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Published on: September 20, 2018
Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India
Ravija Patel1, Jignesh Jethva1, Purvi R Bhagat1
1Glaucoma unit, Department of ophthalmology, M & J Western Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad, Gujarat, India.
Purpose:
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors.
Methods:
Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports.
Results:
Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%].
Conclusion:
With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) is a severe fungal infection. Key risk factors include diabetes and corticosteroid use, particularly in COVID-19 patients.
Area of Science:
- Infectious Diseases
- Mycology
- Epidemiology
Background:
- Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, aggressive fungal infection.
- It predominantly affects immunocompromised individuals, including those with uncontrolled diabetes, on immunosuppressive therapy, or with COVID-19.
- ROCM carries a high mortality rate.
Purpose of the Study:
- To investigate the epidemiology of mucormycosis in COVID-19 patients.
- To identify significant risk factors associated with mucormycosis in this population.
Main Methods:
- An epidemiological study involving 458 mucormycosis patients from August 2020 to May 2021.
- Data collected included demographic, clinical, histopathological, and radiological information.
- Diagnosis was confirmed by clinical, radiological, or microbiological evidence.
Main Results:
- Diabetes (81.92%) and corticosteroid use (79.69%) were the most prevalent risk factors.
- Supplemental oxygen use was also a significant factor (48.90%).
- Nasal and sinus involvement (94.54%) was most common, followed by orbital (45.41%) and cerebral (10.04%) disease.
Conclusions:
- Mucormycosis is a critical consideration in COVID-19 patients, especially those with comorbidities like diabetes and those on high-dose corticosteroids.
- Vigilance is necessary for both active and recovered COVID-19 cases.
- Prompt diagnosis and treatment, including IV amphotericin B and debridement, are crucial.
