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1.
A A Pract ; 16(4): e01581, 2022 Apr 12.
Article in English | MEDLINE | ID: covidwho-1862205

ABSTRACT

Orbital exenteration is occasionally required for rhino-orbital cerebral mucormycosis. Multiple associated comorbidities can pose a risk for general anesthesia. There is only 1 report of exenteration being performed under trigeminal nerve block. We describe 5 patients who underwent orbital exenteration under local infiltration anesthesia with sedation. Patients and surgeons reported satisfactory conditions, with stable hemodynamics and successful day care management. Orbital exenteration under local infiltration anesthesia can be a safe and effective alternative for patients with rhino-orbital mucormycosis who are at risk with use of general anesthesia.


Subject(s)
Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Anesthesia, Local , Antifungal Agents/therapeutic use , Eye Infections, Fungal/drug therapy , Humans , Mucormycosis/drug therapy , Mucormycosis/surgery , Orbital Diseases/drug therapy , Orbital Diseases/surgery
2.
Turk J Ophthalmol ; 52(2): 139-141, 2022 04 28.
Article in English | MEDLINE | ID: covidwho-1818499

ABSTRACT

A 61-year-old woman presented to our clinic with complaints of decreased visual acuity, pain, and redness in her left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers at 3 meters in the left eye. On slit-lamp examination, 1+ cells were detected in the anterior chamber. Fundus examination revealed 1+ haze in the vitreous and multiple creamy-whitish lesions in the retina and vitreous. Her history included a diagnosis of coronavirus disease 2019 (COVID-19) one month earlier, for which she was hospitalized in the intensive care unit for 20 days and received systemic corticosteroid treatment. Vitreous culture yielded Candida albicans. The patient's nasopharyngeal swab sample was positive for COVID-19 by reverse transcription polymerase chain reaction test. BCVA was improved to 20/40 after amphotericin therapy (via intravitreal injection and intravenous routes), and the vitritis and chorioretinitis lesion regressed after 2 weeks of treatment. Two weeks later, intravenous amphotericin was discontinued and oral fluconazole treatment was started at a dose of 400 mg/day. At 3-month follow-up, her BCVA was 20/25 and no inflammatory reaction was observed in the anterior chamber and vitreous.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Amphotericin B/therapeutic use , Critical Care , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Humans , Middle Aged , Steroids
3.
Indian J Ophthalmol ; 70(2): 649-652, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1810683

ABSTRACT

PURPOSE: To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration. METHODS: The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months. RESULTS: The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication. CONCLUSION: Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , Debridement , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/surgery , Humans , Mucormycosis/diagnosis , Mucormycosis/surgery , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/surgery , SARS-CoV-2
4.
Am J Otolaryngol ; 43(3): 103465, 2022.
Article in English | MEDLINE | ID: covidwho-1777939

ABSTRACT

PURPOSE: Second wave of COVID-19 pandemic was associated with an unprecedented rise in cases of mucormycosis, treatment of which has been challenging owing to the availability and side effects associated with amphotericin. METHODS: All patients presenting with rhino-orbital cerebral mucormycosis (ROCM) following COVID-19 infection between April 2021 to June 2021 were included in this retrospective interventional study. Primary objective was to assess the clinical response with combination of intravenous liposomal amphotericin B (4-5 mg/kg/day) and saturated solution of potassium iodide (SSKI) given orally along with surgical debridement. RESULTS: Twenty-five patients of ROCM were treated with the regimen. Mean age and fasting blood sugar levels were 53.48 years and 239.64 mg/dL respectively. All patients had history of intake of steroids with a mean daily dose of 86.39 mg of prednisolone equivalent. 88% of patients had a "proven" diagnosis of mucormycosis. Cultures were positive in 52% of patients with Rhizopus arrhizus as the predominant species. The mean daily dose of amphotericin received was 268 mg/day with a mean duration of 9.52 days. Mean daily dose of SSKI was 2.57 g. 21 patients (84%) had stabilization of disease at week 8 and achieved cure at the end of treatment whereas the mortality rate was 16%. Factors that significantly affected outcome were eye and central nervous system (CNS) involvement on presentation. CONCLUSION: SSKI, with its remarkably low cost and safety profile, makes it a potential adjuvant drug that may help achieve the twin benefits of shortened duration and dose of LAMB.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/epidemiology , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/diagnosis , Pandemics , Potassium Iodide/therapeutic use , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
7.
Am J Trop Med Hyg ; 106(2): 566-570, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1726466

ABSTRACT

There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this surge. We report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted to our center between mid-April and early June 2021. The cases showed a male preponderance, two patients had loss of vision, and four of them showed intracranial extension of disease. Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes, both steroid use and diabetes being the most common identified risk factors. Considering other possible risk factors, immunosuppressed state, antiviral or ayurvedic (Indian traditional) medications, and oxygen therapy were not associated with a definite risk of mucormycosis, because they were not present uniformly in the patients. We propose that COVID-19 itself, through molecular mechanisms, predisposes to mucormycosis, with other factors such as dysglycemia or steroid use increasing the risk.


