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1.
Indian J Ophthalmol ; 70(4): 1371-1375, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760981

ABSTRACT

Purpose: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.


Subject(s)
COVID-19 , Mucormycosis , COVID-19/epidemiology , Epidemiologic Studies , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/microbiology , Tertiary Healthcare
2.
Indian J Ophthalmol ; 70(4): 1365-1370, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760976

ABSTRACT

Purpose: To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization. Methods: A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher's test. Results: A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial muscles. Conclusion: FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.


Subject(s)
COVID-19 , Facial Paralysis , Mucormycosis , COVID-19/complications , COVID-19/diagnosis , Facial Paralysis/diagnosis , Facial Paralysis/etiology , Humans , Magnetic Resonance Imaging , Mucormycosis/complications , Mucormycosis/diagnosis , Prospective Studies
3.
Indian J Ophthalmol ; 70(4): 1425-1427, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760973

ABSTRACT

"Guitar pick sign," also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19-associated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.


Subject(s)
COVID-19 , Mucormycosis , Orbital Cellulitis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/microbiology , Orbit , Tomography, X-Ray Computed
4.
Acta Medica (Hradec Kralove) ; 64(4): 227-231, 2021.
Article in English | MEDLINE | ID: covidwho-1743012

ABSTRACT

Coronavirus infectious disease-19 caused by Severe acute respiratory distress syndrome-coronavirus-2 has emerged to be an emergency global health crisis for more than a year. And, as the disease has spread, a number of new clinical features have been observed in these patients. Immunosuppression caused by this disease results in an exacerbation of pre-existing infections. While corticosteroids are considered a life-saving therapeutic intervention for this pandemic, they have proved to be a double-edged sword and their indiscriminate use has produced some deleterious results. Recently, in the backdrop of this expression, a notable rise in invasive fungal infections has been identified even in the post-remission phase. Mucormycosis, Aspergillosis, and Candidiasis are the three most common opportunistic fungal infections among those observed. COVID-19 patients with diabetes mellitus are already at a higher risk of developing such secondary infections due to impaired immunity. Here we present a rare case report of a 50-year old male diabetic mellitus patient diagnosed with dual fungal infections (Aspergillosis along with Mucormycosis) leading to maxillary sinusitis as a post-COVID manifestation. To our knowledge, this is the first such case reported till date.


Subject(s)
Aspergillosis , COVID-19 , Diabetes Mellitus , Maxillary Sinusitis , Mucormycosis , Mycoses , Aspergillosis/complications , Aspergillosis/diagnosis , Aspergillosis/therapy , COVID-19/complications , Humans , Male , Maxillary Sinusitis/complications , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/therapy , Mycoses/complications , SARS-CoV-2
5.
Front Cell Infect Microbiol ; 12: 850581, 2022.
Article in English | MEDLINE | ID: covidwho-1742206

ABSTRACT

Mucormycosis is an emerging infection caused by fungi of the order Mucorales that has recently gained public relevance due to the high incidence among COVID-19 patients in some countries. The reduced knowledge about Mucorales pathogenesis is due, in large part, to the historically low interest for these fungi fostered by their reluctance to be genetically manipulated. The recent introduction of more tractable genetic models together with an increasing number of available whole genome sequences and genomic analyses have improved our understanding of Mucorales biology and mucormycosis in the last ten years. This review summarizes the most significant advances in diagnosis, understanding of the innate and acquired resistance to antifungals, identification of new virulence factors and molecular mechanisms involved in the infection. The increased awareness about the disease and the recent successful genetic manipulation of previous intractable fungal models using CRISPR-Cas9 technology are expected to fuel the characterization of Mucorales pathogenesis, facilitating the development of effective treatments to fight this deadly infection.


Subject(s)
COVID-19 , Mucorales , Mucormycosis , Antifungal Agents/therapeutic use , Genomics , Humans , Mucorales/genetics , Mucormycosis/diagnosis , Mucormycosis/microbiology , Mucormycosis/pathology
6.
Ophthalmic Surg Lasers Imaging Retina ; 53(3): 173-174, 2022 03.
Article in English | MEDLINE | ID: covidwho-1737123

ABSTRACT

[Ophthalmic Surg Lasers Imaging Retina. 2022;53:173-174.].


