Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report

Veisi, Amirreza; Bagheri, Abbas; Eshaghi, M; Rikhtehgar, Mohamad Hasan; Kanavi, Mozhgan Rezaei; Farjad, Reza

doi:10.1177/11206721211009450

Cited by 111 publications

(100 citation statements)

References 16 publications

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“…In a letter to the editor of 10 cases of orbital mucormycosis, Sarkar et al reported a mortality of 40% [ 24 ]. Multiple case reports were published and most of the survival was poor [ 24 , 25 ]. Quite surprisingly in a case series of 23 patients of CAM by Sharma et al, no death was reported [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Singh¹,

Ganesh²,

Kumar³

et al. 2021

Cureus

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Background: Coronavirus disease (COVID-19) remains a health concern with new challenges emerging as the pandemic progresses. The recent rise of opportunistic infections especially mucormycosis in COVID-19 patients is further complicating their outcomes. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID-19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection.Methodology: Here, we present a retrospective case series of 13 patients with individual clinical characteristics along with the demography and treatment details. The data were collected retrospectively in a single center that caters to a large population of COVID-19 patients with varying severity.Results: Thirteen patients were presented with COVID-19 associated mucormycosis (CAM). The median age was higher in non-survivors (49.5 years), with a higher odds of death (23.8) in those with severe COVID, having overall mortality of 64.3%. Moreover, diabetes mellitus was present in 61.5% of patients with a mortality of 75%. About 11 (84.6%) patients had received prior steroids for COVID-19. The incidence of hyperglycemia at admission was equal among both survivors and non-survivors. Conclusion:The prevalence of mucormycosis seems to be increasing among COVID-19 patients which may be associated with increased use of steroids, the possible immunocompromised state imposed by SARS-CoV-2, or co-existing conditions such as diabetes mellitus. The mortality of CAM is remarkably high and apart from preventive practices and rational use of immunomodulators, a high index of suspicion with early diagnosis would be key to survival.

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Section: Discussionmentioning

confidence: 99%

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Singh¹,

Ganesh²,

Kumar³

et al. 2021

Cureus

View full text Add to dashboard Cite

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“…Of all the reports, 11 publications were from India [ 24 – 26 , 30 – 37 ]. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis[ 24 – 26 , 30 , 32 – 37 , 40 , 42 , 45 , 47 , 52 – 54 ]. Other presentations included pulmonary [ 31 , 41 , 43 , 44 , 49 , 51 , 55 ], cutaneous [ 46 ], disseminated [ 56 ] and gastrointestinal [ 48 ] diseases.…”

Section: Clinical Features and Managementmentioning

confidence: 99%

“…The reported organisms were Rhizopus spp. [ 24 , 31 , 36 , 41 – 44 , 47 , 49 , 51 , 55 ] and the others were reported as unspecified Mucorale [ 25 , 26 , 30 , 33 – 35 , 37 , 40 , 45 , 48 , 50 , 52 , 54 ]. The management of mucormycosis is usually difficult and requires urgent medical and surgical debridement while the choice of drug to treat mucormycosis is Amphotericin B [ 23 , 57 ] and Amphotericin was used in 23 of the included studies [ 24 – 26 , 30 – 37 , 40 – 44 , 46 , 47 , 49 – 54 ] and surgical debridement was reported in 20 of the included studies [ 24 – 26 , 30 , 32 – 37 , 40 , 44 – 47 , 50 – 54 ].…”

Section: Clinical Features and Managementmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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Background The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. Purpose In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. Results Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. Conclusion With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

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“…MRI is more sensitive than CT for detecting orbital and CNS involvement. 7 Based on the infected region, the imaging findings may include paranasal sinuses inflammation itself in early stages later patient may develop bony destruction and invasion to orbital tissues causing intraorbital tissue signal alteration with or without focal mass finally it invades cavernous sinus via blood stream reveals cavernous sinus filling defect suggestive of thrombus, intracranial focal mass. Patients suspecting mucormycosis should always go through diagnostic nasal endoscopy and/or surgical exploration functional endoscopic sinus surgery, with biopsy and KOH mount of the areas of suspected infection.…”

Section: Discussionmentioning

confidence: 99%

Mucormycosis in RT-PCR negative Covid 19 patient with newly diagnosed Diabetes Mellitus: A Case Report

et al. 2021

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Corona Virus Disease 2019 (COVID 19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first identified in Wuhan city of China in December 2019. Since then, the disease has spread very rapidly which has led to the current pandemic. Secondary infections are reported now a days during the illness in Covid-19 patients of any age and patients recovered from COVID 19. The high-risk conditions prone for opportunistic infections are uncontrolled blood sugar levels, prolonged steroid usage and oxygen therapy. Mucormycosis is highly invasive secondary infection. Early diagnosis along with surgical and medical intervention and control of all risk factors plays a crucial role. Delay in presentation of patient to medical care is really challenging to the physicians and ENT surgeons.

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Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report

Cited by 111 publications

References 16 publications

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

COVID-19 and mucormycosis superinfection: the perfect storm

Mucormycosis in RT-PCR negative Covid 19 patient with newly diagnosed Diabetes Mellitus: A Case Report

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