Early Surgical Intervention Followed by Antifungals in Rhino-Orbital Mucormycosis in Patients With COVID-19 Favors Clinical Outcome: A Case Series

Abstract

Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections among some COVID-19 patients with preexisting comorbid illnesses such as diabetes and hypertension, with mucormycosis being one of them. The management of this dreaded fungal infection demands early and prompt surgical intervention to thoroughly remove the infected tissue and necrotic material to reduce the tissue burden of this invasive organism. This should be accompanied by expeditious initiation of amphotericin B along with supportive therapy. Here we present five cases of rhino-orbital mucormycosis in patients with COVID-19, all of whom presented with orbital and facial swelling (three had symptoms of impending blindness) under the backdrop of COVID-19 symptoms in the form of intermittent fever and slight dyspnea. Our treatment strategy comprised an expeditious use of early surgical intervention and amphotericin B along with the control of cytokine storm and hyperglycemia. This treatment strategy eventually resulted in an improved clinical outcome.

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 58 ] India Case series Single-center 5 – [33–70] 20 (1) 100 (5) Singh Y. [ 59 ] India Case series Single-center 13 Nov 2020–Jan 2021 [5–75] 85 (11) 62 (8) Garg R. [ 60 ] India Case series Single-center 7 May 2021 [38–70] 71 (5) 100 (7) Arana C. [ 61 ] Spain Case series Single-center 2 – [48–62] 100 (2) 50 (1) Barman Roy D. [ 62 ] India Case series Single-center 2 – [39–50] 50 (1) 50 (1) Ashour MM. [ 63 ] Egypt Case series Single-center 6 – [41–67] 50 (3) 100 (6) Pal P. [ 64 ] India Case series Single-center 10 ...…”

“…[ 58 ] 40 (2) – – – – 20 (1) 40 (2) – Singh Y. [ 59 ] 46 (6) – 15 (2) 23 (3) 85 (11) 69 (9) 77 (10) 77 (10) Garg R. [ 60 ] – – – 29 (2) 0 (0) 100 (7) 0 (0) Arana C. [ 61 ] 100 (2) 100 (2) 100 (2) 100 (2) 0 (0) 100 (2) 50 (1) Barman Roy D. [ 62 ] – – – 0 (0) 0(0) 50 (1) – Ashour MM. [ 63 ] – 17 (1) – – – – – Pal P. [ 64 ] – 10 (1) – 30 (3) – 80 (8) – …”

Various Treatment Modalities in COVID-19 Associated Facial Mucormycosis and the Need for its Surgical Management: A Systematic Review

“…Out of the chosen twenty five such studies, Gupta et al [6] reported 8 patients with hypertension, three with no [9] reported 3 patients suffering from chronic kidney disease, 1 with myelodysplastic syndrome. Barman et al [10] reported patients with hypertension 1 hyperthyroidism 1, diabetes mellitus 8 patients. Nehra et al [11] reported 4 patients with hypertension and 6 with diabetes mellitus .…”

Comprehensive Review on the Virulence Factors and Therapeutic Strategies with the Aid of Artificial Intelligence against Mucormycosis

“…Surgical tissue removal is crucial in treating mucormycosis, particularly when necrosis and thrombosis impede drug effectiveness . Aggressive debridement of affected areas, especially in rhinocerebral infections, improves survival rates, though such surgical intervention involving otorhinolaryngology, ophthalmology, and neurosurgery is often disfiguring. , Surgery combined with antifungal drugs show promise for rhino-orbital cerebral mucormycosis . However, surgical success varies, limiting its use in disseminated infections.…”

“…217,218 Surgery combined with antifungal drugs show promise for rhino-orbital cerebral mucormycosis. 219 However, surgical success varies, limiting its use in disseminated infections.…”