Subject(s)
COVID-19/complications , Eye Diseases/diagnosis , Eye Infections, Fungal/virology , Mucormycosis/diagnosis , Mucormycosis/virology , Adult , Antifungal Agents/therapeutic use , COVID-19/drug therapy , COVID-19/epidemiology , Case-Control Studies , Comorbidity , Diabetes Mellitus/epidemiology , Eye Diseases/drug therapy , Eye Diseases/epidemiology , Eye Diseases/virology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/epidemiology , Female , Humans , India , Male , Middle Aged , Mucormycosis/drug therapy , Mucormycosis/mortality , Risk Factors , Steroids/therapeutic use
8.
Indian J Ophthalmol ; 70(3): 1019-1024, 2022 03.
Article in English | MEDLINE | ID: covidwho-1715917

ABSTRACT

Purpose: To assess the outcome and response of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in post-coronavirus disease of 2019 (COVID-19) rhino-orbito-cerebral mucormycosis (ROCM) and to establish a scoring system in guiding treatment modalities. Methods: An interventional, prospective study was done on 82 eyes of post-COVID-19 ROCM from May 2021 to July 2021. A comprehensive multi-departmental evaluation along with detailed ophthalmic examination, laboratory investigations, and radiological examination was done. Scoring points were given to each symptom, sign, and radiological features of orbit and the total score was taken. Based on these scores, severity of disease was grouped into A, B, and C corresponding to mild, moderate, and severe orbital ROCM. One milliliter of reconstituted liposomal amphotericin B was given to all patients every alternate day as three doses. Efficacy of these injections was assessed in all groups, even though other treatment modalities like orbital debridement and exenteration were considered for moderate and severe cases. Patients were followed up for a period of 8 weeks. Results: Out of 82 eyes, symptomatic improvement was seen in a major proportion (72%) of patients. A statistically significant improvement in scores was noted in group A (93% improved) with a P value of 0.002, while 68.4% showed improvement in group B (P-value- 0.0001). Group C with severe disease showed minimal improvement in post-injection scores of 41% (P-value 0.086), necessitating surgical intervention. No serious adverse effect of the drug or procedure was noted. Conclusion: Significant improvement in scores of groups A and B highlights TRAMB as an effective and safe treatment modality in mild to moderate ROCM. It is an effective adjunct in severe cases, along with other interventions. Also, the scoring system helps in assessing the severity and guiding in management strategies.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Prospective Studies , SARS-CoV-2
9.
Indian J Ophthalmol ; 70(1): 302-305, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1596279

ABSTRACT

Rhino-orbital mucormycosis has seen a huge resurgence in patients post COVID-19 infection. In patients with minimal orbital disease and especially with preserved vision, retrobulbar injections of amphotericin B can be of great help in controlling the disease. Instead of giving daily injections of amphotericin B using needles every time, we used an 18-gauge intravenous (IV) cannula with injection port and suture holes to deliver the amphotericin into the orbital space for a period of 5 days. Patients were more compliant and less distressed with this method compared with being given an injection with a needle daily. We got a good response in terms of orbital disease regression with this method. In our review of the literature, we did not come across any such case of amphotericin B injection using an IV cannula. Injection of amphotericin B into the orbit using an IV cannula is a viable and easy treatment option for cases of rhino-orbital mucormycosis.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Amphotericin B , Antifungal Agents/therapeutic use , Cannula , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , SARS-CoV-2
10.
Indian J Ophthalmol ; 70(1): 323-326, 2022 01.
Article in English | MEDLINE | ID: covidwho-1594596

ABSTRACT

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications.


