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Case Report: Rhino-orbital Mucormycosis Related to COVID-19: A Case Series Exploring Risk Factors
Sushil Kumar Aggarwal1, Upinder Kaur2, Dolly Talda3
1Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
Abstract:
There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this surge. We report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted to our center between mid-April and early June 2021. The cases showed a male preponderance, two patients had loss of vision, and four of them showed intracranial extension of disease. Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes, both steroid use and diabetes being the most common identified risk factors. Considering other possible risk factors, immunosuppressed state, antiviral or ayurvedic (Indian traditional) medications, and oxygen therapy were not associated with a definite risk of mucormycosis, because they were not present uniformly in the patients. We propose that COVID-19 itself, through molecular mechanisms, predisposes to mucormycosis, with other factors such as dysglycemia or steroid use increasing the risk.
Insights
A surge in rhino-orbital mucormycosis cases occurred in India during the COVID-19 pandemic. Diabetes and steroid use were common risk factors, but COVID-19 itself may also predispose patients to this fungal infection.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Critical Care Medicine
Background:
- The second wave of COVID-19 in India saw a significant increase in rhino-orbital mucormycosis cases.
- Diabetes mellitus is a common comorbidity in COVID-19 patients and a potential risk factor for mucormycosis.
- Indiscriminate steroid use in COVID-19 management has also been implicated in the rise of mucormycosis.
Observation:
- A series of 13 rhino-orbital mucormycosis cases in COVID-19 patients were admitted between April and June 2021.
- The affected patient group showed a male predominance.
- Two patients experienced vision loss, and four cases presented with intracranial disease extension.
Findings:
- Steroid use and diabetes (preexisting or new-onset) were the most frequent risk factors identified in 12 patients each.
- Other potential factors like immunosuppression, specific medications (antiviral, Ayurvedic), and oxygen therapy were not consistently associated with mucormycosis.
- The study identified steroid use and dysglycemia as significant risk factors in COVID-19 patients.
Implications:
- COVID-19 infection, potentially through molecular mechanisms, may increase susceptibility to mucormycosis.
- Understanding these risk factors is crucial for early diagnosis and management of mucormycosis in COVID-19 patients.
- Further research is needed to elucidate the direct role of COVID-19 in predisposing individuals to mucormycosis.
