COVID-19, Diabetes and Steroids: The Demonic Trident for Mucormycosis

Bhandari, Sudhir; Bhargava, Shruti; Samdhani, Sunil; Singh, Suresh; Sharma, Bharat Bhushan; Agarwal, Sunita; Sharma, Malvika; Sharma, Saurabh; Sharma, Vinod; Kakkar, Shivankan; Dube, Amitabh; Grover, Mohnish

doi:10.1007/s12070-021-02883-4

Cited by 6 publications

(3 citation statements)

References 25 publications

(28 reference statements)

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“…In our study, 4 (57%) patients presented with nasal discharge and eye swelling, which were the commonest clinical features as in other studies [12,16,18]. On anterior rhinoscopy examination, thick, blackish nasal crusts and necrosed middle turbinate were seen in all 7 CAM patients, as seen in other studies as well [29]. The tissue biopsy of the mucosa from the middle turbinate was positive for Mucormycosis as in other studies [12].…”

Section: Clinical Features Of Mucormycosissupporting

confidence: 85%

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

Amalanathan

Kumar

Rajendiran

et al. 2023

Egypt J Otolaryngol

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Background India witnessed a massive surge of rhino orbital cerebral mucormycosis (ROCM) cases during the second wave of COVID-19, recording the highest number of cases in the world, indeed, an epidemic within the pandemic. Objectives To describe the clinical profile of patients with COVID-19-associated mucormycosis (CAM) and the clinical suspects for mucormycosis. Methods This single-center descriptive, observational study/audit was done at Indira Gandhi Medical College, Pondicherry, South India. This study is about the clinical profile of 7 CAM patients and 14 COVID-19 patients who were suspects of CAM, based on their risk factors and clinical symptoms, and were referred to the ENT department. Statistical analysis All the descriptive variables were summarized as mean, frequency, and percentages for qualitative data. Results All 7 CAM patients were COVID-19 positive and were not vaccinated against COVID-19, All 7 were known diabetic, all 7 had steroid therapy for their COVID status, and 5 out of 7 (71%) had uncontrolled diabetes mellitus at the time of diagnosis. Facial pain, nasal discharge, and eye swelling were the presenting symptoms of CAM. Maxillary and ethmoid sinuses were the most commonly involved para nasal sinuses. Four out of seven (57.1%) CAM patients survived after 16 months of follow-up, after surgical and medical treatment for CAM. Of the 14 clinical suspects who were negative for CAM, 2 were negative for COVID-19, their risk factors were brought under control, 3 expired due to COVID complications, and 9 patients are alive till date. Conclusion Uncontrolled diabetes is a risk factor for ROCM/CAM, another possible risk factor is steroid therapy, and we hypothesize that COVID infection could also be a possible risk factor that needs to be studied more extensively in a larger sample. Early clinical suspicion, withdrawal of steroids, rapid control of diabetes mellitus, appropriate investigations, and early surgical intervention combined with medical treatment offers better outcome.

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Section: Clinical Features Of Mucormycosissupporting

confidence: 85%

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

Amalanathan

Kumar

Rajendiran

et al. 2023

Egypt J Otolaryngol

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“…COVID-19 since beginning showed variation in its presentations, complications and sequelae [ 1 ]. Among various complications associated with COVID-19 that are being reported, the fungal infection mucormycosis (known as black fungus) becoming a serious issue in India due to its uncommon surge and high morbidity [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Management of Mucormycosis in Post COVID-19 Patients and Its Outcome in a Tertiary Care Center: Our Experience

Rao

Pooja

2022

Indian J Otolaryngol Head Neck Surg

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To assess the common presentation and extent of disease involvement clinically and radiologically and treatment modalities, sequalae of the disease, complications and treatment response. Mucormycosis is a life-threatening infection that most commonly affects immunocompromised individuals and an exponential increase in the incidence of Rhino-orbital-cerebral mucormycosis was witnessed in the second wave of the COVID-19 pandemic, despite aggressive multimodal treatment carries a significant risk of mortality. A high index of suspicion is required in order to begin the appropriate diagnostic workup and treatment. This study is conducted to access the outcome and management of mucormycosis in post covid 19 patients. The prospective study includes 180 Patients, who are attending to E.N.T. outpatient department, Triage and patients referred from other departments who had suspected/confirmed Rhino-orbital-cerebral mucormycosis/underwent surgery and/or medical treatment or both. In our study mucormycosis predominantly affected age group between 40 and 60 years, more common in males (77.8%) than females (22.2%), 77.8% patients had post covid status. Most common risk factor was diabetes mellitus.76% patients had undergone endoscopic/open surgery and 24% patients underwent only medical treatment. Among 138 patients operated, 40% had recurrence and mortality was 16.1% (significantly reduced). Early diagnosis and prompt intervention is paramount to reduce morbidity and mortality. Liposomal Amphotericin B is most effective antifungal with manageable side effects. Patients who underwent Radical debridement either endoscopically or open approach, had better outcome with minimal recurrence rates. Combined medical and surgical treatment has better outcome, lesser recurrence and mortality.

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“…Beyond the realm of COVID-19, another facet of the diabetes narrative emerges in the context of cough medicines containing steroids ( 3 ). Steroids are known to influence blood sugar levels, and patients who require these medications to manage respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD) can face an increased risk of developing steroid-induced diabetes ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Exploring transfer learning in chest radiographic images within the interplay between COVID-19 and diabetes

Shoaib,

Sayed,

Shah

et al. 2023

Front. Public Health

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The intricate relationship between COVID-19 and diabetes has garnered increasing attention within the medical community. Emerging evidence suggests that individuals with diabetes may experience heightened vulnerability to COVID-19 and, in some cases, develop diabetes as a post-complication following the viral infection. Additionally, it has been observed that patients taking cough medicine containing steroids may face an elevated risk of developing diabetes, further underscoring the complex interplay between these health factors. Based on previous research, we implemented deep-learning models to diagnose the infection via chest x-ray images in coronavirus patients. Three Thousand (3000) x-rays of the chest are collected through freely available resources. A council-certified radiologist discovered images demonstrating the presence of COVID-19 disease. Inception-v3, ShuffleNet, Inception-ResNet-v2, and NASNet-Large, four standard convoluted neural networks, were trained by applying transfer learning on 2,440 chest x-rays from the dataset for examining COVID-19 disease in the pulmonary radiographic images examined. The results depicted a sensitivity rate of 98 % (98%) and a specificity rate of almost nightly percent (90%) while testing those models with the remaining 2080 images. In addition to the ratios of model sensitivity and specificity, in the receptor operating characteristics (ROC) graph, we have visually shown the precision vs. recall curve, the confusion metrics of each classification model, and a detailed quantitative analysis for COVID-19 detection. An automatic approach is also implemented to reconstruct the thermal maps and overlay them on the lung areas that might be affected by COVID-19. The same was proven true when interpreted by our accredited radiologist. Although the findings are encouraging, more research on a broader range of COVID-19 images must be carried out to achieve higher accuracy values. The data collection, concept implementations (in MATLAB 2021a), and assessments are accessible to the testing group.

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COVID-19, Diabetes and Steroids: The Demonic Trident for Mucormycosis

Cited by 6 publications

References 25 publications

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

Management of Mucormycosis in Post COVID-19 Patients and Its Outcome in a Tertiary Care Center: Our Experience

Exploring transfer learning in chest radiographic images within the interplay between COVID-19 and diabetes

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