First Report of COVID-19-associated Rhino-Orbito-Cerebral Mucormycosis in Pediatric patients with Type 1 Diabetes Mellitus

Diwakar, Jyoti; Samaddar, Arghadip; Konar, Subhas; Bhat, Maya; Manuel, Emma; Hb, Veenakumari; Nandeesh, B N; Parveen, Asmiya; Hajira, Sadiya Noor; Srinivas, Dwarakanath; Nagarathna, S

doi:10.2139/ssrn.3863080

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…2 3 Though there have been many reports of mucormycosis in adults with COVID-19 infection, there have been very few cases reported in the pediatric population and most have been in immunosuppressed individuals, such as those with diabetes mellitus. 4 We describe a complicated case of cerebral mucormycosis in a 6-year-old immunocompetent child following subclinical COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

“…During the severe acute respiratory syndrome (SARS) COVID-19 pandemic, there has been an increase in the incidence of mucormycosis in adults and children. 2 3 4 The use of steroids, monoclonal antibodies, prolonged intensive care unit hospitalization, and comorbidities such as preexisting diabetes have been cited as the reasons for the occurrence of fungal infections in individuals with COVID-19 infection. 2 3 In a recent comprehensive review on COVID-19-associated mucormycosis (CAM) analyzing cases from 18 countries, published in 2022, the majority of the cases have been reported from India.…”

Section: Introductionmentioning

confidence: 99%

“…Two pediatric cases with ROCM postasymptomatic COVID-19 infection and diabetic ketoacidosis were reported from India recently. 4 Our case presented with disseminated mucormycosis with multiorgan involvement affecting the brain, kidneys, and lungs. Her work-up for diabetes, primary, and secondary immunodeficiency was negative and there were no other identifiable risk factors for contracting mucor except for an asymptomatic COVID -19 infection with the elevation of COVID-19 IgG antibodies.…”

Section: Introductionmentioning

confidence: 99%

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Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

Nagabushana

Samaga

Shenoy

et al. 2022

Journal of Pediatric Neurology

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Mucormycosis is a rare opportunistic fungal infection observed in immunocompromised individuals or in those with uncontrolled diabetes mellitus. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a steep increase in the incidence of mucormycosis among adults. However, the infection is extremely rare in the pediatric population, and its occurrence post-COVID-19 infection has been reported in very few cases. We present a case of cerebral mucormycosis in a 6-year-old immunocompetent girl that was histopathologically confirmed by stereotactic brain biopsy. The fungal infection occurred following asymptomatic COVID-19 infection and this report describes the diagnostic journey and management. It highlights the unusual presentation of cerebral mucormycosis in our case and the role of posaconazole in the successful treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

Nagabushana

Samaga

Shenoy

et al. 2022

Journal of Pediatric Neurology

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COVID-19–Associated Rhino-Orbital-Cerebral Mucormycosis

Medhi

Bhattacharyya

Sarma

et al. 2021

Indian Journal of Pharmacology

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BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19–associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. “R-metafor package” was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041–0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212–4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205–0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.

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First Report of COVID-19-associated Rhino-Orbito-Cerebral Mucormycosis in Pediatric patients with Type 1 Diabetes Mellitus

Cited by 2 publications

References 26 publications

Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

COVID-19–Associated Rhino-Orbital-Cerebral Mucormycosis

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