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. 2021 Sep;20(3):418-425.
doi: 10.1007/s12663-021-01532-1. Epub 2021 Mar 6.

SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis

Aditya Moorthy  1   2   3 , Rohith Gaikwad  1   2 , Shreya Krishna  2 , Raghuraj Hegde  4 , K K Tripathi  5 , Preeti G Kale  6 , P Subramanya Rao  7   8 , Deepak Haldipur  9 , Krishnamurthy Bonanthaya  10
Affiliations

SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis

Aditya Moorthy et al. J Maxillofac Oral Surg. 2021 Sep.

Abstract

Objectives: Collate and analyse data of maxillofacial/rhino-cerebro-orbital fungal infections reported during the era of the Covid-19 pandemic, with the aim of investigating the common contributing factors leading to such infections and of highlighting the significance of this surge seen in patients infected with SARS-CoV-2.

Method: This retrospective observational multi-centric study analysed patient data collected from clinicians belonging to different specialties in Bangalore, India. The data included the presentation and management of patients presenting with aggressive maxillofacial and rhino-cerebro-orbital fungal infections and explored the relationship between SARS-CoV-2, corticosteroid administration and uncontrolled diabetes mellitus.

Results: All 18 patients were Covid positive. Sixteen of the 18 patients received steroids for Covid treatment and 16 patients were diabetic (of whom 15 patients who were diabetics received steroids for Covid-19 treatment). Loss of vision was noted in 12 of the 18 patients and 7 of them underwent orbital exenteration. The fungi noted was mucormycosis in 16 patients, aspergillosis in 1 patient and a mixed fungal infection in 1 patient. Eleven of the patients survived, 6 died and 1 was lost to follow-up. There was a significantly higher incidence of diabetes (p = 0.03) amongst these cohort of patients who were Covid-19 positive with mucormycosis. A significantly higher number (p = 0.0013) of patients were administered steroids at some point during the treatment.

Conclusion: Despite the limited sample size, it is evident that there is a significant increase in the incidence of angioinvasive maxillofacial fungal infections in diabetic patients treated for SARS-CoV-2 with a strong association with corticosteroid administration.

Keywords: Aspergillosis; Covid-19; Diabetes; Mucormycosis; Rhino-cerebro-orbital.

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Conflict of interest statement

Conflict of interestThe authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Figures

Fig. 1
Fig. 1
Facial/orbital cellulitis in a patient with mucormycosis
Fig. 2
Fig. 2
Palatal mucosal discolouration in a patient with mucormycosis
Fig. 3
Fig. 3
Ptosis of left eye in a patient with frontal sinus mucormycosis
Fig. 4
Fig. 4
Contrast enhanced computed tomography (CECT) images showing the involvement of left maxillary, ethmoid and frontal sinuses
Fig. 5
Fig. 5
Specimen of a partially resected maxilla in a patient who reported with avascular necrosis
Fig. 6
Fig. 6
Orbital exenteration done in a patient with loss of vision and orbital spread of the disease. A: Specimen of left eye along with contents of the orbit till the orbital apex. B: Left orbit after completion of exenteration
Fig. 7
Fig. 7
Section shows broad aseptate hyphae branching at right angle (black arrowhead) consistent with mucor species (H and E × 40) along with dense inflammatory infiltrate (white arrow)
See this image and copyright information in PMC

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