Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

Srivastava, Smiti Rani; Barman, Debasis; Das, Sudip; Bandyopadhyay, Manimoy; Ghosh, Asim Kumar; Sarkar, Sourav; Sengupta, Amitabha; Swaika, Sarbari; Chatterjee, Pritam; Gupta, Amit Kumar; Mondal, Alok Ranjan; Guha, Soumyajit; Dutta, Sirshak; Adhikari, Sudhir; Kaushik, Aditi; Biswas, Partha Sundar; Ayub, Asif

doi:10.18240/ijo.2022.04.01

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Orbital apex syndrome is a rare presentation of mucormycosis that include ophthalmoplegia and rapid vision loss, involving cranial nerves II, III, IV, V, and VI and requiring anti-fungal and surgical debridement ( 21 , 24 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

Rhinocerebral Mucormycosis Following Post-COVID-19 Infection in Iran

Khorasani Esmaili,

Dabiri,

Mirshekari

et al. 2023

Iran J Pathol

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Background & Objective: Mucormycosis (also called black fungus) is an opportunistic serious fungal infection caused by mucormycetes. It can occur in diabetes mellitus patients and other immunosuppressive conditions with recent predisposing factors such as maxillofacial surgery and corticosteroid usage. Methods: In this study, 14 patients were referred to the otorhinolaryngology or ophthalmology ward of Shafa Hospital (Kerman, Iran) with primary symptoms of nasal fullness and facial nerve dysfunction; they were admitted to the hospital to rule out the fungal infection. An endoscopic biopsy was taken from facial sinuses or orbit, and a microscopic evaluation was performed using hematoxylin and eosin (H&E) and periodic acid–Schiff (PAS) staining methods to rule out mucormycosis. Results: In the histopathological examination, broad-based nonseptate branching fungal hyphae were found in nasal sinuses through the endoscopic biopsy. Most of the patients had diabetes mellitus with a primary symptom of facial nerve palsy; also, most of them received corticosteroids (intravenous [IV] or intramuscular [IM] injection). All patients have recently been infected with COVID-19 (less than 1 month ago). Conclusion: COVID-19 infection might be a predisposing factor for many opportunistic infections, such as fungal elements); thus, the physician should be aware of the dosage and duration of corticosteroid therapy to prevent the development of these infections.

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Section: Discussionmentioning

confidence: 99%

Rhinocerebral Mucormycosis Following Post-COVID-19 Infection in Iran

Khorasani Esmaili,

Dabiri,

Mirshekari

et al. 2023

Iran J Pathol

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“…Although there are several studies providing evidence on the impact of COVID-19 on the eye [1][2][3][4][5][6][7][8][9][10][11][12][25][26][27][28] , few of them focus on its impact on visual perception [13][14][15] . The present study has shown that there appears to be an impairment of color and achromatic-chromatic contrast vision in hospitalized patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Visual perception alterations in COVID-19: a preliminary study

Coco-Martín¹,

Alcoceba-Herrero²,

Molina‐Martín³

et al. 2023

Int J Ophthalmol

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AIM: To compare the visual perception (color and chromatic-achromatic contrast vision) of a small cohort of COVID-19 patients at the time of infection and after 6mo with that of a healthy population matched for sex and age. METHODS: A total of 25 patients (9 females, 16 males, mean age: 54±10y) with COVID-19 hospitalized in the COVID-19 Unit of the University Clinical Hospital of Valladolid were recruited for this preliminary study. Visual perception, as determined by monocular measurement of contrast sensitivity function (CSF) and color vision was assessed in each patient using the Optopad test. The results obtained were then compared with those of a sample of 16 age- and sex-matched healthy controls (5 females, 11 males, mean age: 50±6y) in which the same measurement procedure was repeated. Statistically significant differences between groups were assessed using the Mann-Whitney U test. Measurements were repeated after a minimum follow-up period of 6mo and statistically significant differences between the two time points in each group were assessed using the Wilcoxon signed rank test. RESULTS: Discrimination thresholds (color and chromatic-achromatic contrast vision) and their corresponding sensitivity, calculated as the inverse of the discrimination threshold, were evaluated. Analysis of the data revealed higher contrast threshold results (i.e., worse contrast sensitivity) in the COVID-19 group than in the control group for all spatial frequencies studied in the Optopad-CSF achromatic test and most of the spatial frequencies studied in the Optopad-CSF chromatic test for the red-green and blue-yellow mechanisms. In addition, color threshold results in the COVID-19 group were also significantly higher (i.e., worse color sensitivity) for almost all color mechanisms studied in the Optopad-Color test. At 6mo, most of the differences found between the groups were maintained despite COVID-19 recovery. CONCLUSION: The present results provide preliminary evidence that visual perception may be impaired in COVID-19, even when the infection has passed. Although further research is needed to determine the precise causes of this finding, analysis of CSF and color vision could provide valuable information on the visual impact of COVID-19.

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“…A study conducted by Srivastava et al reported that the prevalence of orbital apex involvement is as high as 34.8% in COVID-19-associated mucormycosis (CAM). Among these patients, 74.2% had a vision of light perception that subsequently led to permanent loss of vision [ 2 ]. In diabetics, orbital apex syndrome secondary to mucormycosis may initially present as a partial ophthalmoplegia and is felt to represent microvascular disease, especially when there are minimal sinus findings by CT scan [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The widespread use of steroids has been mandated as a life-saving response to COVID-19. There has been a significant increase in the number of mucormycosis cases post-COVID-19 worldwide because of the widespread use of steroids, especially in patients with preexisting poorly controlled diabetes mellitus [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Presumptive Rhino-Orbital Mucormycosis Secondary to Corticosteroid Therapy in a Diabetic Patient With COVID-19 Infection

Sidhu¹,

Hitam²,

Tajudin³

2023

Cureus

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The coronavirus disease 2019 pandemic has led to the widespread use of steroids as a life-saving measure. In patients with preexisting diabetes, the therapeutic use of steroids coupled with poorly controlled sugar has led to a surge of mucormycosis. We report a rare case of orbital apex syndrome secondary to mucormycosis post-COVID-19. A 43-year-old female with poorly controlled diabetes mellitus presented with right eye complete ptosis one week post-recovery from COVID-19 infection. During COVID-19 hospitalization, she received a course of dexamethasone. The visual acuity of the right eye was 6/60. She had complete ophthalmoplegia and diplopia in all gazes. There was a positive relative afferent pupillary defect (RAPD) and reduced optic nerve function test in the right eye. MRI showed right ethmoid sinusitis with possible extension to the right orbit and the presence of right perineural optic nerve enhancement. The nasal scope revealed fungal-like thick mucopurulent discharge at the middle meatus. She was clinically diagnosed with rhino-orbital mucormycosis and was started on antifungal for six weeks. Her overall condition improved with 6/6 visual acuity and minimum residual ophthalmoplegia. In conclusion, corticosteroid treatment for COVID-19 infection in diabetic patients causes poor glycemic control and immunosuppression that can lead to secondary infections such as rhino-orbital mucormycosis.

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Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

Cited by 5 publications

References 18 publications

Rhinocerebral Mucormycosis Following Post-COVID-19 Infection in Iran

Rhinocerebral Mucormycosis Following Post-COVID-19 Infection in Iran

Visual perception alterations in COVID-19: a preliminary study

Presumptive Rhino-Orbital Mucormycosis Secondary to Corticosteroid Therapy in a Diabetic Patient With COVID-19 Infection

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