Subject(s)
COVID-19 , Mucormycosis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , SARS-CoV-2 , Vision Disorders
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): 1013-1018, 2022 03.
Article in English | MEDLINE | ID: covidwho-1715919

ABSTRACT

Purpose: Known predisposing factors for mucormycosis are neutropenia and diabetes. Though COVID-19 is associated with hyperinflammatory response, a high surge in rhino-orbital-cerebral mucormycosis (ROCM) cases was observed during the second wave. The histopathological features reflect the background pathogenesis. This study analyzes the histopathological features and clinical presentation of COVID-19-associated ROCM. Methods: In this retrospective observational study, the clinical details of 89 proven ROCM patients treated during May-July 2021 were collected from the case records. Histopathological features were correlated with clinical staging groups and outcomes. The mean neutrophil-to-lymphocyte ratio (NLR) of clinical and outcome groups were compared. Results: The mean age was 54.71 ± 11.03 years, with male patients constituting a majority (78.7%). Uncontrolled diabetes mellitus was noted in 70.8% of patients, and 3.4% had normal range of blood sugar. The mean blood sugar was 298.08 ± 99.51 mg/dL. The mean duration of onset of symptoms of mucormycosis from the diagnosis of COVID-19 was 17.36 ± 7.392 (3-45) days. Poor outcome with disease progression or death occurred in 21.3% of patients. Clinical group II patients (44.9%) with ROCM stages 3c and above had poor outcomes (P = 0.005). Histopathological analysis showed minimal inflammation in 25.8%, neutrophil extracellular trap (NET) in 75.3%, and angio-invasion in 28.1% of patients. Minimal inflammation was associated with clinical group II (P = 0.004) and poor outcome (P = 0.001). Angio-invasion correlated with poor outcome (P = 0.007). Patients with severe clinical group and poor outcome had higher mean NLR with P = 0.017 and P = 0.007, respectively. Conclusion: Vision loss and cerebral involvement had poor outcomes. The histopathologic features such as inflammation and angio-invasion along with NLR aid as prognostic indicators in the management of ROCM. The role of NET in the pathogenesis of COVID-19-associated ROCM needs further studies.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Adult , Aged , COVID-19/complications , COVID-19/diagnosis , Eye Infections, Fungal/diagnosis , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Orbital Diseases/drug therapy , SARS-CoV-2
9.
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
10.
Indian J Ophthalmol ; 70(3): 1024-1025, 2022 03.
Article in English | MEDLINE | ID: covidwho-1715909
11.
Saudi J Kidney Dis Transpl ; 32(4): 1152-1157, 2021.
Article in English | MEDLINE | ID: covidwho-1715894

ABSTRACT

Coronavirus disease-2019 (COVID-19) emerged as a pandemic with varied clinical presentations. Patients with an underlying comorbidity such as diabetes and chronic kidney diseases (CKDs) had an increased risk of developing secondary bacterial and fungal coinfections which was further accentuated by the use of steroids during the management and with prolonged intensive care unit stay. This case series describes the clinical course of two patients with CKD who developed acute respiratory syndrome coronavirus-2 infection and mucormycosis.


Subject(s)
COVID-19 , Mucormycosis , COVID-19/complications , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Pandemics , Renal Dialysis/adverse effects , SARS-CoV-2
12.
Indian J Ophthalmol ; 69(12): 3728-3733, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1700647

ABSTRACT

Mucormycosis, commonly known as 'Black Fungus' which was then a rare fungal infection, has suddenly come to light post the COVID-19- pandemic, more so during the second wave in India. It thus becomes important not only for the medical fraternity but also the general population to build awareness about the same. The present review will focus on the pathophysiology, etiology, outcomes of some case studies, and current treatment methods of mucormycosis infection. Major focus of the current article is on rhino-orbital-cerebral mucormycosis. All the studies included in the present review article was extracted from the PubMed database.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Nose , SARS-CoV-2
13.
J Infect Public Health ; 15(4): 466-479, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693246

