Published: 2021-10-26

Comprehensive study on manifestation, management and outcome of post COVID rhino orbito cerebral mucormycosis in our institution

Shanthimalar R., Muthuchitra S., Mary Nirmala S., Thamizharasan P., Udhayachandrika G., Balaji C., Indu S. P., Kousalya P., Senthoorani A., Yuvaraj E.


Rhino orbital mucor mycosis in covid infected patients presented a challenge in management. We tried analysing comprehensively the manifestations and management and prognosis of post COVID rhino orbito cerebral mucormycosis (ROCM) patients in our institution. Patients with symptoms of ROCM were managed according to the guidelines issued by the directorate of medical education, Tamil Nadu, India. 30 possible ROCM patients were treated so far from May 2021. Patients underwent radiological, microbiological and pathological investigation. In stage 1, nasal cavity alone was involved in 11 patients. In stage 2, paranasal sinus extension was seen in 8 patients. In stage 3, orbital extension was seen in 10 patients. In stage 4, intra cranial extension was seen in 1 patient. 10 patients were probable ROCM without microbiological or pathological evidence. 20 patients had proven ROCM. They were treated with endoscopic debridement. Out of them 10 patients had to undergo orbital decompression and 5 of them had improvement in vision. All proven ROCM patients were treated with 3 weeks of injection liposomal amphotericin B along with oral posaconazole 300 mg for 3-6 weeks. Post-operative histopathology noted fungal invasion of blood vessels in 19 cases and thrombus in 10 cases of orbital involvement. No mortality was reported in the study group. COVID variant associated thrombosis may be the reason for increased incidence of mucor mycosis in post COVID patients. Team work, appropriate guidelines and adequate supply of medications helped in achieving desired outcome.


ROCM, Post COVID, Mucormycosis

Full Text:



COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Available at: Accessed on 14 August 2021.

Spellberg B, Ibrahim AS. Mucormycosis. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo D, Loscalzo J, editors. Harrison’s principles of internal medicine, 20th edition. McGraw-Hill Education, New York. 2018;1538.

Cornely OA, Arenz D, Vehreschild JJ, Vehreschild MJGT, Ellinghoff SC, Seidel D. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19:40521.

Management guidelines Mucormycosis. Directorate of medical education, Tamil Nadu. Available at: Accessed on 14 August 2021.

Ribes JC, Vanover-Sans CL. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236-301.

Skiada A, Pavleas I, Drogari Apiranthitou M. Epidemiology and diagnosis of mucormycosis: an update. J Fungi. 2020;6(4):265.

White PL, Dhillon R, Cordey A, Hughes H, Faggian F, Soni S, et al. A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin Infect Dis. 2020;1298.

Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185:599-26.

Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2000;12(9):10726.

Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically ill coronavirus disease patients, India, April-July 2020. Emerg Infect Dis. 2020;26(11):2694-6.

Mishra N, Mutya VSS, Thomas A, Rai G, Reddy B, Mohanan AA, et al. A case series of invasive mucormycosis in patients with COVID-19 infection. Int J Otorhinolaryngol Head Neck Surg. 2021;7(5):867-70.

Ahmadikia K, Hashemi SJ, Khodavaisy S, Getso MI, Alijani N, Badali H, et al. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses. 2021;64(8):798-808.

Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg. 2021;20(3):1-8.

Peman J, Gaitan AR, Vidal CG, Salavert M, Ramirez P, Puchades F, et al. Fungal co-infection in COVID-19 patients: should we be concerned? Rev Iberoam Micol. 2020;37(2):41-6.

Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and orbital mucormycosis. Indian J Ophthalmol. 2021;69(4):1002-4.

Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J Med Cases. 2021;12(3):85-9.

Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital mucormycosis in a COVID-19 patient: A case report. Int J Surg Case Rep. 2021;82:105957.

Sai Krishna D, Raj H, Kurup P, Juneja M. Maxillofacial Infections in Covid-19 Era-Actuality or the Unforeseen: 2 Case Reports. Indian J Otolaryngol Head Neck Surg. 2021;1-4.

Mitra S, Janweja M, Sengupta A. Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control. Eur Arch Otorhinolaryngol. 2021;1-6.

Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;135(5):442-7.