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1.
Acad Radiol ; 29(5): 674-684, 2022 May.
Article in English | MEDLINE | ID: covidwho-1568451

ABSTRACT

OBJECTIVE: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis. METHOD: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability. RESULTS: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively. CONCLUSION: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Magnetic Resonance Imaging , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnosis , Reproducibility of Results
2.
Curr Probl Diagn Radiol ; 51(1): 112-120, 2022.
Article in English | MEDLINE | ID: covidwho-1528054

ABSTRACT

BACKGROUND AND PURPOSE: Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India. MATERIALS AND METHODS: A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed. RESULTS: Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were "Black turbinate sign" and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%). CONCLUSIONS: CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Magnetic Resonance Imaging , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Retrospective Studies , SARS-CoV-2
3.
AJR Am J Roentgenol ; 217(6): 1431-1432, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526736

ABSTRACT

An increasing incidence of rhinoorbitocerebral mucormycosis (ROCM) among patients with COVID-19 has recently been reported in India. We report the imaging findings for 25 patients with COVID-19 and invasive ROCM at a single hospital in India. Findings included sinus wall erosions (n = 20), air within bony sinus structures (n = 11), and focal mucosal nonenhancement (n = 8). Orbital, vascular, and intracranial complications were also observed. Radiologists should recognize the increasing incidence of ROCM among patients with COVID-19 to facilitate early diagnosis.


Subject(s)
COVID-19/complications , Central Nervous System Fungal Infections/diagnostic imaging , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Adult , Aged , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/microbiology , Female , Humans , Incidence , India/epidemiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mucormycosis/epidemiology , Optic Nerve Diseases/diagnostic imaging , Optic Nerve Diseases/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Paranasal Sinus Diseases/epidemiology , Paranasal Sinus Diseases/microbiology , Paranasal Sinuses/diagnostic imaging , Paranasal Sinuses/microbiology , Retrospective Studies , Tomography, X-Ray Computed/methods
4.
Clin Imaging ; 82: 172-178, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1499741

ABSTRACT

PURPOSE: The study aims to depict the radiological features of Cov-ROCM, depict the common routes of spread to orbits and intracranial compartment and look for an association of the risk factors with radiological severity of the disease. METHODS: 96 patients who had COVID-19 infection in the past 3 months and were diagnosed with ROCM underwent CECT PNS examinations which were assessed by two experienced radiologists. They were divided into three groups based on the intraorbital and intracranial involvement and were correlated with various risk factors. RESULTS: The incidence of bony erosions which was the commonest finding (75%) was double in Cov-ROCM than the ROCM cases of pre COVID era (33-40%). The most common route of spread to orbit was through angioinvasion(52%) with intact orbital walls; and intracranial extension was via erosion of the cribriform plate(52%). Sphenoid sinus involvement is strongly associated with intracranial and intraorbital involvement.(p-value = .0004). History of longer ICU stays and being on mechanical ventilation as a part of COVID management is associated with aggressive disease pattern(p-value = .002). Similarly, poor glycaemic control signified by raised HbA1c levels showed statistically significant correlation with severe Cov-ROCM(intraorbital/intracranial extension) (p-value = .040). CONCLUSION: Amidst the COVID pandemic, it is pertinent to look at bony erosions in case of any sinusitis, especially bony maxillary walls and the turbinates. The intraorbital compartment must be viewed thoroughly even in the absence of bony erosions due to the angioinvasive nature of these fungi. Aggressive follow-up for patients with ICU stays for COVID and for glycaemic control would help reduce the morbidity.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/diagnostic imaging , Mucormycosis/epidemiology , Orbit , Orbital Diseases/diagnostic imaging , SARS-CoV-2
5.
Br J Radiol ; 94(1127): 20210648, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1456034

ABSTRACT

ADVANCES IN KNOWLEDGE: Radiological findings of mucormycosis in post COVID-19 patients show varied patterns of disease involvement and spectrum of imaging features. One should not solely rely on CT imaging to detect the extent of disease. MRI helps in early and accurate detection of invasion into adjacent structures and so helpful in early intervention.


