Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 45
Filter
Add filters

Document Type
Year range
1.
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
2.
Indian J Pharmacol ; 53(6): 499-510, 2021.
Article in English | MEDLINE | ID: covidwho-1603884

ABSTRACT

BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19-associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. "R-metafor package" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041-0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212-4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205-0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.


Subject(s)
Brain Diseases/complications , COVID-19/complications , Mucormycosis/complications , Nose Diseases/complications , Orbital Diseases/complications , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Brain Diseases/drug therapy , COVID-19/virology , Humans , Mucormycosis/drug therapy , Nose Diseases/drug therapy , Orbital Diseases/drug therapy , Regression Analysis , Risk Factors , SARS-CoV-2/isolation & purification
3.
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
4.
Chest ; 161(1): e5-e11, 2022 01.
Article in English | MEDLINE | ID: covidwho-1595933

ABSTRACT

CASE PRESENTATION: A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.


Subject(s)
Acute Kidney Injury/virology , Antifungal Agents/therapeutic use , COVID-19/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Aged , Amphotericin B/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Atrial Fibrillation/complications , Bronchoscopy , Dexamethasone/therapeutic use , Diabetes Mellitus, Type 2/complications , Fatal Outcome , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Male , Nitriles/therapeutic use , Obesity/complications , Oxygen Inhalation Therapy , Pyridines/therapeutic use , Respiration, Artificial , SARS-CoV-2 , Smoking/adverse effects , Tomography, X-Ray Computed , Triazoles/therapeutic use , Voriconazole/therapeutic use
5.
PLoS Negl Trop Dis ; 15(11): e0009921, 2021 11.
Article in English | MEDLINE | ID: covidwho-1523404

ABSTRACT

Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19-induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19-associated mucormycosis in India.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Mucormycosis/epidemiology , Mucormycosis/virology , Antifungal Agents/therapeutic use , COVID-19/microbiology , Coinfection/drug therapy , Coinfection/microbiology , Comorbidity , Diabetes Complications/microbiology , Humans , India/epidemiology , Mucormycosis/drug therapy , Risk Factors
6.
J Clin Microbiol ; 59(9): e0123021, 2021 08 18.
Article in English | MEDLINE | ID: covidwho-1501536

ABSTRACT

The global incidence of mucormycosis has increased in recent years owing to higher numbers of individuals at risk for these infections. The diagnosis and treatment of this aggressive fungal infection are of clinical concern due to differences in species distribution in different geographic areas and susceptibility profiles between different species that are capable of causing highly aggressive infections. The purpose of this study was to evaluate the epidemiology and susceptibility profiles of Mucorales isolates in the United States over a 52-month period. Species identification was performed by combined phenotypic characteristics and DNA sequence analysis, and antifungal susceptibility testing was performed by CLSI M38 broth microdilution for amphotericin B, isavuconazole, itraconazole, and posaconazole. During this time frame, 854 isolates were included, representing 11 different genera and over 26 species, of which Rhizopus (58.6%) was the predominant genus, followed by Mucor (19.6%). The majority of isolates were cultured from the upper and lower respiratory tracts (55%). Amphotericin B demonstrated the most potent in vitro activity, with geometric mean (GM) MICs of ≤0.25 µg/ml against all genera with the exception of Cunninghamella species (GM MIC of 1.30 µg/ml). In head-to-head comparisons, the most active azole was posaconazole, followed by isavuconazole. Differences in azole and amphotericin B susceptibility patterns were observed between the genera with the greatest variability observed with isavuconazole. Awareness of the epidemiology of Mucorales isolates and differences in antifungal susceptibility patterns in the United States may aide clinicians in choosing antifungal treatment regimens. Further studies are warranted to correlate these findings with clinical outcomes.


Subject(s)
Mucorales , Mucormycosis , Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Fungi , Humans , Itraconazole , Microbial Sensitivity Tests , Mucormycosis/drug therapy , Mucormycosis/epidemiology , United States/epidemiology
8.
BMC Infect Dis ; 21(1): 906, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1455941

ABSTRACT

BACKGROUND: COVID-19 disease may be associated with a wide range of bacterial and fungal infections. We report a patient with COVID-19 infection who developed rhino-facial mucormycosis during treatment with corticosteroids. CASE PRESENTATION: A 59-year-old non-diabetic male patient was admitted with a diagnosis of COVID-19 based on positive RT-PCR and CT of the lungs. Due to sever lung involvement, he was treated with methylprednisolone. The patient was re-admitted to hospital, due to nasal obstruction and left side facial and orbital swelling, several days after discharge. In sinus endoscopic surgery, debridement was performed and the specimens were sent to pathology and mycology laboratories. A nasal biopsy showed wide hyphae without septa. The sequenced PCR product revealed Rhizopus oryzae. Despite all medical and surgical treatment, the patient died. In addition, the characteristics of patients with COVID-19-associated mucormycosis were reviewed in 44 available literatures. In most studies, diabetes mellitus was the most common predisposing factor for mucormycosis. CONCLUSION: Our report highlights the need for assessing the presence of mucormycosis in patients with COVID-19 and also it shows that physicians should consider the potential for secondary invasive fungal infections in COVID-19 cases.


