Radiologic Findings of COVID-19 Associated Mucormycosis (CAM) from India
Open Forum Infectious Diseases
; 8(SUPPL 1):S268-S269, 2021.
Article
in English
| EMBASE | ID: covidwho-1746667
ABSTRACT
Background. The unique feature of the second wave of the COVID -19 pandemic in India has been the alarming surge of acute invasive fungal infection among COVID -19 patients. The increased incidence of rhino-orbito-cerebral mucormycosis is a matter of concern, as this fulminant infection has high morbidity and mortality. Hence, it is imperative to understand it's imaging features, for early diagnosis, staging and treatment. Methods. We systematically reviewed 32 COVID-19 cases with imaging diagnosis of acute invasive fungal rhino-sinusitis or rhino-orbital-cerebral disease between March to May 2021. These patients underwent contrast MRI of the paranasal sinus, orbit and brain. Contrast enhanced CT chest and paranasal sinuses were done as needed. Results. The age group ranged between 30 to 71 yrs with male preponderance. The most common predisposing factors were intravenous steroid therapy and supplemental oxygen. All cases were confirmed by fungal culture and most common was Mucor. The rhino-orbito-cerebral mucormycosis was staged as below In our study we found that the most common site in the nasal cavity was the middle turbinate /meatus and the earliest sign was non-enhancing / "black" turbinate. Premaxillary and retroantral fat necrosis was the earliest sign of soft tissue invasion. Spread via the sphenopalatine foramen and pterygopalatine fossa was more common than bony erosions. Orbital cellulitis and optic neuritis were the most common among stage 3 cases. Of patients with CNS involvement, the most common were cavernous sinus thrombosis and trigeminal neuritis. Two patients with pulmonary mucormycosis showed large necrotic cavitary lesions, giving the characteristic "bird's nest" appearance. Conclusion. The mortality rate was 20% in our study. In our short term follow up, 30 % of recovered patients had relapse on imaging due to incomplete clearance and partial antifungal treatment. High clinical suspicion and low imaging threshold are vital for early Mucormycosis detection in COVID-19 patients. Familiarity with early imaging signs is critical to prevent associated morbidity /mortality. Axial CT chest image in lung window shows necrotic right upper lobe cavity with internal septations and debris on a background of surrounding COVID-19 changes.
oxygen; adult; aged; antifungal therapy; bird; brain; cavernous sinus thrombosis; central nervous system; conference abstract; contrast enhancement; controlled study; coronavirus disease 2019; diagnosis; early diagnosis; erosion; fat necrosis; follow up; fungal sinusitis; groups by age; human; India; intravenous drug administration; lung; male; morbidity; mortality; mortality rate; mucormycosis; nonhuman; nose cavity; nuclear magnetic resonance imaging; optic neuritis; orbit cellulitis; paranasal sinus; pterygopalatine fossa; relapse; soft tissue; steroid therapy; systematic review; thorax; turbinate
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Open Forum Infectious Diseases
Year:
2021
Document Type:
Article
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