Fatal rhino-orbito-cerebral mucormycosis infection associated with diabetic ketoacidosis post-COVID-19

Bessa, Paula Bonates; João, Guilherme Augusto Pivoto; Cruz, Kátia Santana; Ferreira, Marcelo de Souza; Baía-da-Silva, Djane Clarys; Farias, Maria Eduarda Leão de; Brito-Sousa, José Diego; Santana, Monique Freire; Oliveira, Luciana Aires de; Cortez, Ana Cláudia Alves; Souza, João Vicente Braga de; Lacerda, Marcus Vinícius Guimarães

doi:10.1590/0037-8682-0358-2021

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…[ 10 17 ] Death in ROCM was associated with diabetic ketoacidosis and cerebral involvement. [ 18 ] Similar to COVID-19, high neutrophil-lymphocyte ratios were associated with severe ROCM and poor outcomes. [ 19 ]…”

Section: Discussionmentioning

confidence: 87%

A clinico-pathological study of COVID-19 associated rhino-orbital-cerebral mucormycosis

Senthilkumar

Thirunavukkarasu

2022

Indian Journal of Ophthalmology

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Purpose: Known predisposing factors for mucormycosis are neutropenia and diabetes. Though COVID-19 is associated with hyperinflammatory response, a high surge in rhino-orbital-cerebral mucormycosis (ROCM) cases was observed during the second wave. The histopathological features reflect the background pathogenesis. This study analyzes the histopathological features and clinical presentation of COVID-19-associated ROCM. Methods: In this retrospective observational study, the clinical details of 89 proven ROCM patients treated during May–July 2021 were collected from the case records. Histopathological features were correlated with clinical staging groups and outcomes. The mean neutrophil-to-lymphocyte ratio (NLR) of clinical and outcome groups were compared. Results: The mean age was 54.71 ± 11.03 years, with male patients constituting a majority (78.7%). Uncontrolled diabetes mellitus was noted in 70.8% of patients, and 3.4% had normal range of blood sugar. The mean blood sugar was 298.08 ± 99.51 mg/dL. The mean duration of onset of symptoms of mucormycosis from the diagnosis of COVID-19 was 17.36 ± 7.392 (3–45) days. Poor outcome with disease progression or death occurred in 21.3% of patients. Clinical group II patients (44.9%) with ROCM stages 3c and above had poor outcomes ( P = 0.005). Histopathological analysis showed minimal inflammation in 25.8%, neutrophil extracellular trap (NET) in 75.3%, and angio-invasion in 28.1% of patients. Minimal inflammation was associated with clinical group II ( P = 0.004) and poor outcome ( P = 0.001). Angio-invasion correlated with poor outcome ( P = 0.007). Patients with severe clinical group and poor outcome had higher mean NLR with P = 0.017 and P = 0.007, respectively. Conclusion: Vision loss and cerebral involvement had poor outcomes. The histopathologic features such as inflammation and angio-invasion along with NLR aid as prognostic indicators in the management of ROCM. The role of NET in the pathogenesis of COVID-19-associated ROCM needs further studies.

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Section: Discussionmentioning

confidence: 87%

A clinico-pathological study of COVID-19 associated rhino-orbital-cerebral mucormycosis

Senthilkumar

Thirunavukkarasu

2022

Indian Journal of Ophthalmology

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“…The search conducted in the databases resulted in 1282 articles, of which 33 met the inclusion criteria 23 – 55 ( Figure 1 ). The reviewed articles are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Fungal infections in patients after recovering from COVID-19: a systematic review

Ulloque-Badaracco,

Copaja-Corzo,

Hernandez-Bustamante

et al. 2024

Therapeutic Advances in Infection

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Background and aims: The presence of fungal infections has been described in patients after recovering from COVID-19. This study aims to conduct a systematic review of studies that reported fungal infections ( Mucor spp., Pneumocystis jirovecii, or Aspergillus spp.) in adults after recovering from COVID-19. Methods: We performed a systematic review through PubMed, Web of Science, OVID-Medline, Embase, and Scopus. The study selection process was performed independently and by at least two authors. We performed a risk of bias assessment using the Newcastle–Ottawa Scale for cohort and case–control studies, and the Joanna Briggs Institute’s Checklists for Case Series and Case Reports. Results: The systematic search found 33 studies meeting all inclusion criteria. There was a total population of 774 participants, ranging from 21 to 87 years. From them, 746 developed a fungal infection. In 19 studies, Mucor spp. was reported as the main mycosis. In 10 studies, P. jirovecii was reported as the main mycosis. In seven studies, Aspergillus spp. was reported as the main mycosis. Regarding the quality assessment, 12 studies were classified as low risk of bias and the remaining studies as high risk of bias. Conclusion: Patients’ clinical presentation and prognosis after recovering from COVID-19 with fungal infection differ from those reported patients with acute COVID-19 infection and those without COVID-19 infection.

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“…Additionally, Fouad et al [ 13 ] reported 26 cases from Egypt. In our region, 2 cases were from Brazil and 1 case was described in Mexico [ 7 , 8 , 10 ]. In Peru, the literature is scarce, with only four cases reported by Elguera-Falcon and Cumpa-Quiróz [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru

Ponce-Rosas

Zamora

Diaz-Reyes

et al. 2022

Case Reports in Infectious Diseases

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Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

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Fatal rhino-orbito-cerebral mucormycosis infection associated with diabetic ketoacidosis post-COVID-19

Cited by 11 publications

References 9 publications

A clinico-pathological study of COVID-19 associated rhino-orbital-cerebral mucormycosis

A clinico-pathological study of COVID-19 associated rhino-orbital-cerebral mucormycosis

Fungal infections in patients after recovering from COVID-19: a systematic review

Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru

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