Subject(s)
COVID-19 , Cytomegalovirus Infections , Endophthalmitis , Eye Infections, Fungal , Optic Nerve Diseases , Antifungal Agents/therapeutic use , Candida , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Female , Humans , Middle Aged , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/etiology , Random Amplified Polymorphic DNA Technique , SARS-CoV-2 , Vitrectomy
11.
Transpl Infect Dis ; 24(2): e13777, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1583254

ABSTRACT

BACKGROUND: Invasive mucormycosis (IM) is a life-threatening fungal infection occurring mostly in solid organ transplant (SOT) recipients, patients with hematological malignancies, and diabetes. A sudden spurt of mucormycosis has been reported in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic in India; however, there is little data about coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) in kidney transplant recipients (KTRs). METHODS: We describe the clinical presentations, risk factors, treatment and outcomes of 11 mucormycosis cases in KTRs post-COVID-19 infection from February 2020 to June 2021 at a single center in India. RESULTS: Mucormycosis was seen in 11/102 (10.7%) KTRs during the pandemic. Six patients had mild disease and rest five had moderate disease. Seven patients had pre-existing diabetes mellitus and four developed new onset hyperglycemia after receiving steroids for COVID-19 infection. All had poorly controlled sugars at the time of presentation. Most common presentation was rhino-orbital-cerebral mucormycosis (ROCM) in 10/11 (89%) patients and one has pulmonary mucormycosis. All patients received combination of amphotericin B and surgical debridement/excision of affected tissue followed by posaconazole prophylaxis. Nine patients recovered, however two patients succumbed to their illness after median of 14 (7-21) days from diagnosis. One patient developed acute T-cell-mediated rejection during the course of recovery. At last follow up, the mean serum creatinine was 2.05 mg/dl as compared to 1.4 mg/dl at presentation. CONCLUSIONS: IM is a common fungal infection in transplant recipients in India after COVID-19. Early diagnosis and prompt treatment with combination of surgical debridement and liposomal amphotericin B are key to better outcomes in CAM. Judicious use of steroids and control of hyperglycemia is key to avoid flaring up of the fungal infection.


Subject(s)
COVID-19 , Eye Infections, Fungal , Kidney Transplantation , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Kidney Transplantation/adverse effects , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Risk Factors , SARS-CoV-2 , Transplant Recipients
12.
J Mycol Med ; 32(2): 101238, 2022 May.
Article in English | MEDLINE | ID: covidwho-1586952

ABSTRACT

OBJECTIVE: To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management. MATERIALS AND METHODS: It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave. RESULTS: A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up. CONCLUSION: ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , COVID-19/epidemiology , Eye Infections, Fungal/drug therapy , Female , Humans , Male , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Mucormycosis/surgery , Orbital Diseases/drug therapy , Pandemics , SARS-CoV-2 , Tertiary Care Centers
15.
Indian J Ophthalmol ; 69(12): 3664-3676, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538653

ABSTRACT

PURPOSE: Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. METHODS: We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. RESULTS: The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5-72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7-63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. CONCLUSION: Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Bacterial , Eye Infections, Fungal , Adult , Anti-Bacterial Agents/therapeutic use , COVID-19/drug therapy , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Eye Infections, Fungal/drug therapy , Humans , India/epidemiology , Male , Retrospective Studies , SARS-CoV-2 , Visual Acuity , Young Adult
16.
Indian J Ophthalmol ; 69(12): 3759-3761, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538649

ABSTRACT

We present a case of endogenous fungal endophthalmitis in a nondiabetic, nonhypertensive patient who recovered from COVID-19 infection. Endogenous fungal endophthalmitis in an immunocompetent individual is quite uncommon. The organism in our patient was resistant to amphotericin and voriconazole and was successfully treated with intravitreal caspofungin. The rarity of an opportunistic nosocomial infection in an immunocompetent person with a drug-resistant organism prompted us to write this report.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Antifungal Agents/therapeutic use , Caspofungin/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Intravitreal Injections , SARS-CoV-2 , Voriconazole
17.
Mikrobiyol Bul ; 55(4): 673-682, 2021 Oct.
Article in Turkish | MEDLINE | ID: covidwho-1478369

ABSTRACT

Coronavirus 2019 (COVID-19) infection causes excessive cytokine response and a decrease in cellular immune response and this increases susceptibility to fungal co-infections. Mucormycosis is a rare, lifethreatening invasive fungal infection. In this report, two cases who developed rhino-orbito-cerebral mucormycosis shortly after having COVID-19 infection were presented. The first case was a 68-year old woman who admitted to our clinic with orbital cellulitis in her left eye and had a known diagnosis of asthma and rheumatoid arthritis. She was diagnosed with COVID-19 pneumonia 40 days ago, stayed in the intensive care unit for a long time, and received pulse steroid (1000 mg methylprednisolone), interleukin-1 (IL-1) inhibitor (anakinra) and broad-spectrum antibiotic treatments together with antiviral therapy during this period. The second case was a 63-year-old male patient with known diabetes mellitus, hypertension and retinitis pigmentosa, with a history of hospitalization in the intensive care unit due to COVID-19 pneumonia 20 days ago and received pulse steroid therapy during this period. He admitted to our clinic with the complaints of droopy right eyelid, swelling, nausea and vomiting. In both cases, paranasal sinus tomography findings were consistent with invasive sinusitis. Functional endoscopic sinus surgery was performed immediately in less than 16 hours from the first admission in both cases. Histopathological examination of the both cases revealed results consistent with mucormycosis. Mucorales spp. was isolated in sinus tissue culture of the second case taken during the operation. Both of the patients received liposomal amphotericin B. First case died on the 19th day of the treatment. Second case was discharged with full recovery after nine weeks of treatment. The suppression of cellular immunity during the COVID-19 infection, and the use of steroids and interleukin inhibitors in the treatment of severe cases may increase secondary invasive fungal infections. Therefore, clinicians should more frequently consider possible fungal infections in patients with COVID-19.


