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Coronavirus Disease 2019 (COVID-19)-Associated Rhino-Orbito-Cerebral Mucormycosis: A Multi-Institutional
Sharath Kumar Gg1, Saikant Deepalam2, Ata Siddiqui3
1Department of Neuroimaging and Interventional Neuroradiology, Apollo Hospital, Bangalore, India.
Background:
Mucormycosis infection of the maxillofacial region and brain has been associated with coronavirus disease 2019 (COVID-19) infection. Mucormycosis was relatively a rare infection before COVID-19, and imaging findings are not very well described.
Materials And Methods:
A retrospective imaging study of 101 patients diagnosed with COVID-19-associated mucormycosis by histopathology and/or culture was performed. All patients underwent computed tomography and/or magnetic resonance imaging based on the clinical condition of the patient and on consensus decision by the team of treating physicians. A simple 3-stage classification system based on imaging findings was adopted.
Results:
One hundred one cases were included in the final analysis (mean age = 55.1 years; male/female ratio = 67:34). The affected patients had diabetes in 94% of the instances (n = 95), 80.1% (n = 81) received steroids), whereas 59.4% (n = 60) patients received supplemental oxygen. The majority underwent surgical intervention, whereas in 6 cases, patients were treated with antibiotic regimens. Sixty subjects improved following therapy, whereas 18 eventually succumbed to the illness. We noted a significant positive correlation between the imaging stage and outcomes. No association was seen between other clinical parameters and final clinical outcomes. Salient imaging findings include lack of normal sinonasal mucosal enhancement, perisinus inflammation, ischemic optic neuropathy, perineural spread, pachymeningeal enhancement, and presence of strokes.
Conclusions:
We describe the imaging findings in the largest cohort of patients with rhino-orbito-cerebral mucormycosis in the context of the current COVID-19 pandemic. A simplified staging system described here is helpful for standardized reporting and carries prognostic information.
Insights
COVID-19-associated mucormycosis, a rare fungal infection, often affects the maxillofacial region and brain. This study details imaging findings and introduces a staging system that correlates with patient outcomes.
Area of Science:
- Radiology
- Infectious Diseases
- Ophthalmology
Background:
- Mucormycosis, a rare fungal infection, has been increasingly associated with coronavirus disease 2019 (COVID-19).
- Imaging findings of COVID-19-associated mucormycosis, particularly in the maxillofacial and brain regions, are not well-described.
- This condition poses a significant threat, especially to immunocompromised individuals.
Purpose of the Study:
- To describe the imaging findings in the largest cohort of patients with rhino-orbito-cerebral mucormycosis related to the COVID-19 pandemic.
- To introduce and evaluate a simplified 3-stage classification system for reporting imaging findings.
- To assess the correlation between imaging findings, staging, and clinical outcomes.
Main Methods:
- A retrospective analysis of 101 patients diagnosed with COVID-19-associated mucormycosis via histopathology and/or culture.
- All patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI).
- A 3-stage classification system based on imaging characteristics was applied.
Main Results:
- The cohort (n=101) comprised patients with a mean age of 55.1 years, predominantly with diabetes (94%) and a history of steroid use (80.1%).
- Key imaging findings included lack of sinonasal mucosal enhancement, perisinus inflammation, ischemic optic neuropathy, perineural spread, pachymeningeal enhancement, and strokes.
- A significant positive correlation was observed between the imaging stage and patient outcomes, with 60 patients improving and 18 succumbing to the illness.
Conclusions:
- The study presents the largest cohort of imaging findings for rhino-orbito-cerebral mucormycosis in the context of the COVID-19 pandemic.
- The proposed simplified staging system aids in standardized reporting of imaging findings.
- This staging system demonstrates prognostic value, correlating with clinical outcomes.
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