Subject(s)
COVID-19/complications , Magnetic Resonance Imaging/methods , Mucormycosis/diagnostic imaging , Mucormycosis/etiology , Paranasal Sinus Diseases/diagnostic imaging , Paranasal Sinus Diseases/etiology , Humans , Paranasal Sinuses/diagnostic imaging , SARS-CoV-2
6.
AJR Am J Roentgenol ; 217(6): 1431-1432, 2021 12.
Article in English | MEDLINE | ID: covidwho-1456222

ABSTRACT

An increasing incidence of rhinoorbitocerebral mucormycosis (ROCM) among patients with COVID-19 has recently been reported in India. We report the imaging findings for 25 patients with COVID-19 and invasive ROCM at a single hospital in India. Findings included sinus wall erosions (n = 20), air within bony sinus structures (n = 11), and focal mucosal nonenhancement (n = 8). Orbital, vascular, and intracranial complications were also observed. Radiologists should recognize the increasing incidence of ROCM among patients with COVID-19 to facilitate early diagnosis.


Subject(s)
COVID-19/complications , Central Nervous System Fungal Infections/diagnostic imaging , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Adult , Aged , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/microbiology , Female , Humans , Incidence , India/epidemiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mucormycosis/epidemiology , Optic Nerve Diseases/diagnostic imaging , Optic Nerve Diseases/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Paranasal Sinus Diseases/epidemiology , Paranasal Sinus Diseases/microbiology , Paranasal Sinuses/diagnostic imaging , Paranasal Sinuses/microbiology , Retrospective Studies , Tomography, X-Ray Computed/methods
7.
Emerg Radiol ; 28(6): 1097-1106, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1449970

ABSTRACT

Rhino-orbito-cerebral mucormycosis (ROCM) has regained significance following its resurgence in the second wave of the COVID-19 pandemic in India. Rapid and progressive intracranial spread occurs either by direct extension across the neural foraminae, cribriform plate/ethmoid, walls of sinuses, or angioinvasion. Having known to have a high mortality rate, especially with intracranial extension of disease, it becomes imperative to familiarise oneself with its imaging features. MRI is the imaging modality of choice. This pictorial essay aims to depict and detail the various intracranial complications of mucormycosis and to serve as a broad checklist of structures and pathologies that must be looked for in a known or suspected case of ROCM.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , Humans , Mucormycosis/diagnostic imaging , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/drug therapy , Orbital Diseases/epidemiology , Pandemics , SARS-CoV-2
8.
Pan Afr Med J ; 39: 183, 2021.
Article in English | MEDLINE | ID: covidwho-1395298

ABSTRACT

Mucormycosis is relatively uncommon, fulminant, progressive, life threatening fungal disease which is most often seen in debilitating patients with immunocompromised condition. Mucormycosis cases are seen in patients with the use of systemic steroids in the treatment of severely affected COVID-19 cases and also in the patients with uncontrolled diabetes which causes immunosuppression are being reported with mucormycosis. The main symptoms of this disease include pain on the temporal and the orbital region of the affected side which could be throbbing or lancinating type, mobility of the teeth, jaw pain and often swelling is present which could be extraoral and intraoral both or sometimes only intraorally. The diagnostic approach in such cases is done with the help of clinical diagnosis, histopathology and with advanced imaging like cone beam computed tomography, magnetic resonance imaging and computed tomography. We here used cone beam computed tomography imaging that revealed haziness in the sinuses and breach in cortical bone of the affected area which confirmed the diagnosis of mucormycosis. Early treatment planning like administration of antifungal drugs and surgical debridement will be life saving in such a deadly disease.


Subject(s)
COVID-19/complications , Cone-Beam Computed Tomography/methods , Mucormycosis/diagnostic imaging , Antifungal Agents/administration & dosage , Cortical Bone/diagnostic imaging , Debridement , Humans , Male , Middle Aged , Mucormycosis/therapy , Paranasal Sinus Diseases/diagnostic imaging , Paranasal Sinus Diseases/microbiology , Paranasal Sinus Diseases/therapy
10.
Clin Radiol ; 76(10): 784.e27-784.e33, 2021 10.
Article in English | MEDLINE | ID: covidwho-1336359