Subject(s)
COVID-19 , Eye Infections, Fungal , Orbital Diseases , Aged , Antifungal Agents/therapeutic use , Eye Infections, Fungal/drug therapy , Female , Humans , Male , Middle Aged , Orbital Diseases/drug therapy , SARS-CoV-2
18.
J Mycol Med ; 31(4): 101203, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1386354

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a major public health problem worldwide. These patients are at increased risk of developing secondary infections due to a combination of virus- and drug-induced immunosuppression. Recently, several countries have reported an emergence of COVID-19 associated mucormycosis (CAM), particularly among patients with uncontrolled diabetes, with India reporting an alarming increase in rhino-orbito-cerebral mucormycosis (ROCM) in post-COVID cases. Hyperglycemia and diabetic ketoacidosis (DKA) are the major underlying risk factors. So far, case reports and review articles have reported CAM only in adult patients. Here, we describe the first cases of COVID-19-associated ROCM in two pediatric patients with Type 1 diabetes mellitus (DM). Both the cases had asymptomatic infection with SARS-CoV-2 and developed ROCM during the course of treatment of DKA. None of them had exposure to systemic steroids. Imaging findings in both cases revealed involvement of orbit, paranasal sinuses, and brain with cavernous sinus thrombosis. The patients underwent craniotomy with evacuation of abscess. Microbiological and histopathological findings were consistent with the diagnosis of mycormycosis, with fungal culture growing Rhizopus arrhizus. Post-operatively, the patients received liposomal amphotericin B (LAMB) and systemic antibiotics. Retrobulbar injection of LAMB was given in an attempt to halt orbital disease progression. However, it wasn't successful and both of them had to undergo orbital exenteration eventually. ROCM is a rapidly progressive disease and prompt diagnosis with aggressive surgery and timely initiation of antifungal therapy can be life-saving. Physicians should have a high index of suspicion, so as to avoid a delayed diagnosis, particularly in post-COVID patients with uncontrolled diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Adolescent , Antifungal Agents/therapeutic use , COVID-19/complications , Child , Diabetes Mellitus, Type 1/complications , Eye Infections, Fungal/drug therapy , Female , Humans , India , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/drug therapy
19.
BMJ Case Rep ; 14(7)2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1334549

ABSTRACT

A wide range of bacterial and fungal coinfections may be associated with COVID-19. We report a case of rhino-orbital mucormycosis in a patient with COVID-19. A 67-year-old man, known case of diabetes, hypertension and ischaemic heart disease, was being treated for COVID-19 pneumonia when he developed right cheek eschar and ophthalmoplegia. Imaging studies revealed pansinusitis of bilateral maxillary and sphenoid sinuses with thickening and enhancement of right-sided soft tissue, lacrimal gland, mastication muscles, temporal lobe infiltrate and cerebellum infarct. Emergency right face debridement, right eye exenteration and bilateral functional endoscopic sinus surgery were done. Histopathological examination confirmed mucormycosis diagnosis. He was given amphotericin B and broad-spectrum antibiotics. It is important to have high index of suspicion for fungal coinfections in patients with COVID-19 with pre-existing medical conditions. There is a need to emphasise judicious and evidence-based use of immunomodulators in patients with COVID-19 to avoid triggering and flaring up of fungal infections.


Subject(s)
COVID-19 , Diabetes Mellitus , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Aged , Antifungal Agents/therapeutic use , Diabetes Mellitus/microbiology , Eye Infections, Fungal/drug therapy , Humans , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/drug therapy
20.
Orbit ; 40(6): 499-504, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1334049

ABSTRACT

PURPOSE: To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM). METHOD: Retrospective study. RESULTS: A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections. CONCLUSIONS: Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Adult , Antifungal Agents/therapeutic use , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/etiology , Retrospective Studies , SARS-CoV-2
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