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1.
J Laryngol Otol ; 136(9): 788-798, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1900379

ABSTRACT

OBJECTIVE: This study aimed to compute the pooled prevalence of diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. METHOD: A systematic literature review was performed in PubMed, Scopus, Web of Science, Embase and Google Scholar. The cross-sectional studies that reported the frequency of diabetes mellitus in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis were included. RESULTS: Eighteen eligible studies with a total number of 3718 patients were included in the current study. The pooled prevalence of diabetes in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis was 89 per cent and with new-onset diabetes was 32 per cent. The pooled prevalence of steroid use was high (79 per cent) too. The all-cause mortality rate was 24 per cent. CONCLUSION: Diabetes mellitus was the most frequent underlying condition in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis. The second most frequent underlying condition was steroid use during coronavirus disease 2019 infection. The appropriate control of hyperglycaemia and rational prescription of steroids during the treatment of coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis is recommended.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Orbital Diseases , COVID-19/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Humans , Mucormycosis/complications , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/epidemiology
2.
Indian J Ophthalmol ; 70(6): 2163-2168, 2022 06.
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
3.
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
4.
J R Coll Physicians Edinb ; 51(4): 352-358, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1560894

ABSTRACT

BACKGROUND: Mucormycosis has been reported in several Indian states with the second wave of COVID-19 from January 2021 onwards. This prospective study was conducted with the objective of defining the contribution or association of various known and many suspected factors in the incidence of this disease during the ongoing pandemic. METHOD: The study included 464 adults with mucormycosis. Basic demographic data were collected. Patient history of COVID infection, its severity, duration of treatment, and oxygen use was taken to assess the association. History of use of antibiotics, steroids, antivirals, biologicals, and other complementary treatments was sought. History of diabetes and other comorbidities was noted. Patients were investigated for mucor confirmation using a nasal swab KOH mount, nasal endoscopy with biopsy, and radiological investigations were done to assess the extent. RESULTS: Out of 464 patients, 175 were known diabetics, and 157 were treated with steroids during COVID infection. Out of 287 post-COVID patients, 125 (44%) had rhino-mucormycosis (RM), 102 (35%) had rhino-oculo-mucormycosis (ROM) and 60 (21%) had rhino-oculo-cerebral-mucormycosis (ROCM). 162 did not have a history of COVID, of which 93 (57%) had RM, 48 (30%) had ROM and 21 (13%) had ROCM. CONCLUSION: This study has showed that COVID was not the only factor contributing to mucor, rather other factors such as diabetes, steroid use etc. were also contributory. Many patients who were suffering from mucormycosis did not have a history of COVID. Advanced age, ROCM, and ICU admission were associated with increased mortality.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Adult , Humans , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Orbital Diseases/epidemiology , Pandemics , Prospective Studies , SARS-CoV-2 , Tertiary Care Centers
5.
Indian J Ophthalmol ; 69(12): 3685-3689, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538662

ABSTRACT

PURPOSE: Mucormycosis is a life-threatening infection that has made sudden comeback in COVID-19 era. We conducted this study to determine demography, site of involvement, management, and outcome in these patients. METHODS: All cases presenting with signs and symptoms of mucormycosis were thoroughly evaluated and confirmed diagnosis was made on demonstration of fungi in the tissue (or body fluids) either by direct microscopy and/or culture. Patients underwent computerized tomography scan for paranasal sinuses and magnetic resonance imaging scan with contrast orbit and brain to know extent of disease. RESULTS: 540 proven cases of mucormycosis were included. Most common age group affected was 41-50 years with male preponderance (69%). Sinonasal was the most common site of involvement in mucormycosis (100%), followed by orbital (51.85%), cerebral (9.44%), cutaneous (1.85%), and pulmonary (0.18%). Most common presentation was periocular and facial swelling (28%). 97.96% patients had associated diabetes and 89.44% patients had history of COVID-19 with concurrent steroids use (84.85%), higher antibiotics (82.59%), oxygen therapy (52.40%), remdesivir (28.89%), and biological agents (2.56%). Duration from COVID-19 positivity to presentation of mucormycosis was 22.56 days, while 4.44% patients had coexisting COVID-19 with mucormycosis. The mortality rate was 9.25% (50/540). CONCLUSION: Timely diagnosis and appropriate management can ameliorate the consequences of mucormycosis. With the third wave of COVID-19 coming, epidemiological study to identify risk factors and possible management options can help physicians to develop the treatment strategy.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Adult , Antifungal Agents/therapeutic use , Humans , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/epidemiology , SARS-CoV-2
6.
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
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.
Emerg Infect Dis ; 28(1): 1-8, 2022 01.
Article in English | MEDLINE | ID: covidwho-1444025

ABSTRACT

We provide an overview of the epidemiology and clinical course of mucormycosis in the coronavirus disease (COVID-19) pandemic era. We conducted a retrospective chart review of 178 patients with clinical or diagnostic, endoscopically or histopathologically confirmed rhino-sino-orbital or cerebral mucormycosis after COVID-19 treatment during the second wave of COVID-19 in Pune, India. Median time to symptom onset from COVID-19 detection was 28 days. Moderate or severe COVID-19 was seen in 73% of patients and diabetes in 74.2%. A total of 52.8% received steroids. Eschar over or inside the nose was seen in 75%, but baseline clinical and laboratory parameters were mostly unremarkable. Bone penetration was present in ≈90% of cases, 30% had soft-tissue swelling of the pterygopalatine fossa and 7% had cavernous sinus thrombosis, and 60% had multifocal mucormycosis. Of the 178 study cases, 151 (85%) underwent surgical debridement. Twenty-six (15%) died, and 16 (62%) of those had multifocal mucormycosis.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , COVID-19/drug therapy , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Orbital Diseases/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
9.
J Laryngol Otol ; 135(11): 981-986, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1402000

ABSTRACT

BACKGROUND: Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery. METHODS: An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021. RESULTS: There were 28 males and 13 females with a mean age of 48.2 years (range, 21-68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive. CONCLUSION: Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.


Subject(s)
COVID-19/epidemiology , Coinfection/epidemiology , Epidemics , Mucorales , Mucormycosis/epidemiology , SARS-CoV-2 , Adult , Aged , Antifungal Agents/therapeutic use , Brain Diseases/epidemiology , Brain Diseases/microbiology , COVID-19/microbiology , Coinfection/microbiology , Debridement , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/microbiology , Female , Humans , Male , Middle Aged , Mucormycosis/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Rhinitis/epidemiology , Rhinitis/microbiology , Young Adult
10.
Diabetes Metab Syndr ; 15(5): 102267, 2021.
Article in English | MEDLINE | ID: covidwho-1377695

ABSTRACT

AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.


Subject(s)
COVID-19/complications , Mucormycosis/epidemiology , Mucormycosis/etiology , Adult , COVID-19/epidemiology , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/etiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/etiology , Female , Humans , India/epidemiology , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Nervous System Diseases/microbiology , Orbit/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Prevalence , Rhinitis/epidemiology , Rhinitis/etiology , Rhinitis/microbiology , Risk Factors , SARS-CoV-2/physiology , Socioeconomic Factors
11.
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): 1670-1692, 2021 07.
Article in English | MEDLINE | ID: covidwho-1280829

ABSTRACT

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , COVID-19 Testing , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/therapy , Humans , India/epidemiology , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/therapy , Orbital Diseases/diagnosis , Orbital Diseases/epidemiology , Orbital Diseases/therapy , Pandemics , SARS-CoV-2
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