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COVID-19 associated rhino-orbital-cerebral mucormycosis-an institutional series
Suresh Naruka1, Nishant Rana1, Neeraj Singh2
1ENT, Indraprastha Apollo Hospital, New Delhi, India.
Abstract:
Mucormycosis is almost always confined to the patients with altered host defenses amongst which diabetes is considered as the strongest risk factor. COVID-19 only been seen in severe cases but also in mild and moderate cases of SARS-CoV-2 infections. After preliminary clinical and radiological diagnosis, surgical management in the form of endoscopic sinus surgery, debridement, and orbital exenteration (8) was performed. Medical management in the form of antifungal therapy (amphotericin-B, posaconazole, and isavuconazole) was initiated. In this case series, 79 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from mid-April 2021 to mid-September 2021. 67 patients were known diabetics, whereas rest 12 had new onset diabetes mellitus. Of these 79 cases, 27 cases had the disease limited to sinuses (rhino-mucormycosis), 43 had orbital involvement also (rhino-orbital mucormycosis), and 9 had cerebral involvement as well (rhino-orbital-cerebral mucormycosis). During this time-period, a total of 14 mortalities occurred. Most of the patients were discharged after completion of amphotericin-B therapy and rest stayed little longer till their general condition improved. COVID-19 causes dysregulation and alteration of immune response in the body which predispose to invasive fungal infections. In addition, uncontrolled diabetes mellitus and corticosteroid treatment increase the risk of mucormycosis by many folds.
Insights
COVID-19 associated mucormycosis, a serious fungal infection, frequently impacts patients with diabetes. This study analyzed 79 cases, highlighting the link between SARS-CoV-2 infection, diabetes, and invasive fungal infections.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Mucormycosis is a severe fungal infection strongly associated with compromised host defenses, particularly diabetes mellitus.
- The COVID-19 pandemic has seen a rise in mucormycosis, even in mild to moderate SARS-CoV-2 infections, due to immune dysregulation.
- Corticosteroid use in COVID-19 treatment further elevates the risk of invasive fungal infections like mucormycosis.
Purpose of the Study:
- To retrospectively analyze cases of COVID-19 associated rhino-orbital-cerebral mucormycosis.
- To understand the clinical presentation, management, and outcomes of this co-infection.
- To identify risk factors and disease spectrum in patients with COVID-19 and mucormycosis.
Main Methods:
- Retrospective analysis of 79 proven cases of COVID-19 associated mucormycosis.
- Data collected from mid-April 2021 to mid-September 2021.
- Involved preliminary clinical and radiological diagnosis, surgical interventions (endoscopic sinus surgery, debridement, orbital exenteration), and antifungal medical management (amphotericin-B, posaconazole, isavuconazole).
Main Results:
- Out of 79 patients, 67 had pre-existing diabetes mellitus, and 12 had new-onset diabetes mellitus.
- Disease distribution included 27 rhino-mucormycosis, 43 rhino-orbital mucormycosis, and 9 rhino-orbital-cerebral mucormycosis.
- A total of 14 mortalities were recorded during the study period.
Conclusions:
- COVID-19 can lead to immune dysregulation, predisposing individuals to invasive fungal infections like mucormycosis.
- Uncontrolled diabetes mellitus and corticosteroid therapy significantly increase the risk and severity of mucormycosis in COVID-19 patients.
- Prompt surgical and medical management, including antifungal therapy, is crucial for improving outcomes in these complex cases.
