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1.
Indian J Ophthalmol ; 70(6): 2163-2168, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1875907

ABSTRACT

Purpose: An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.


Subject(s)
COVID-19 , Eye Diseases , Mucormycosis , Orbital Diseases , Adult , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Eye Diseases/complications , Humans , India/epidemiology , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/therapy , Orbital Diseases/diagnosis , Orbital Diseases/epidemiology , Orbital Diseases/therapy , Pandemics , Prospective Studies , Tertiary Care Centers
2.
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
3.
Indian J Ophthalmol ; 70(5): 1822-1824, 2022 05.
Article in English | MEDLINE | ID: covidwho-1835163

ABSTRACT

The storm of COVID-19-associated mucormycosis (CAM) has not yet settled, and it has proven itself a disfiguring and potentially life-threatening disease, complicating the course of COVID-19 infection. Mucormycosis is a rare but devastating fungal infection caused by filamentous fungi of the family Mucoraceae. We report a rare case of a 37-year-old diabetic male with bilateral rhino-orbital-cerebral mucormycosis (ROCM) where it leads to bilateral central retinal artery occlusion (CRAO) as manifestation of the disease. Bilateral CRAO secondary to ROCM is extremely rare. A strong suspicion of CAM in uncontrolled diabetics can result in early diagnosis and management.


Subject(s)
COVID-19 , Eye Diseases , Mucorales , Mucormycosis , Orbital Diseases , Retinal Artery Occlusion , Adult , Blindness/diagnosis , Blindness/etiology , Eye Diseases/complications , Humans , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/microbiology , Orbital Diseases/complications , Orbital Diseases/diagnosis , Retinal Artery Occlusion/complications
4.
Eur J Radiol ; 152: 110341, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1821220

ABSTRACT

In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Magnetic Resonance Imaging , Mucormycosis/complications , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Prognosis , SARS-CoV-2
5.
Indian J Ophthalmol ; 70(2): 641-648, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1810684

ABSTRACT

PURPOSE: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation. METHODS: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs. RESULTS: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively. CONCLUSION: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.


Subject(s)
COVID-19 , Mucormycosis , Orbital Cellulitis , Orbital Diseases , Cross-Sectional Studies , Female , Humans , India/epidemiology , Magnetic Resonance Imaging , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Orbital Diseases/diagnosis , Orbital Diseases/epidemiology , SARS-CoV-2
6.
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
7.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801772

ABSTRACT

Mucormycosis is life threatening fungal infection that occurs in immunocompromised patients. Patients at risk are those with poorly controlled diabetes mellitus, immunosuppressed patients such as those undergoing treatment for hematological cancer or recipients of solid organ and hematopoietic stem cell transplantation. COVID 19 infection is known to produce a state of hyper inflammation with release of various cytokines this state of immune dysfunction is associated with development of opportunistic infections, of which Mucormycosis is on the rise currently. The widespread use of corticosteroids can cause secondary infections including mucormycosis. CNS penetration typically starts with nasal involvement followed by the paranasal sinuses and palate, ultimately invading the orbit and brain or by direct hematological spread which is called as Rhino-orbito-cerebral Mucormycosis (ROCM) . MATERIAL: This is a cross sectional study conducted on 50 patients diagnosed with COVID 19 associated mucormycosis admitted to the hospitals attached to BMCRI from May2021 to August 2021.All the ROCM cases with CNS manifestation were included The relevant demographic data, clinical presentation, neurologic manifestations, underlying co morbidity, medical treatments, and surgical interventions done were recorded and analyzed. OBSERVATION: A total of 50 patients were included mean age 49.3 year with 38 males and 12 females .Most common comorbidity was diabetes (94%)followed by hypertension (26%) .Most common symptom was headache (86%) followed by facial swelling (68%), facial pain (66%).40% Patients had CNS symptom among which most common was hemiparesis. EOM restriction(70%) and abnormal vision(70%) being most common examination finding. Most common sinus being involved was maxillary 94% followed by ethmoid sinus 92%. Neurological manifestation included acute infarct (56%), Cavernous sinus thrombosis (28%),ICA occlusion (10%) abscess (34%), 3 patients had dual fungal infection. 26% patient underwent craniotomy, 6%carniotomy with Denkers procedure, 30% underwent maxillectomy. Among the mortality group, average duration of diabetes was 11.5 years, average steroid use of 9.53 days, CRP was 104mg/l, D Dimer 755ng/dl, as compared to 5.89 years, 5.3 days, 58.9mg/l, 419ng/dl, respectively among recovered patients. Most patient were left with morbidity like vision loss and facial disfigurement (40%) being most common while hemiparesis in (14%) patients . CONCLUSION: Diabetes mellitus being the main predisposing factor for ROCM. Delayed diagnosis or inappropriate treatment may result in massive tissue destruction and possible extension into the cranial base and/or vault and orbit. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability.


