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. 2023 Apr;75(Suppl 1):1014-1020.
doi: 10.1007/s12070-023-03474-1. Epub 2023 Feb 23.

Rhino Orbital Cerebral Mucormycosis in Covid-19 Crisis

Suresh Vadivel  1 , M Gowrishankar  1 , Kanagavel Vetrivel  1 , B Sujatha  1 , P Navaneethan  1
Affiliations

Rhino Orbital Cerebral Mucormycosis in Covid-19 Crisis

Suresh Vadivel et al. Indian J Otolaryngol Head Neck Surg. 2023 Apr.

Abstract

Rhino-Orbital cerebral Mucormycosis (ROCM) an angioinvasive fungal infection commonly seen in diabetic and immunocompromised patients. In recent days, due to COVID 19 pandemic mucormycosis has been significantly increased (Smith et al. in Radiol Cardiothorac Imaging 2(5):e200280, 2020). In this study we evaluate the involvement, clinical features, contributing risk factors and outcome of post covid Rhino orbital cerebral mucormycosis. A cross sectional descriptive study was conducted on post covid rhino orbital cerebral mucormycosis patients from May 2021 to October 2021 in Otorhinolaryngology department of Stanley Medical college Chennai. We collected detailed history of Covid-19 hospital stay, treatment taken, co morbidities, Endoscopic findings, management and outcome. 243 cases analysed with median age 51 years (range 28-75 years) and male predominance with M:F ratio 1.6. The median time interval between covid and ROCM was 20 (15-35) days. Based on involvement 111 (46%) Stage-II, 87 (36%) Stage-I, 37 (15%) stage III and 8 (3%) stage IV disease observed. with overall mortality of 5.7%. Among which 230 (94.6%) patients had diabetes mellitus, 111 (45.8%) patients received steroid and 134 (54.3%) had immunomodulators during covid management. Despite of surgical debridement and antifungal therapy 14 (5.8%) patients died from mucormycosis. we conclude that covid be the predisposing factor for mucormycosis especially in patients with diabetes and increased usage of steroids. Treatment needs multimodality approach with antifungals and surgical debridement with surveillance fir good outcome.

Keywords: Diabetes; Mucormycosis; Post covid; Steroids.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Obtuse angled hyphae in KOH mount, b Computerised tomography showing left orbital and optic nerve involvement
Fig. 2
Fig. 2
a Stage-III Rhino orbital cerebral Mucormycosis, b Zero degree Endoscopic view of eschar over middle turbinate
Fig. 3
Fig. 3
Clinical features of rhino orbital cerebral mucormycosis
Fig. 4
Fig. 4
Distribution of ROCM based on involvement
Fig. 5
Fig. 5
Outcome of various stages of post covid ROCM
Fig. 6
Fig. 6
a postoperative Endoscopic debridement of sinonasal mucormycosis, b Histopathology shows mucormycosis
See this image and copyright information in PMC

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