ABSTRACT

AIM: To analyse combined computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of invasive rhino-orbital mucormycosis (IROM) in post-COVID-19 infection patients for accurate diagnosis and delineation of the extent of involvement. MATERIALS AND METHODS: A retrospective analysis was undertaken of 50 patients who developed IROM post-COVID-19 infection who underwent combined CT/MRI evaluation. RESULTS: The age range of the 50 affected patients was 23-73 years. Out of these, 41 were diabetic. CT/MRI showed predominant involvement of the maxillary (n=26) and ethmoid (n=19) sinuses. Extension of disease to the orbit (n=35), cavernous sinus (n=18), hard palate (n=15), skull base (n=8), and intracranial involvement (n=3) was seen. Perineural spread of the disease was analysed along all divisions of the trigeminal nerve and its branches. MRI showed T2-hypointense soft-tissue thickening with heterogeneous contrast enhancement with corresponding hyperdensities on CT diagnosing the presence of fungal elements. CONCLUSION: Clinicians should be aware of the possibility of IROM post-COVID-19 infection. Conjunctive use of CT, which depicts bone destruction and other reactive bony changes along with MRI, which reveals characteristic findings of soft-tissue thickening of the involved sinuses with extension of disease to the orbits, cavernous sinus, dura, hard palate, skull base, and intracranial structures. Accurate diagnosis and early recognition of the disease and its extension with appropriate use of these techniques helps to initiate appropriate and timely treatment, which is vital to prevent a fatal outcome.


Subject(s)
COVID-19/complications , Mucormycosis/diagnostic imaging , Multimodal Imaging , Orbital Diseases/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Adult , Aged , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Orbital Diseases/microbiology , Paranasal Sinus Diseases/microbiology , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
11.
Clin Radiol ; 76(11): 812-819, 2021 11.
Article in English | MEDLINE | ID: covidwho-1330728

ABSTRACT

A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic "black turbinate" on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients.


Subject(s)
Brain Diseases/diagnostic imaging , COVID-19/complications , Magnetic Resonance Imaging/methods , Mucormycosis/complications , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Tomography, X-Ray Computed/methods , Brain/diagnostic imaging , Brain/microbiology , Brain Diseases/microbiology , Humans , Orbit/diagnostic imaging , Orbit/microbiology , Orbital Diseases/microbiology , SARS-CoV-2
12.
Mycoses ; 64(11): 1366-1377, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1305494

ABSTRACT

BACKGROUND: COVID-19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino-orbital mucormycosis in patients with COVID-19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID-19 associated with mucormycosis infection. METHODS: The medical records of COVID-19 patients with rhino-orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics. RESULTS: Twelve patients with COVID-19-associated rhino-orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID-19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy-five per cent of patients received corticosteroids for COVID- 19 treatment. The sites of involvement were rhino-sino-orbital (83%) and rhino-sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first-line therapy. The overall mortality rate was 66.7% (8/12). CONCLUSIONS: We found a high incidence of mucormycosis among COVID-19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life-threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.


Subject(s)
COVID-19/complications , Mucormycosis/epidemiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Rhinitis/epidemiology , Rhinitis/microbiology , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Hospitals, Teaching , Humans , Incidence , Iran/epidemiology , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnostic imaging , Orbital Diseases/complications , Orbital Diseases/diagnostic imaging , Retrospective Studies , Rhinitis/complications , Rhinitis/diagnostic imaging
13.
Indian J Ophthalmol ; 69(7): 1915-1927, 2021 07.
Article in English | MEDLINE | ID: covidwho-1278615

ABSTRACT

Coronavirus disease-associated mucormycosis (CAM) is an established clinical entity in India. In the past 4 months, there has been a sharp upsurge in the number of CAM cases in most parts of the country. Early diagnosis can be lifesaving. Magnetic resonance imaging (MRI) imaging remains the corner stone of management in patients with ROCM. This review discussed the utility of MRI imaging in ROCM with an emphasis on the ideal MRI protocol in a suspected case of ROCM, the pathways of spread of infection, the classic diagnostic features, MRI for staging of the disease, MRI for prognostication, MRI for follow up, and imaging features of common differentials in ROCM. The pit falls of MRI imaging and a comparison of CT and MRI imaging in ROCM are discussed. The clinical interpretation of areas of contrast uptake and those of necrosis and its relevance to treatment are discussed. This review aims to familiarize every member of the multidisciplinary team involved in managing these patients to be able to interpret the findings on MRI in ROCM.


Subject(s)
Mucormycosis , Nose Diseases , Orbital Diseases , Antifungal Agents/therapeutic use , Humans , India , Magnetic Resonance Imaging , Mucormycosis/diagnostic imaging , Nose Diseases/drug therapy , Orbital Diseases/diagnostic imaging , Orbital Diseases/drug therapy
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