Subject(s)
COVID-19 , Eye Diseases , Mucormycosis , Orbital Diseases , COVID-19/complications , Central Nervous System , Cross-Sectional Studies , Eye Diseases/complications , Female , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Orbital Diseases/diagnosis , Paresis
8.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801751

ABSTRACT

Rhino-orbital mucormycosis is an aggressive fungal opportunistic infection of the immune-compromised, debilitated patients. The presence of neutrophilia and lymphocytopenia in patients affected with mucormycosis have been reported. Not much study has been done to establish the ratio of neutrophil to lymphocyte as a possible indicator for the severity of Rhino-orbital mucormycosis which is clinical staged. As such, this study aims to find out the relationship of the neutrophil-lymphocyte ratio with the clinical staging of Rhino-orbital mucormycosis in COVID19 recovered patient and if such a ratio can help to identify the severity of the opportunistic fungal infection. MATERIAL: This is a Cross-sectional study done on 100 patients who were diagnosed with Mucormycosis based on radiological findings, post-COVID19 recovery. The neutrophil-lymphocyte ratio was estimated after obtaining the complete blood count of the patient and calculating the ratio by the division of differential Neutrophil by the differential Lymphocyte count. The clinical staging of Mucormycosis was done based on radiological findings. OBSERVATION: The median value of Neutrophil Lymphocyte ratio was found to be elevated in all the clinical stages of Mucormycosis (from stage 2 to 4) at the time of admission as well as discharge considering the normal value of N/L ratio in a healthy individual to be 3. The median N/L ratio was also found to be in decreasing trend as compared from the time of admission to discharge in all the stages 2 to 4 of mucormycosis and was statistically significant (p=0.00) in stage 3 of mucormycosis. CONCLUSION: The Neutrophil-Lymphocyte ratio can be used as a viable marker of severity of mucormycosis and is a good prognostic indicator for resolution of disease especially in stage 3 of mucormycosis. This study helps to reiterate the importance of N/L ratio in the treatment protocol of mucormycosis.


Subject(s)
COVID-19 , Eye Diseases , Mucormycosis , Orbital Diseases , Cross-Sectional Studies , Humans , Lymphocytes , Mucormycosis/diagnosis , Neutrophils , Orbital Diseases/diagnosis
9.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801384

ABSTRACT

A wide range of opportunistic infections have been described in patients with Coronavirus disease 2019 (COVID-19). Aspergillus and Candida have been reported as the main fungal pathogens for co-infection in these patients. Mucormycosis including Rhino-Orbital-Cerebral Mucormycosis (ROCM) has been increasingly described in patients with COVID-19 disease but the risk factors and outcome of such patients are not well described. MATERIAL: This prospective observational study was conducted at a tertiary centre in North India of 50 patients with radiologically and microbiologically proven Mucormycosis. OBSERVATION: The included subjects were evaluated for the risk factors, the clinical presentation, and outcomes. Frequency(t=50) Percentage 1 Age Below 40 10 20 40 and above 40 80 2 Sex F 21 42 M 29 58 3 Covid 19 history positive 39 78 negative 4 8 nr 7 14 4 HTN history Present 21 42 absent 29 58 5 Diabetes history present 42 84 absent 8 16 6 Duration of DM <1 month 8 16 >1 month 26 52 NR 16 32 7 Vaccination Status Vaccinated 2 4 Not vaccinated 48 96 8 HbA1c <6.5 7 14 6.5 to 7 7 14 >7 27 54 9 History of hospital/ home oxygen Present 17 34 absent 33 66 10 SpO2 during admission <90 1 2 90to95 8 16 >95 37 74 No record available 4 8 11 pH at admission <7.35 4 8 7.35 to 7.45 16 32 >7.45 7 14 Data not available 23 46 12 TLC <4400 1 2 4400 to 10900 27 54 >11000 16 32 Data Not available 6 12 Steroid Use in Hospital Stay prednisolone 2 4 Dexamethasone 23 46 13 Hydrocortisone 1 2 Methylprednisolone 1 2 Unavailable 4 8 Not received 19 38 14 Outcome Discharged 41 82 Expired 6 12 Absconded 3 6. CONCLUSION: Out of the 50 patients under study, 78% had Covid-19 disease. The primary risk factor of Mucor in patients of Covid-19 was Diabetes Mellitus (84%) with known diabetics (52%) having uncontrolled hyperglycemia (54%) and those who required oxygen support (home/ hospital) (32%). Mucor was more common in males (58%) of age 40 years and above (80%). About 96% of these patients were not vaccinated against Covid-19, and only 42% had a history of Hypertension. Dexamethasone was used in 46% of the patients admitted and 82% were discharged with satisfactory recovery.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Adult , COVID-19/therapy , Dexamethasone , Humans , India/epidemiology , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Oxygen , Risk Factors , SARS-CoV-2 , Tertiary Care Centers
10.
World Neurosurg ; 162: e131-e140, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1783842

