Study of patterns of presentation in post COVID19 mucormycosis

ABSTRACT

Objective: To study the clinico-radiological presentation patterns in patients of post COVID-19 mucormycosis. Background: COVID-19 infection has been responsible for various neurological disorders like stroke, encephalitis, Guillain Barre syndrome etc. almost all over the world. The second wave of this deadly virus was followed by sudden upsurge of cases of mucormycosis in India. While the exact reason for this is still unknown, it is hypothesized to be attributed to steroid use in immunocompromised states like Diabetes Mellitus and possible contamination of intranasal oxygen with industrial oxygen. There have been various patterns of presentations of these patients to mucor units. Neurological involvement was seen in majority of these cases. This study was aimed to study clinical and radiological aspects of such patients. Design/Methods: Total 81 patients, diagnosed as mucormycosis after recovery from COVID-19 illness and who got admitted in mucor units of two tertiary care hospitals of India were included in the study. The presenting clinical features and radiological patterns of involvements were assessed. Results: Out of 81, 46(56.79%) were males and 35(43.21%) were females. Maximum 21(25.92%) patients were between 51-60 years. Most common presenting complaints were heaviness over cheek followed by headache, blurring of vision, nasal discharge, nasal crusting, chemosis of eye, decreased facial sensations and hemiparesis. MRI findings included sinusitis, cavernous sinus thrombosis, orbital cellulitis, anterior circulation infarcts and intracranial fungal abscesses. Rhino-orbital-cerebral mucormycosis was the most common pattern seen in 49(60.49%) patients followed by rhino-orbital form in 19(23.45%) patients and rhino-cerebral mucormycosis in the remaining 13(16.04%) patients. Conclusions: Mucormycosis has emerged as an important complication of COVID-19 infection after the second wave of pandemic in India. Major neurological manifestations have been seen to be associated with it. Lessons need to be learned from this mucormycosis epidemic for prevention of spread and management of this dreaded entity in other regions of the world.