Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control

Abstract

Objective To document and analyse demographic data, clinical presentation, possible interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM). Method 32 patients having history of SARS-CoV-2 infection with features of ROCM were observed in terms of their history, presenting features, clinical, microbiological examination, type of surgical intervention, surgical sites of involvement which were subsequently analyzed. Results The mean (± S.D.) age of patients was 57 ± 13 years. All patients were diabetic. Mean (± S.D.) time of onset of ROCM symptoms, since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients received steroid therapy; 28.1% received high flow nasal oxygen. 87.5% patients had blurring of vision, 65.62% headache, 59.37% cheek and eyelid swelling, 50% proptosis, 46.87% ophthalmoplegia, 40.62% ptosis, 40.62% loss of sensation over cheek, 25% orbital pain. Examination of specimen with KOH mount revealed Mucor spp. in all patients. 87.5% patients underwent endoscopic sinus surgery with debridement with/without orbital clearance; 56.25% maxillectomy; 25% orbital exenteration. 87.5% patients had paranasal sinus involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had involvement of pterygopalatine fossa±infratemporal fossa. 50% patients had disease in Vidian canal and pterygoid wedge. 25% of patients had involvement of palate and 56.25% cheek and eyelid soft tissues. Conclusion A judicious COVID treatment protocol, high index of suspicion, close monitoring of high-risk patients and early institution of treatment can prevent case severity and reduce mortality.

Ocular involvement in mucormycosis during COVID-19 and post-COVID 19 syndrome: a new challenge in ophthalmology

“…Mucormycosis is an emerging fungal infection that has raised global health alarms due to its association with COVID-19 [1][2][3][4][5][6][7][8]. Although this condition frequently affects the lungs, a major outbreak has been described in India and elsewhere in the world, with rhino-orbito-cerebral involvement, with morbidity, mortality and disability rates of concern (Tab.…”

“…Although this condition frequently affects the lungs, a major outbreak has been described in India and elsewhere in the world, with rhino-orbito-cerebral involvement, with morbidity, mortality and disability rates of concern (Tab. 1) [1][2][3][4][5][6][7][8].…”

“…Normal eye movements were observed in 42% of patients, while restricted eye movements were present in 58% of patients What is confusing and complicated in the early diagnosis of this ophthalmologic condition is its nonspecific presentation. Most present with headache [5][6][7] and nonspecific ocular signs [2, 7], which may be associated with some phenotype of post-COVID 19 neurological syndrome or any other nonspecific neurological condition. Fortunately, although management is aggressive (surgical debridement, liposomal amphotericin B (i.v.…”

“…Some useful strategies would be the design of specialized groups for strict follow-up of COVID-19 patients with mild-to-moderate phenotype and home care and patients with the post-COVID-19 syndrome. Especially patients between 14 and 25 days from the onset of symptoms should be followed-up -in this period, according to the literature, manifestations of orbital mucormycosis appear [1][2][3][4][5][6][7][8]. Similarly, specialized rehabilitation centers should be created to reduce morbidity and mortality during the post-COVID 19 syndrome in order to reduce health costs and the overall burden of disease in the coming months and years.…”

COVID-19 associated rhino orbital mucormycosis : Single center experience of 21 cases

“…Even though its prevalence in Sri Lanka is low , we have had 42 recorded cases in 2019, 24 cases in 2020 and 24 recorded cases upto May 2021 2 . Uncontrolled DM, Prior steroids, immunosuppression by the virus have been proposed as causative factors, the exact mechanism yet to be revealed 3 .…”