Rhino-orbital mucormycosis during COVID-19 pandemic: our clinical experience

Authors

  • Prakash N. S. Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Arfan Nasser Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Prathvi P. Nayak Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Ima Chandra Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Mathew Thomas Manampuram Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Mayur S. Warad Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • S. K. Ranjani Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India
  • Sushmita Sulhyan Department of ENT, JJM Medical College, Rajiv Gandhi University, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240056

Keywords:

COVID-19, Mucormycosis, Rhino-orbital-cerebral mucormycosis, COVID-19-associated ROCM

Abstract

Background: The ongoing COVID-19 pandemic declared by the WHO was compounded by the sudden and unexpected increase of Rhino-orbital mucormycosis infections during the year 2021. Mucormycosis a life-threatening infection, with added COVID-19 infection further increases the morbidity and mortality of the disease. Our aim is to shed some light on possible risk factors, treatment options and outcomes when these diseases occur together.

Methods: 22 cases diagnosed with rhino-orbital mucormycosis with history of COVID-19 infection were selected. Cases underwent surgical and medical management. Patients were followed up for 3 months and were continued on medical treatment and regular post-operative DNE, CECT PNS and brain and relapses were treated accordingly.

Results: Of these 22 patients, 15 were males and 7 were females ranging between 31-60 years. 15 (68.18%) had history of DM, 16 (72.72%) gave history of oxygen therapy and 18 (81.82%) had history of high dose steroid therapy. 15 (68.18%), 4 (18.18%) and 3 (13.64%) respectively underwent Endoscopic debridement, Total maxillectomy and Medial maxillectomy. There were 3 cases of relapse which were managed with additional full course treatment with Intravenous Liposomal Amphotericin B.

Conclusion: COIVD-19 and uncontrolled DM to both be probable pre-disposing factors for developing Mucormycosis. Oxygen therapy & high dose of steroids used in the treatment of COIVD-19 may increase incidences of mucormycosis. Early treatment with surgery is necessary to reduce the need for more radical procedures and improving the recovery.

References

Al-Tawfiq JA, Alhumaid S, Alshukairi AN, Temsah M-H, Barry M, Al Mutair A, et al. Covid-19 and mucormycosis superinfection: The perfect storm. Infection. 2021;49(5):833-53.

Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diab Metab Syndr Clin Res Rev. 2021;15(4):102146.

Eucker J, Sezer O, Graf B, Possinger K. Mucormycoses. Mycoses. 2001;44(7-8):253-60.

Bennett JE, Dolin R, Blaser MJ. Mandell, douglas, and bennett's principles and practice of infectious diseases. USA: Elsevier Health Sciences; 2019.

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

Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, PrajapatM et al. Rhino-orbital-cerebral mucormycosis in Covid-19: A systematic review. Indian J Pharmacol. 2021;53(4):317-27.

Malhotra HS, Gupta P, Mehrotra D, Dandu H, Kohli N, Verma V, et al. Covid-19 associated mucormycosis: Staging and Management Recommendations (Report of a multi-disciplinary expert committee). J Oral Biol Craniofac Res. 2021; 11(4):569-80.

Honavar SG, Sen M, Sengupta S, Rao R, Kim U, Sharma M, et al. Epimpact of the use of digital devices on E of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – collaborative OPAI-IJO study on mucormycosis in covid-19 (cosmic), report. Indian J Ophthalmol. 2021; 69(7):1670.

Dave TV, Gopinathan NA, Hegde R, Vithalani N, Desai S, Adulkar N, et al. Clinical presentations, management and outcomes of Rhino-orbital-cerebral mucormycosis (ROCM) following covid-19: A multi-centric study. Ophthal Plast Reconstr Surg. 2021;37(5):488-95.

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(4):599-606.

Downloads

Published

2024-01-25

Issue

Section

Original Research Articles