ABSTRACT

BACKGROUND: Mucormycosis infection of the maxillofacial region and brain has been associated with coronavirus disease 2019 (COVID-19) infection. Mucormycosis was relatively a rare infection before COVID-19, and imaging findings are not very well described. MATERIALS AND METHODS: A retrospective imaging study of 101 patients diagnosed with COVID-19-associated mucormycosis by histopathology and/or culture was performed. All patients underwent computed tomography and/or magnetic resonance imaging based on the clinical condition of the patient and on consensus decision by the team of treating physicians. A simple 3-stage classification system based on imaging findings was adopted. RESULTS: One hundred one cases were included in the final analysis (mean age = 55.1 years; male/female ratio = 67:34). The affected patients had diabetes in 94% of the instances (n = 95), 80.1% (n = 81) received steroids), whereas 59.4% (n = 60) patients received supplemental oxygen. The majority underwent surgical intervention, whereas in 6 cases, patients were treated with antibiotic regimens. Sixty subjects improved following therapy, whereas 18 eventually succumbed to the illness. We noted a significant positive correlation between the imaging stage and outcomes. No association was seen between other clinical parameters and final clinical outcomes. Salient imaging findings include lack of normal sinonasal mucosal enhancement, perisinus inflammation, ischemic optic neuropathy, perineural spread, pachymeningeal enhancement, and presence of strokes. CONCLUSIONS: We describe the imaging findings in the largest cohort of patients with rhino-orbito-cerebral mucormycosis in the context of the current COVID-19 pandemic. A simplified staging system described here is helpful for standardized reporting and carries prognostic information.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , Female , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnostic imaging , Orbital Diseases/complications , Orbital Diseases/diagnostic imaging , Pandemics , Retrospective Studies , SARS-CoV-2
11.
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
14.
Mycopathologia ; 187(2-3): 271-289, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1750791

ABSTRACT

The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12-21%, I2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22-36%, I2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Nose Diseases , Orbital Diseases , COVID-19/complications , Diabetes Mellitus/epidemiology , Glucocorticoids/therapeutic use , Humans , Mucormycosis/diagnosis , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Pain/complications , SARS-CoV-2
15.
Mycoses ; 65(5): 526-540, 2022 May.
Article in English | MEDLINE | ID: covidwho-1741478

ABSTRACT

BACKGROUND: The second COVID-19 wave in India has been associated with an unprecedented increase in cases of COVID-19 associated mucormycosis (CAM), mainly Rhino-orbito-cerebral mucormycosis (ROCM). METHODS: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM. RESULTS: 59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. CONCLUSIONS: CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , COVID-19/epidemiology , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/drug therapy , Retrospective Studies , SARS-CoV-2 , Steroids/therapeutic use
16.
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
17.
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
18.
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
19.
Eur Arch Otorhinolaryngol ; 279(6): 3201-3210, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1669788

ABSTRACT

AIM: During the second wave of COVID-19, cases of mucormycosis were increased suddenly over a period of 3 months in Maharashtra, India. An attempt was made to study the clinical profile and risk factors associated with mucormycosis. MATERIALS AND METHODS: A retrospective descriptive study was carried out at a tertiary hospital during May 2021-July 2021. After obtaining informed written consent from the participants, various details of all participants, such as diabetes mellitus, use of steroids in COVID-19 treatment, use of immunosuppressant drugs, oxygen therapy, use of ventilators, complications that occurred during treatment, etc., were noted. All mucormycosis patients were treated with amphotericin B and aggressive surgical treatment. RESULTS: In the present study, 74.7% of mucormycosis patients were male. 77.4% of mucormycosis patients were above 40 years of age. 6.7% of mucormycosis patients were partially vaccinated. Among risk factors, 86.6% had diabetes mellitus, 84% had COVID-19 infection, 44% had received steroids, and 54.7% had received oxygen. 80% of patients were present during and within 1 month of COVID-19 infection. 52% of patients were presented in stage III and 41.3% were presented in stage II. Despite aggressive surgical debridement along with amphotericin B, mortality was 25.33%. 5.3% of patients had brain abscesses, 8% of patients had cavernous sinus thrombosis, 4% of patients had facial nerve palsy and 1.3% of patients had meningitis. CONCLUSION: Mucormycosis was predominantly seen in male above the age of 40 years COVID-19 infection and diabetes mellitus was common risk factor for mucormycosis.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Adult , Amphotericin B/therapeutic use , COVID-19/drug therapy , COVID-19/epidemiology , Female , Humans , India/epidemiology , Male , Mucormycosis/complications , Mucormycosis/epidemiology , Mucormycosis/therapy , Orbital Diseases/therapy , Oxygen , Pandemics , Retrospective Studies , Steroids/therapeutic use , Tertiary Care Centers
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