ABSTRACT

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is yet to be controlled worldwide, especially in India. The second wave of coronavirus disease 2019 (COVID-19) led to panic and confusion in India, owing to the overwhelming number of the population that fell prey to this highly infectious virus of recent times. In the second wave of COVID-19, the patients had to fight both the virus and opportunistic infections triggered by fungi and bacteria. Repeated use of steroids, antibiotics, and oxygen masks during the management of severely and critically ill COVID-19 patients nurtured opportunistic infections such as mucormycosis. Despite mucormycosis being a decades-old disease, it has gained notice of its widespread occurrence in COVID-19 patients throughout India. Instances of mucormycosis are usually unearthed in immunocompromised individuals and are caused by the inhalation of filamentous fungi, either from the natural environment or through supportive care units. In the recent outbreak during the second wave of COVID-19 in India, it has been seen to cause secondary infection as it grows along with the treatment of COVID-19. Furthermore, COVID-19 patients with comorbidities such as diabetes were more likely to have the mucormycosis co-infection because of their challenged immune systems' inability to fight it. Despite the hype, mucormycosis still remains neglected and least studied, which is predominantly due to all focus on diagnostics, vaccine, and therapeutic research. In this review, we emphasize mainly on the association of mucormycosis in COVID-19 patients. We also present the molecular mechanism of mucormycosis for a better understanding of the fungal infections in patients who have recently been infected with SARS-CoV-2. Better understanding of fungal pathogens, immediate diagnosis, and management of the infections are crucial in COVID-19 patients, as high mortalities have been recorded in co-infected patients despite recovery from COVID-19.


Subject(s)
COVID-19 , Coinfection , Mucormycosis , Opportunistic Infections , Coinfection/epidemiology , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Pandemics , SARS-CoV-2
15.
BMJ Case Rep ; 15(2)2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1685521

ABSTRACT

We describe a case of cutaneous mucormycosis in a middle-aged man with ethanol-related chronic liver disease. He presented with symptoms of fever, breathlessness for 10 days and altered mental status for 2 days. On admission, he was in septic shock and had acute respiratory distress syndrome (ARDS). He was noted to have ruptured blisters in his left axilla. Although he repeatedly had negative COVID-19 Reverse Transcription-PCR results, he had positive IgG antibodies for COVID-19. He was managed with broad-spectrum antibiotics, steroids, vasopressors and ventilation for ARDS. Over the course of his hospitalisation, the axillary lesion progressed to a necrotising ulcer with deep tissue invasion. Debridement and culture of the axillary ulcer revealed mucor species, and he was started on amphotericin and posaconazole for mucormycosis. Unfortunately, he continued to deteriorate despite aggressive management and died after a prolonged hospital stay of 40 days.


Subject(s)
COVID-19 , Mucormycosis , Ethanol , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , SARS-CoV-2
16.
J Laryngol Otol ; 135(5): 442-447, 2021 May.
Article in English | MEDLINE | ID: covidwho-1637623

ABSTRACT

OBJECTIVE: To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease. METHODS: A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection. RESULTS: Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment. CONCLUSION: New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.


Subject(s)
COVID-19/microbiology , Mucorales/isolation & purification , Mucormycosis/microbiology , Paranasal Sinuses/microbiology , Administration, Intravenous , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Diabetes Mellitus/epidemiology , Female , Humans , India/epidemiology , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/epidemiology , Invasive Fungal Infections/microbiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mucorales/drug effects , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/etiology , Pandemics , Paranasal Sinuses/diagnostic imaging , Prospective Studies , SARS-CoV-2 , Sinusitis/diagnosis , Sinusitis/microbiology , Steroids/adverse effects , Steroids/therapeutic use
17.
Indian J Ophthalmol ; 69(12): 3728-3733, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1635871

