Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T19:22:58.642Z Has data issue: false hasContentIssue false
  • English
  • Français

Rhino-orbital-cerebral mucormycosis: fungal epidemic in a viral pandemic

Part of: JLO Coronavirus Collection

Published online by Cambridge University Press:  02 September 2021

M Chouhan ,
B Solanki  and
N Shakrawal
M Chouhan
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Dr Sampurnanand Medical College, Jodhpur, India
B Solanki
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Dr Sampurnanand Medical College, Jodhpur, India
N Shakrawal*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Dr Sampurnanand Medical College, Jodhpur, India
*
Author for correspondence: Dr Neha Shakrawal, Department of Otorhinolaryngology and Head and Neck Surgery, OPD Block, MDM Hospital, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery.

Methods

An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021.

Results

There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive.

Conclusion

Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.

Keywords

COVID-19MucormycosisDiabetes MellitusImmunosuppression
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 11 , November 2021 , pp. 981 - 986
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr N Shakrawal takes responsibility for the integrity of the content of the paper

References

Lin, E, Moua, T, Limper, AH. Pulmonary mucormycosis: clinical features and outcomes. Infection 2017;45:443–8CrossRefGoogle ScholarPubMed
Sugar, AM. Agents of mucormycosis and related species. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, 5th edn. Philadelphia: Churchill Livingstone, 2000;2685–95Google Scholar
Jeong, W, Keighley, C, Wolfe, R, Lee, WL, Slavin, MA, Kong, DCM et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect 2019;25:26–34CrossRefGoogle ScholarPubMed
Werthman-Ehrenreich, A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med 2021;42:264.e5–264.e8CrossRefGoogle Scholar
Hirabayashi, KE, Idowu, OO, Kalin-Hajdu, E, Oldenburg, CE, Brodie, FL, Kersten, RC et al. Invasive fungal sinusitis: risk factors for visual acuity outcomes and mortality. Ophthalmic Plast Reconstr Surg 2019;35:535–42CrossRefGoogle ScholarPubMed
Bottone, EJ, Weitzman, I, Hanna, BA. Rhizopus rhizopodiformis: emerging etiological agent of mucormycosis. J Clin Microbiol 1979;9:530–710.1128/jcm.9.4.530-537.1979CrossRefGoogle ScholarPubMed
Sen, M, Lahane, S, Lahane, TP, Parekh, R, Honavar, SG. Mucor in a viral land: a tale of two pathogens. Indian J Ophthalmol 2021;69:244–52Google Scholar
Prenissl, J, Jaacks, LM, Mohan, V, Manne-Goehler, J, Davies, JI, Awasthi, A et al. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15–49 years. BMC Med 2019;17:92CrossRefGoogle Scholar
Kumar, A, Arora, A, Sharma, P, Anikhindi, SA, Bansal, N, Singla, V et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr 2020;14:535–4510.1016/j.dsx.2020.04.044CrossRefGoogle ScholarPubMed
de Almeida-Pititto, B, Dualib, PM, Zajdenverg, L, Dantas, JR, de Souza, FD, Rodacki, M et al. ; Brazilian Diabetes Society Study Group (SBD). Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr 2020;12:75CrossRefGoogle ScholarPubMed
Yang, W, Cao, Q, Qin, L, Wang, X, Cheng, Z, Pan, A et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388–93CrossRefGoogle ScholarPubMed
De Pauw, B, Walsh, TJ, Donnelly, JP, Stevens, DA, Edwards, JE, Calandra, T et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus group. Clin Infect Dis 2008;46:1813–21CrossRefGoogle Scholar
Yang, X, Yu, Y, Xu, J, Shu, H, Xia, J, Liu, H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475–81CrossRefGoogle ScholarPubMed
Honavar, SG. Code Mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol 2021;69:1361–510.4103/ijo.IJO_1165_21CrossRefGoogle ScholarPubMed
