Increased incidence of rhino‐orbital mucormycosis in an educational therapeutic hospital during the COVID‐19 pandemic in western Iran: An observational study

Fazeli, Manouchehr Avatef; Rezaei, Leila; Javadirad, Etrat; Iranfar, Khosro; Khosravi, Abbas; Saman, Javad Amini; Poursabbagh, Pardis; Ghadami, Mohammad Rasoul; Parandin, Mohammad Mehdi; Dehghani, Amrollah; Jouybari, Touraj Ahmadi; Mahdavian, Behzad; Eivazi, Nastaran; rezaei, Sohbat; Rezaei, Alireza; Bashir, Emami; Haqgou, Mohadeseh; Bozorgomid, Arezoo; Sayad, Babak

doi:10.1111/myc.13351

Cited by 42 publications

(22 citation statements)

References 33 publications

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“…[ 37 ] India Prospective Single-center 80 May 2021–Aug 2021 – 69 (55) 90 (72) Ismaiel WF. [ 38 ] Egypt Retrospective Single-center 10 – – – – Avatef Fazeli M. [ 39 ] Iran Retrospective Single-center 9 Oct 2020–Nov 2020 59 33 (3) 78 (7) Goddanti N. [ 40 ] India Retrospective Single-center 300 Apr 2021–Jun 2021 49 ± 12 74 (222) 96 (287) Kulkarni R. [ 41 ] India Retrospective Multi-center 49 Dec 2020–Jun 2021 53 ± 11 71 (35) 82 (40) Dokania V. [ 42 ] India Prospective Single-center 21 Apr 2021–Jun 2021 50 ± 14 71 (15) 90 (19) Nair AG. [ 43 ] India Retrospective Multi-ce...…”

Section: Resultsmentioning

confidence: 99%

“…[ 37 ] 75 (60) 1.3 (1) – – – – – – Ismaiel WF. [ 38 ] – – – – – – – – Avatef Fazeli M. [ 39 ] 44 (4) 22 (2) 11 (1) – – 13 (1) 100 (7) 25 (2) Goddanti N. [ 40 ] – – – – 60 (180) – 79 (237) – Kulkarni R. [ 41 ] 37 (18) – – – – – – – Dokania V. [ 42 ] 0.5 (1) – – – – 4.8 (1) 90 (19) 19 (4) Nair AG. [ 43 ] – – – – 38 (5) – 54 (7) …”

Section: Resultsmentioning

confidence: 99%

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

Watanabe

Mitaka

et al. 2022

Mycopathologia

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The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12–21%, I 2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22–36%, I 2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Watanabe

Mitaka

et al. 2022

Mycopathologia

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“…Reports of CAM outside the Indian population are scarce, 25 most of which are case reports. 28 In Iran, two cross-sectional studies from Tehran 20 and west Iran 29 have reported on 15 and 12 CAM cases, of which 86% and 87.3% had DM, with a mortality rate of 47% and 66.6%, respectively. A series of 10 cases with CAM were also reported from Pakistan, 30 of which 70% were diabetic and 80% had received corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Fouad¹,

Bakre²,

Nassar³

et al. 2021

OPTH

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Purpose: To report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021). Methods: A multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included. Results: Of the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died. Conclusion: CAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

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“…Many other countries have also reported a sudden surge in cases of CAM during the past few months, suggesting that this condition could soon emerge as a global problem. 11 Even before the pandemic, mucormycosis has been known to occur in patients with immunodeficiency, mainly in those with uncontrolled diabetes and ketoacidosis. 12,13 In the largest study on CAM to date, Sen et al 4 clearly showed that uncontrolled diabetes and use of high-dose systemic corticosteroids were the main risk factors for CAM.…”

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confidence: 99%

Cumulative Mortality and Factors Associated With Outcomes of Mucormycosis After COVID-19 at a Multispecialty Tertiary Care Center in India

et al. 2022

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IMPORTANCE An outbreak of COVID-19-associated rhino-orbitocerebral mucormycosis (CAM) has occurred in many parts of the world. Although the clinical profile and risk factors for CAM have been studied, cumulative mortality and its risk factors have not.OBJECTIVE To report the cumulative mortality rates at different times in cases with CAM and identify risk factors for CAM-associated mortality. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case-control study was conducted from March 1 to May 30, 2021, in a tertiary care multispecialty hospital in western India. All patients diagnosed with CAM and with a minimum follow-up of 30 days or those who died before 30 days due to CAM were included. MAIN OUTCOMES AND MEASURECumulative mortality in CAM using survival analysis.RESULTS A total of 73 consecutive patients with CAM with a mean (SD) age of 53.5 (12.5) years were included in the analysis, of whom 48 (66%) were men. CAM developed at a median of 28 (IQR, 15-45; range, 4-90) days after recovery from COVID-19. Of the 73 patients with CAM, 26 (36%) died; the cumulative probability of death was 26% (95% CI, 16%-41%) at day 7 and doubled to 53% (95% CI, 39%-69%) at day 21. Sinus debridement was performed in 18 of 51 patients (35%), and 5 of 52 (10%) underwent exenteration, whereas intravenous lyophilized amphotericin B was administered to 48 patients (66%). A multivariate Cox proportional hazards regression analysis showed that receiving mechanical ventilation in the past was associated with a nearly 9-fold increased risk of death (hazard ratio [HR], 8.98; 95% CI, 2.13-38.65; P = .003), and patients who had visual acuity of light perception or better had a 46% lower risk of death (HR, 0.56; 95% CI, 0.32-0.98; P = .04). Intravenous amphotericin B administration was associated with a reduced rate of exenteration (0 vs 5 of 25 [20%]; P < .001). On multivariate analysis, those who received intravenous amphotericin B had a 69% reduced risk of death (HR, 0.31; 95% CI, 0.06-1.43; P = .13).CONCLUSIONS AND RELEVANCE These findings suggest that the mortality rate after rhino-orbitocerebral mucormycosis is high and that a subgroup of patients with severe COVID-19 or presenting with severe orbital disease are more likely to die within 10 days of admission.

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Increased incidence of rhino‐orbital mucormycosis in an educational therapeutic hospital during the COVID‐19 pandemic in western Iran: An observational study

Cited by 42 publications

References 33 publications

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

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

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave

Cumulative Mortality and Factors Associated With Outcomes of Mucormycosis After COVID-19 at a Multispecialty Tertiary Care Center in India

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