ABSTRACT

Mucormycosis, commonly known as 'Black Fungus' which was then a rare fungal infection, has suddenly come to light post the COVID-19- pandemic, more so during the second wave in India. It thus becomes important not only for the medical fraternity but also the general population to build awareness about the same. The present review will focus on the pathophysiology, etiology, outcomes of some case studies, and current treatment methods of mucormycosis infection. Major focus of the current article is on rhino-orbital-cerebral mucormycosis. All the studies included in the present review article was extracted from the PubMed database.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Nose , SARS-CoV-2
19.
Microb Pathog ; 163: 105388, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1611919

ABSTRACT

BACKGROUND: GI mucormycosis (GI) is a rare but highly lethal infection in patients. There is no single comprehensive review of the literature that demonstrates the various clinical aspects of this infection. METHODS: A structured search of PubMed/Medline was used to collect case reports of GI mucormycosis in patients of all ages published between 2015 and November 2021. RESULTS: Eighty-seven cases were identified through PubMed bibliographic database searches, and final analyses were conducted on 70 adults and ten neonatal patients with GI mucormycosis. Asia had the highest number of reported cases, with 46 (57.5%). Neonatal cases had a mortality rate of 70%, while other cases had a mortality rate of 44%. Corticosteroid therapy and diabetes were the most significant risk factors in patients, while 11% were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in four adult patients. Moreover, neonatal cases included premature and low-weight infants, metabolic acidosis, and malnutrition. Abdominal pain, fever, and GI perforation were the most common signs of infection, while vomiting occurred in 40% of neonatal cases. In 97% of patients, a histopathologic examination was used to detect infection, whereas culture and molecular methods were used in only 28% and 17% of patients, respectively. Surgery plus anti-infection therapy, anti-infection therapy alone, and surgery alone were used in 61%, 28%, and 11% of patients, respectively. Nonetheless, all neonatal patients underwent surgery. Although used in a small number of patients, posaconazole (30%) and isavuconazole (11%) demonstrated high efficacy in treating patients. CONCLUSION: GI mucormycosis is a rare but highly lethal disease. Treatment of underlying conditions, the use of multiple diagnostic techniques, and appropriate antifungals in conjunction with surgery can all contribute to infection control.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Adult , Antifungal Agents/therapeutic use , Humans , Infant , Infant, Newborn , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , SARS-CoV-2
20.
Am J Otolaryngol ; 43(2): 103371, 2022.
Article in English | MEDLINE | ID: covidwho-1611586

ABSTRACT

BACKGROUND: Mucormycosis of the nose and paranasal sinuses has emerged as an epidemic following COVID-19 pandemic. The management involves surgical debridement, the extent of which depends on the bulk of the disease. Extension to the orbit and palate depends on the involvement of specific sites in the nose and paranasal sinuses. This study intended to identify those sites. MATERIALS AND METHODS: This was a single-center case-control study. There were 3 groups according to the region involved (Palate, orbit and both). The fourth group with neither involvement was the control. Scoring system was used to estimate the bulk of disease according to the site involved in MRI scan. Odds ratio and chi-square tests were used to study risk and association respectively. ROC curve was obtained for the MRI scores of the cases and controls. RESULTS: 214 patients were studied in all; 44.39% and 61.68% had palate and orbit involvement, respectively. Maxillary sinus roof had significant association and the highest risk for spread of disease into the palate. The risk for the orbit to be involved was increased when there was disease in the cavernous and sphenoid sinus. For the orbit, the site with the significant association was the ethmoid sinus, infratemporal fossa and roof of the maxillary sinus. CONCLUSION: Due attention should be given for clearance during surgical debridement to the high-risk sites to prevent recurrences and reduce morbidity and mortality. MRI scores were most helpful to identify the bulk of disease when both palate and orbit were involved.


Subject(s)
COVID-19 , Mucormycosis , COVID-19/epidemiology , Case-Control Studies , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Palate , Pandemics , Risk Factors , SARS-CoV-2
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