Cornely, OA, Alastruey-Izquierdo, A, Arenz, D, Chen, SC, Dannaoui, E, Hochhegger, B et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019;19:e405–21CrossRefGoogle Scholar
Zhou, P, Yang, XL, Wang, XG, Hu, B, Zhang, L, Zhang, W et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270–3CrossRefGoogle ScholarPubMed
Wang, Y, Wang, Y, Chen, Y, Qin, Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020;92:568–76CrossRefGoogle ScholarPubMed
Sharma, S, Grover, M, Bhargava, S, Samdani, S, Kataria, T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol 2021;135:442–710.1017/S0022215121000992CrossRefGoogle Scholar
Zhang, Y, Li, WX, Huang, KW, Cao, ZX, Hao, JY. Hospital acquired pneumonia occurring after acute stage of the serious SARS and its treating strategies. Chin J Nosocomiol 2003;11:1081–7Google Scholar
Peeri, NC, Shrestha, N, Rahman, MS, Zaki, R, Tan, Z, Bibi, S et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol 2020;49:717–26CrossRefGoogle ScholarPubMed
Kaur, N, Singh, R, Dar, Z, Bijarnia, RK, Dhingra, N, Kaur, T. Genetic comparison among various coronavirus strains for the identification of potential vaccine targets of SARS-CoV2. Infect Genet Evol 2021;89:104490CrossRefGoogle ScholarPubMed
Waizel-Haiat, S, Guerrero-Paz, JA, Sanchez-Hurtado, L, Calleja-Alarcon, S, Romero-Gutierrez, L. A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus 2021;13:e13163Google ScholarPubMed
Serris, A, Danion, F, Lanternier, F. Disease entities in mucormycosis. J Fungi (Basel) 2019;5:23CrossRefGoogle ScholarPubMed
Liu, J, Li, S, Liu, J, Liang, B, Wang, X, Wang, H et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARSCoV-2 infected patients. EBioMedicine 2020;55:102763CrossRefGoogle Scholar
Siddiqi, HK, Libby, P, Ridker, PM. COVID-19 - a vascular disease. Trends Cardiovasc Med 2021;31:1–5CrossRefGoogle ScholarPubMed
Mehta, S, Pandey, A. Rhino-orbital mucormycosis associated with COVID-19. Cureus 2020;12:e10726Google ScholarPubMed
Lim, S, Bae, JH, Kwon, HS, Nauck, MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol 2021;17:11–3010.1038/s41574-020-00435-4CrossRefGoogle ScholarPubMed
Apicella, M, Campopiano, MC, Mantuano, M, Mazoni, L, Coppelli, A, Del Prato, S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020;8:782–9210.1016/S2213-8587(20)30238-2CrossRefGoogle ScholarPubMed
White, PL, Dhillon, R, Cordey, A, Hughes, H, Faggian, F, Soni, S et al. A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin Infect Dis 2020. Epub 2020 Aug 29Google Scholar
Müller, JA, Groß, R, Conzelmann, C, Krüger, J, Merle, U, Steinhart, J et al. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab 2021;3:149–6510.1038/s42255-021-00347-1CrossRefGoogle ScholarPubMed
WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, JAC, Murthy, S, Diaz, JV, Slutsky, AS, Villar, J et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19 a meta-analysis. JAMA 2020;324:1330–41Google ScholarPubMed
Skiada, A, Pagano, L, Groll, A, Zimmerli, S, Dupont, B, Lagrou, K et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011;17:1859–67CrossRefGoogle Scholar
Rawson, TM, Moore, LSP, Zhu, N, Ranganathan, N, Skolimowska, K, Gilchrist, M et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020;71:2459–68Google ScholarPubMed
Song, G, Liang, G, Liu, W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia 2020;185:599–60610.1007/s11046-020-00462-9CrossRefGoogle ScholarPubMed
Jung, SH, Kim, SW, Park, CS, Song, CE, Cho, JH, Lee, JH et al. Rhinocerebral mucormycosis: consideration of prognostic factors and treatment modality. Auris Nasus Larynx 2009;36:274–910.1016/j.anl.2008.07.003CrossRefGoogle ScholarPubMed
Patel, A, Kaur, H, Xess, I, Michael, JS, Savio, J, Rudramurthy, S et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect 2020;26:944.e9–944.e15CrossRefGoogle ScholarPubMed