neck spaces and intracranial extension. We divided sinonasal mucormycosis into four groups and mortality was seen in patients of stage 3 and 4 (total mortality was 26.7%). Conclusion-MRI played an important role in diagnosis and staging of sinonasal mucormycosis as well as determining the extrasinus extent of disease. Mortality was seen in patients presenting in advanced stage of the disease, with orbital or intracranial extension. Thus, it is imperative that high index of suspicion, early imaging with diagnosis and aggressive management protocol needed to reduce morbidity and mortality.