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Post-COVID-19 Related Rhinocerebral Mucormycosis in Bulgaria: A Report of Three Cases
Kamelia Milcheva1, Nikolay R Sapundzhiev1, Radoslav Georgiev2
1Otolaryngology, Medical University of Varna, Varna, BGR.
Abstract:
Rhinocerebral mucormycosis is a rare and rapidly progressive fungal infection caused by opportunist fungi from the Mucoraceae family, which are omnipresent in nature. Fungal sporangiospores discharged into the atmosphere could be inhaled or directly penetrate damaged skin and mucosa, and they strongly prefer angioinvasive spread. These relatively rare and opportunistic infections have spiked in recent years, particularly during the coronavirus disease identified in 2019 (COVID-19). Herein, we describe a series of three cases of rhino-orbital-cerebral mucormycosis (ROCM) during the second and third waves of COVID-19 in Bulgaria. The average age of the patients was 60.3 years (range 40-73, standard deviation ± 17.8). All of them contracted COVID-19 prior to developing ROCM and have a common comorbidity: type II diabetes mellitus. One of the cases was further complicated with a cerebral abscess as a result of ROCM. All patients underwent surgical treatments, and full recovery was achieved in two of the cases. In the third case, despite the extent of surgical and pharmaceutical treatment, ROCM progressed to a stable chronic disease.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) cases increased during COVID-19 waves, particularly in diabetic patients. Prompt surgical intervention led to recovery in most cases, though one progressed to chronic disease.
Area of Science:
- Mycology
- Infectious Diseases
- Epidemiology
Background:
- Rhino-orbital-cerebral mucormycosis (ROCM) is a severe fungal infection.
- Mucoraceae fungi cause ROCM, thriving in nature and spreading via spores.
- ROCM incidence has risen, notably during the COVID-19 pandemic.
Observation:
- This study details three ROCM cases in Bulgaria during COVID-19 waves.
- Patients averaged 60.3 years, all had prior COVID-19 and type II diabetes mellitus.
- One case developed a cerebral abscess secondary to ROCM.
Findings:
- All patients received surgical treatment for ROCM.
- Two patients achieved full recovery.
- One patient developed chronic ROCM despite extensive treatment.
Implications:
- Highlights the link between COVID-19, diabetes, and ROCM.
- Emphasizes the need for vigilance and timely intervention for ROCM.
- Suggests potential for chronic ROCM even with aggressive management.