Subject(s)
COVID-19 , Diabetes Mellitus , Invasive Fungal Infections , Mucormycosis , Humans , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/drug therapy , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/drug therapy , SARS-CoV-2
9.
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
10.
Emerg Infect Dis ; 27(11): 2963-2965, 2021.
Article in English | MEDLINE | ID: covidwho-1444022

ABSTRACT

We established an online registry of coronavirus disease-associated mucormycosis cases in India. We analyzed data from 65 cases diagnosed during April-June 2021, when the Delta variant predominated, and found that patients frequently received antibacterial drugs and zinc supplementation. Online registries rapidly provide relevant data for emerging infections.


Subject(s)
COVID-19 , Mucormycosis , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Registries , SARS-CoV-2
11.
Rocz Panstw Zakl Hig ; 72(3): 239-244, 2021.
Article in English | MEDLINE | ID: covidwho-1436570

ABSTRACT

The second wave of the COVID-19 pandemic has affected India significantly with country reporting more than 400,000 cases in the month of May 2021 and health system almost collapsing. This was attributed to the new mutant strain also called as the 'Delta Strain' which led to high surge of cases across the country. As the country was stabilising over this situation, another imminent threat in the form of Covid Associated Mucormycosis (CAM) challenged the already burdened health system of India. Also called as 'Black Fungus,' cases of CAM began to rise rapidly in the last week of May 2021 with multiple states reporting steady rise in the number of cases. Based on the published literature, India contributed to approximately 71% of global cases of CAM from December 2019 to start of April 2021, with majority of the cases occurring during the second wave. The present paper focuses on the epidemic of CAM during the second wave in India highlighting the causes, symptoms and various treatment modalities that have been adopted to cure the disease. Also, spotlight has also been thrown on some other nations where cases of CAM have begun to emerge. Some key recommendations are also mentioned which can prove vital towards disease prevention.


Subject(s)
COVID-19/epidemiology , Antifungal Agents/therapeutic use , COVID-19/complications , Diabetes Mellitus/epidemiology , Epidemics , Fungi , Humans , India/epidemiology , Mucormycosis/complications , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Pandemics , SARS-CoV-2
12.
BMJ Case Rep ; 14(9)2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1416638

ABSTRACT

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.


Subject(s)
Mucorales , Mucormycosis , Osteomyelitis , Antifungal Agents/therapeutic use , Debridement , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Osteomyelitis/diagnostic imaging , Osteomyelitis/drug therapy , Skull Base/diagnostic imaging
13.
Emerg Infect Dis ; 27(9): 2349-2359, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1406812

ABSTRACT

During September-December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)-associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September-December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.


Subject(s)
COVID-19 , Mucormycosis , Antifungal Agents/therapeutic use , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
14.
Am J Otolaryngol ; 43(1): 103220, 2022.
Article in English | MEDLINE | ID: covidwho-1401162

ABSTRACT

BACKGROUND: It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. OBJECTIVE: To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. METHODOLOGY: Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. RESULTS: Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. CONCLUSION: It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.


Subject(s)
COVID-19/immunology , Mucormycosis/immunology , Adrenal Cortex Hormones/adverse effects , Antifungal Agents/therapeutic use , COVID-19/epidemiology , Diabetes Complications/immunology , Diagnostic Imaging , Endoscopy , Female , Humans , India/epidemiology , Longitudinal Studies , Male , Middle Aged , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Pandemics , Prospective Studies , Risk Factors , SARS-CoV-2
15.
Mycopathologia ; 186(6): 739-754, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1366388

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has led to a concerning resurgence of mucormycosis. More than 47,000 cases of mucormycosis were reported in three months from India. We update our systematic review on COVID-19-associated mucormycosis (CAM) till June 21st, 2021, comparing cases reported from India and elsewhere. We included individual patient details of 275 cases of CAM, of which 233 were reported from India and 42 from the rest of the world. Diabetes mellitus was the most common underlying risk factor for CAM in India than in other countries. The fatality rate of cases reported from India (36.5%) was less than the globally reported cases (61.9%), probably due to the predominance of rhino-orbital mucormycosis. On a multivariate analysis, we found that pulmonary or disseminated mucormycosis cases and admission to the intensive care unit were associated with increased mortality, while combination medical therapy improved survival. The paucity of pulmonary and disseminated mucormycosis cases from India suggests that these cases were either not diagnosed or reported, further supported by a trend of search data from the Google search engine. In this review, we discuss the factors explaining the substantial rise in cases of CAM. We also propose a hypothetical model describing the epidemiologic triad of CAM.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Risk Factors , SARS-CoV-2
16.
Indian J Pharmacol ; 53(4): 317-327, 2021.
Article in English | MEDLINE | ID: covidwho-1367964

ABSTRACT

Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.


Subject(s)
COVID-19/virology , Coinfection , Meningitis, Fungal/microbiology , Mucormycosis/microbiology , Nose Diseases/microbiology , Opportunistic Infections/microbiology , Orbital Diseases/microbiology , SARS-CoV-2/pathogenicity , Antifungal Agents/therapeutic use , COVID-19/immunology , COVID-19/mortality , Host-Pathogen Interactions , Humans , Meningitis, Fungal/drug therapy , Meningitis, Fungal/immunology , Meningitis, Fungal/mortality , Mucormycosis/drug therapy , Mucormycosis/immunology , Mucormycosis/mortality , Nose Diseases/drug therapy , Nose Diseases/immunology , Nose Diseases/mortality , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Orbital Diseases/drug therapy , Orbital Diseases/immunology , Orbital Diseases/mortality , Prognosis , Risk Assessment , Risk Factors , SARS-CoV-2/immunology
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
SELECTION OF CITATIONS
SEARCH DETAIL
...